Non-communicable diseases (NCDs) such as cardiovascular disease, cancer, respiratory disease, and diabetes are becoming more prevalent worldwide, particularly among people aged 30–69. Each year, these diseases take a toll on around 41 million people globally.1 Of these, diabetes is responsible for killing around 6.7 million people in 2021, making it a major public health concern.
Moreover, the number of people suffering from diabetes is estimated to rise to 643 million by 2030 and 783 million by 2045, especially in low and middle-income countries. Diabetes-related healthcare spending has risen to USD 966 billion in 2021.2 Yet diabetes complications such as ischemic heart disease, nephropathy, neuropathy, and retinopathy are widespread.3 Furthermore, despite the availability of appropriate diagnostic and treatment options, it is suspected that about one in every two people living with diabetes is undiagnosed.2
In the following blog, we will evaluate the prevalence and risk factors for diabetic retinopathy in diabetes patients by analyzing the findings of three different research studies.
Diabetes-related eye complications such as diabetic retinopathy (DR), diabetic macular edema (DME), cataracts, and glaucoma affect roughly one-third of diabetes patients worldwide.4 In the United States alone, 4.1 million adults aged 40 and above have advanced, vision-threatening retinopathies.5 What is the reason behind this? Let us examine some case studies to identify the risk factors that may lead to ocular complications in diabetes patients.
The first research study examined 1232 patients diagnosed with diabetes within the last 0–5 years to collect relevant data. Following analysis, it was discovered that the study population’s age- adjusted and sex-adjusted prevalence of DR and DME was 17.4% and 6.6%, respectively. Also, the ODDS ratio (a measure of association) for high levels of HbA1c was found to be 2.98 and 2.38 for DR and DME, respectively. While for albuminuria, the ratio was 2.45 for both diseases.
Furthermore, their prevalence increased as the duration of diabetes increased. Thus, it can be inferred that long-term uncontrolled diabetes and albuminuria increase the risk of eye complications in diabetic patients. The study findings are summarized in figures 1 and 2.6
To answer this question, a study was conducted on 4,251 people with type 2 diabetes to know the prevalence of ocular complications in the elderly. The results of this study showed that DR was prevalent in 30.7%, whereas vision-threatening DR was found in only 7% of the study population. Moreover, high diastolic blood pressure, along with long-term uncontrolled diabetes and higher postprandial serum glucose, was found to increase the risk of developing vision-threatening eye complications in the elderly. The study findings are depicted in Figure 3.7
In fact, when a total of 300 adult patients (age>18 years) with equal numbers of males and females were examined for diabetic retinopathy, its findings were found to coincide with the previous study.8
It is clear from the above discussion that age, duration of diabetes, hypertension, uncontrolled blood glucose levels, albuminuria, and high cholesterol levels can increase the risk of DR and DME, especially in the elderly. Long-term hyperglycemia not only damages body tissues but also slows recovery in affected patients. Hence, efforts must be made to control hyperglycemia. Moreover, regular physical check-ups in diabetes patients can help in the early detection of these complications.
Since early detection of diabetic retinopathies can help prevent vision loss in diabetic patients, they should be educated on the importance of regular health checkups. Moreover, efforts are being made to develop an AI-powered diagnostic tool for the early detection of diabetic retinopathy,
such as artificial intelligence-enhanced Retinophotography9 and an automatic analysis algorithm for referable diabetic retinopathy from fundus images.10
In addition, patients should be informed about the various treatment options for DR, like laser therapy, VEGF inhibitor drugs, vitrectomy, retinal reattachment, and corticosteroid injections.11 Furthermore, drugs such as Faricimab-svoa (recently approved by the FDA)12 and Lucentis (in phase 4 clinical trial)13 offer patients new hope for DR and DME treatment.
It is clear from the preceding discussion that complications like diabetic retinopathy and diabetic macular edema can cause vision loss in patients with uncontrolled long-term diabetes. While efforts are being made to develop diagnostic and therapeutic solutions for early detection and treatment of DR and DME, more research is required to determine their safety and efficacy.
Meanwhile, patients should be made aware of the risks and complications of diabetes. They should also be encouraged to regulate their blood glucose and blood pressure with proper medication, frequent health checks, diet control, and exercise to decrease the risk of vision loss due to diabetic retinopathy. In the future, the breakthroughs in the development of effective diagnostic and treatment options will help reduce healthcare costs for management of diabetes-related complications while also improving clinical care quality and overall life quality for diabetic patients.
Reviewer: Priyanka
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