Associations of renal function with diabetic retinopathy and visual impairment in type 2 diabetes: A multicenter nationwide cross-sectional study
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摘要
BACKGROUND Diabetic retinopathy(DR) separately has been noted as a major public health problem worldwide as well. Currently, many studies have demonstrated an association between diabetic nephropathy and DR in type 1 diabetes mellitus(T1DM) patients, but this association is less strong in T2DM. The evidence for an association between renal function and DR and visual impairment among T2DM patients is limited, particularly in the Asian population.AIM To assess the association between glomerular filtration rate(GFR) and DR, severe DR, and severe visual impairment among T2DM patients in Thailand.METHODS We conducted a nationwide cross-sectional study based on the DM/HT study of the Medical Research Network of the Consortium of Thai Medical Schools. This study evaluated adult T2DM patients from 831 public hospitals in Thailand in the year 2013. GFR was categorized into ≥ 90, 60-89, 30-59 and < 30 mL/min/1.73 m~2.The association between GFR and DR, severe DR, and severe visual impairment were assessed using multivariate logistic regression.RESULTS A total of 13192 T2DM patients with available GFR were included in the analysis.The mean GFR was 66.9 ± 25.8 mL/min/1.73 m~2. The prevalence of DR,proliferative DR, diabetic macular edema, and severe visual impairment were 12.4%, 1.8%, 0.2%, and 2.1%, respectively. Patients with GFR of 60-89, 30-59 and <30 mL/min/1.73 m~2 were significantly associated with increased DR and severe DR when compared with patients with GFR of ≥ 90 mL/min/1.73 m~2. In addition,increased severe visual impairment was associated with GFR 30-59 and < 30 m L/min/1.73 m~2.CONCLUSION Decreased GFR was independently associated with increased DR, severe DR, and severe visual impairment. GFR should be monitored in diabetic patients for DR awareness and prevention.
BACKGROUND Diabetic retinopathy(DR) separately has been noted as a major public health problem worldwide as well. Currently, many studies have demonstrated an association between diabetic nephropathy and DR in type 1 diabetes mellitus(T1DM) patients, but this association is less strong in T2DM. The evidence for an association between renal function and DR and visual impairment among T2DM patients is limited, particularly in the Asian population.AIM To assess the association between glomerular filtration rate(GFR) and DR, severe DR, and severe visual impairment among T2DM patients in Thailand.METHODS We conducted a nationwide cross-sectional study based on the DM/HT study of the Medical Research Network of the Consortium of Thai Medical Schools. This study evaluated adult T2DM patients from 831 public hospitals in Thailand in the year 2013. GFR was categorized into ≥ 90, 60-89, 30-59 and < 30 mL/min/1.73 m~2.The association between GFR and DR, severe DR, and severe visual impairment were assessed using multivariate logistic regression.RESULTS A total of 13192 T2DM patients with available GFR were included in the analysis.The mean GFR was 66.9 ± 25.8 mL/min/1.73 m~2. The prevalence of DR,proliferative DR, diabetic macular edema, and severe visual impairment were 12.4%, 1.8%, 0.2%, and 2.1%, respectively. Patients with GFR of 60-89, 30-59 and <30 mL/min/1.73 m~2 were significantly associated with increased DR and severe DR when compared with patients with GFR of ≥ 90 mL/min/1.73 m~2. In addition,increased severe visual impairment was associated with GFR 30-59 and < 30 m L/min/1.73 m~2.CONCLUSION Decreased GFR was independently associated with increased DR, severe DR, and severe visual impairment. GFR should be monitored in diabetic patients for DR awareness and prevention.
BACKGROUND Diabetic retinopathy(DR) separately has been noted as a major public health problem worldwide as well. Currently, many studies have demonstrated an association between diabetic nephropathy and DR in type 1 diabetes mellitus(T1DM) patients, but this association is less strong in T2DM. The evidence for an association between renal function and DR and visual impairment among T2DM patients is limited, particularly in the Asian population.AIM To assess the association between glomerular filtration rate(GFR) and DR, severe DR, and severe visual impairment among T2DM patients in Thailand.METHODS We conducted a nationwide cross-sectional study based on the DM/HT study of the Medical Research Network of the Consortium of Thai Medical Schools. This study evaluated adult T2DM patients from 831 public hospitals in Thailand in the year 2013. GFR was categorized into ≥ 90, 60-89, 30-59 and < 30 mL/min/1.73 m~2.The association between GFR and DR, severe DR, and severe visual impairment were assessed using multivariate logistic regression.RESULTS A total of 13192 T2DM patients with available GFR were included in the analysis.The mean GFR was 66.9 ± 25.8 mL/min/1.73 m~2. The prevalence of DR,proliferative DR, diabetic macular edema, and severe visual impairment were 12.4%, 1.8%, 0.2%, and 2.1%, respectively. Patients with GFR of 60-89, 30-59 and <30 mL/min/1.73 m~2 were significantly associated with increased DR and severe DR when compared with patients with GFR of ≥ 90 mL/min/1.73 m~2. In addition,increased severe visual impairment was associated with GFR 30-59 and < 30 m L/min/1.73 m~2.CONCLUSION Decreased GFR was independently associated with increased DR, severe DR, and severe visual impairment. GFR should be monitored in diabetic patients for DR awareness and prevention.
引文
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3 Yau JW,Rogers SL,Kawasaki R,Lamoureux EL,Kowalski JW,Bek T,Chen SJ,Dekker JM,Fletcher A,Grauslund J,Haffner S,Hamman RF,Ikram MK,Kayama T,Klein BE,Klein R,Krishnaiah S,Mayurasakorn K,O'Hare JP,Orchard TJ,Porta M,Rema M,Roy MS,Sharma T,Shaw J,Taylor H,Tielsch JM,Varma R,Wang JJ,Wang N,West S,Xu L,Yasuda M,Zhang X,Mitchell P,Wong TY;Meta-Analysis for Eye Disease(META-EYE)Study Group.Global prevalence and major risk factors of diabetic retinopathy.Diabetes Care 2012;35:556-564[PMID:22301125 DOI:10.2337/dc11-1909]
4 Sivaprasad S,Gupta B,Crosby-Nwaobi R,Evans J.Prevalence of diabetic retinopathy in various ethnic groups:a worldwide perspective.Surv Ophthalmol 2012;57:347-370[PMID:22542913 DOI:10.1016/j.survophthal.2012.01.004]
5 Kapur A,Harries AD.The double burden of diabetes and tuberculosis-public health implications.Diabetes Res Clin Pract 2013;101:10-19[PMID:23305899 DOI:10.1016/j.diabres.2012.12.001]
6 Corriere M,Rooparinesingh N,Kalyani RR.Epidemiology of diabetes and diabetes complications in the elderly:an emerging public health burden.Curr Diab Rep 2013;13:805-813[PMID:24018732 DOI:10.1007/s11892-013-0425-5]
7 Laxy M,Hunger M,Stark R,Meisinger C,Kirchberger I,Heier M,von Scheidt W,Holle R.The Burden of Diabetes Mellitus in Patients with Coronary Heart Disease:A Methodological Approach to Assess Quality-Adjusted Life-Years Based on Individual-Level Longitudinal Survey Data.Value Health 2015;18:969-976[PMID:26686780 DOI:10.1016/j.jval.2015.07.003]
8 Costa AF,Flor LS,Campos MR,Oliveira AF,Costa MF,Silva RS,Lobato LC,Schramm JM.Burden of type 2 diabetes mellitus in Brazil.Cad Saude Publica 2017;33:e00197915[PMID:28380131 DOI:10.1590/0102-311X00197915]
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12 Chen YH,Chen HS,Tarng DC.More impact of microalbuminuria on retinopathy than moderately reduced GFR among type 2 diabetic patients.Diabetes Care 2012;35:803-808[PMID:22338100 DOI:10.2337/dc11-1955]
13 Sabanayagam C,Foo VH,Ikram MK,Huang H,Lim SC,Lamoureux EL,Tai ES,Wong TY.Is chronic kidney disease associated with diabetic retinopathy in Asian adults?J Diabetes 2014;6:556-563[PMID:24636277 DOI:10.1111/1753-0407.12148]
14 Medical Research Network of the Consortium of Thai Medical Schools:MedResNet(Thailand).Data Archival for Maximum Utilization System(DAMUS).DM/HT study(NHSO Research Project).2013;Available from:URL:http://www.damus.in.th/damus/index.php
15 von Elm E,Altman DG,Egger M,Pocock SJ,G?tzsche PC,Vandenbroucke JP;STROBE Initiative.The Strengthening the Reporting of Observational Studies in Epidemiology(STROBE)statement:guidelines for reporting observational studies.PLoS Med 2007;4:e296[PMID:17941714 DOI:10.1371/journal.pmed.0040296]
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17 Reutrakul S,Deerochanawong C.Diabetes in Thailand:Status and Policy.Curr Diab Rep 2016;16:28[PMID:26894266 DOI:10.1007/s11892-016-0725-7]
18 Nitiyanant W,Chetthakul T,Sang-A-kad P,Therakiatkumjorn C,Kunsuikmengrai K,Yeo JP.A survey study on diabetes management and complication status in primary care setting in Thailand.J Med Assoc Thai 2007;90:65-71[PMID:17621735 DOI:10.1186/1744-8603-9-11]
19 Namperumalsamy P,Kim R,Vignesh TP,Nithya N,Royes J,Gijo T,Thulasiraj RD,Vijayakumar V.Prevalence and risk factors for diabetic retinopathy:a population-based assessment from Theni District,south India.Br J Ophthalmol 2009;93:429-434[PMID:19091856 DOI:10.1136/bjo.2008.147934]
20 Javadi MA,Katibeh M,Rafati N,Dehghan MH,Zayeri F,Yaseri M,Sehat M,Ahmadieh H.Prevalence of diabetic retinopathy in Tehran province:a population-based study.BMC Ophthalmol 2009;9:12[PMID:19835608 DOI:10.1186/1471-2415-9-12]
21 Bursell SE,Fonda SJ,Lewis DG,Horton MB.Prevalence of diabetic retinopathy and diabetic macular edema in a primary care-based teleophthalmology program for American Indians and Alaskan Natives.PLoS One 2018;13:e0198551[PMID:29924846 DOI:10.1371/journal.pone.0198551]
22 Hapnes R,Bergrem H.Diabetic eye complications in a medium sized municipality in southwest Norway.Acta Ophthalmol Scand 1996;74:497-500[PMID:8950402 DOI:10.1111/j.1600-0420.1996.tb00607.x]
23 Varma R,Macias GL,Torres M,Klein R,Pe?a FY,Azen SP;Los Angeles Latino Eye Study Group.Biologic risk factors associated with diabetic retinopathy:the Los Angeles Latino Eye Study.Ophthalmology 2007;114:1332-1340[PMID:17306879 DOI:10.1016/j.ophtha.2006.10.023]
24 Zhang G,Chen H,Chen W,Zhang M.Prevalence and risk factors for diabetic retinopathy in China:a multi-hospital-based cross-sectional study.Br J Ophthalmol 2017;101:1591-1595[PMID:28855195DOI:10.1136/bjophthalmol-2017-310316]
25 Ruta LM,Magliano DJ,Lemesurier R,Taylor HR,Zimmet PZ,Shaw JE.Prevalence of diabetic retinopathy in Type 2 diabetes in developing and developed countries.Diabet Med 2013;30:387-398[PMID:23331210 DOI:10.1111/dme.12119]
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2 Wild S,Roglic G,Green A,Sicree R,King H.Global prevalence of diabetes:estimates for the year 2000and projections for 2030.Diabetes Care 2004;27:1047-1053[PMID:15111519 DOI:10.2337/diacare.27.5.1047]
3 Yau JW,Rogers SL,Kawasaki R,Lamoureux EL,Kowalski JW,Bek T,Chen SJ,Dekker JM,Fletcher A,Grauslund J,Haffner S,Hamman RF,Ikram MK,Kayama T,Klein BE,Klein R,Krishnaiah S,Mayurasakorn K,O'Hare JP,Orchard TJ,Porta M,Rema M,Roy MS,Sharma T,Shaw J,Taylor H,Tielsch JM,Varma R,Wang JJ,Wang N,West S,Xu L,Yasuda M,Zhang X,Mitchell P,Wong TY;Meta-Analysis for Eye Disease(META-EYE)Study Group.Global prevalence and major risk factors of diabetic retinopathy.Diabetes Care 2012;35:556-564[PMID:22301125 DOI:10.2337/dc11-1909]
4 Sivaprasad S,Gupta B,Crosby-Nwaobi R,Evans J.Prevalence of diabetic retinopathy in various ethnic groups:a worldwide perspective.Surv Ophthalmol 2012;57:347-370[PMID:22542913 DOI:10.1016/j.survophthal.2012.01.004]
5 Kapur A,Harries AD.The double burden of diabetes and tuberculosis-public health implications.Diabetes Res Clin Pract 2013;101:10-19[PMID:23305899 DOI:10.1016/j.diabres.2012.12.001]
6 Corriere M,Rooparinesingh N,Kalyani RR.Epidemiology of diabetes and diabetes complications in the elderly:an emerging public health burden.Curr Diab Rep 2013;13:805-813[PMID:24018732 DOI:10.1007/s11892-013-0425-5]
7 Laxy M,Hunger M,Stark R,Meisinger C,Kirchberger I,Heier M,von Scheidt W,Holle R.The Burden of Diabetes Mellitus in Patients with Coronary Heart Disease:A Methodological Approach to Assess Quality-Adjusted Life-Years Based on Individual-Level Longitudinal Survey Data.Value Health 2015;18:969-976[PMID:26686780 DOI:10.1016/j.jval.2015.07.003]
8 Costa AF,Flor LS,Campos MR,Oliveira AF,Costa MF,Silva RS,Lobato LC,Schramm JM.Burden of type 2 diabetes mellitus in Brazil.Cad Saude Publica 2017;33:e00197915[PMID:28380131 DOI:10.1590/0102-311X00197915]
9 Pedro RA,Ramon SA,Marc BB,Juan FB,Isabel MM.Prevalence and relationship between diabetic retinopathy and nephropathy,and its risk factors in the North-East of Spain,a population-based study.Ophthalmic Epidemiol 2010;17:251-265[PMID:20642348 DOI:10.3109/09286586.2010.498661]
10 Wolf G,Müller N,Mandecka A,Müller UA.Association of diabetic retinopathy and renal function in patients with types 1 and 2 diabetes mellitus.Clin Nephrol 2007;68:81-86[PMID:17722706 DOI:10.5414/CNP68081]
11 Man RE,Sasongko MB,Wang JJ,MacIsaac R,Wong TY,Sabanayagam C,Lamoureux EL.The Association of Estimated Glomerular Filtration Rate With Diabetic Retinopathy and Macular Edema.Invest Ophthalmol Vis Sci 2015;56:4810-4816[PMID:26218909 DOI:10.1167/iovs.15-16987]
12 Chen YH,Chen HS,Tarng DC.More impact of microalbuminuria on retinopathy than moderately reduced GFR among type 2 diabetic patients.Diabetes Care 2012;35:803-808[PMID:22338100 DOI:10.2337/dc11-1955]
13 Sabanayagam C,Foo VH,Ikram MK,Huang H,Lim SC,Lamoureux EL,Tai ES,Wong TY.Is chronic kidney disease associated with diabetic retinopathy in Asian adults?J Diabetes 2014;6:556-563[PMID:24636277 DOI:10.1111/1753-0407.12148]
14 Medical Research Network of the Consortium of Thai Medical Schools:MedResNet(Thailand).Data Archival for Maximum Utilization System(DAMUS).DM/HT study(NHSO Research Project).2013;Available from:URL:http://www.damus.in.th/damus/index.php
15 von Elm E,Altman DG,Egger M,Pocock SJ,G?tzsche PC,Vandenbroucke JP;STROBE Initiative.The Strengthening the Reporting of Observational Studies in Epidemiology(STROBE)statement:guidelines for reporting observational studies.PLoS Med 2007;4:e296[PMID:17941714 DOI:10.1371/journal.pmed.0040296]
16 Levey AS,Stevens LA,Schmid CH,Zhang YL,Castro AF,Feldman HI,Kusek JW,Eggers P,Van Lente F,Greene T,Coresh J;CKD-EPI(Chronic Kidney Disease Epidemiology Collaboration).A new equation to estimate glomerular filtration rate.Ann Intern Med 2009;150:604-612[PMID:19414839 DOI:10.7326/0003-4819-150-9-200905050-00006]
17 Reutrakul S,Deerochanawong C.Diabetes in Thailand:Status and Policy.Curr Diab Rep 2016;16:28[PMID:26894266 DOI:10.1007/s11892-016-0725-7]
18 Nitiyanant W,Chetthakul T,Sang-A-kad P,Therakiatkumjorn C,Kunsuikmengrai K,Yeo JP.A survey study on diabetes management and complication status in primary care setting in Thailand.J Med Assoc Thai 2007;90:65-71[PMID:17621735 DOI:10.1186/1744-8603-9-11]
19 Namperumalsamy P,Kim R,Vignesh TP,Nithya N,Royes J,Gijo T,Thulasiraj RD,Vijayakumar V.Prevalence and risk factors for diabetic retinopathy:a population-based assessment from Theni District,south India.Br J Ophthalmol 2009;93:429-434[PMID:19091856 DOI:10.1136/bjo.2008.147934]
20 Javadi MA,Katibeh M,Rafati N,Dehghan MH,Zayeri F,Yaseri M,Sehat M,Ahmadieh H.Prevalence of diabetic retinopathy in Tehran province:a population-based study.BMC Ophthalmol 2009;9:12[PMID:19835608 DOI:10.1186/1471-2415-9-12]
21 Bursell SE,Fonda SJ,Lewis DG,Horton MB.Prevalence of diabetic retinopathy and diabetic macular edema in a primary care-based teleophthalmology program for American Indians and Alaskan Natives.PLoS One 2018;13:e0198551[PMID:29924846 DOI:10.1371/journal.pone.0198551]
22 Hapnes R,Bergrem H.Diabetic eye complications in a medium sized municipality in southwest Norway.Acta Ophthalmol Scand 1996;74:497-500[PMID:8950402 DOI:10.1111/j.1600-0420.1996.tb00607.x]
23 Varma R,Macias GL,Torres M,Klein R,Pe?a FY,Azen SP;Los Angeles Latino Eye Study Group.Biologic risk factors associated with diabetic retinopathy:the Los Angeles Latino Eye Study.Ophthalmology 2007;114:1332-1340[PMID:17306879 DOI:10.1016/j.ophtha.2006.10.023]
24 Zhang G,Chen H,Chen W,Zhang M.Prevalence and risk factors for diabetic retinopathy in China:a multi-hospital-based cross-sectional study.Br J Ophthalmol 2017;101:1591-1595[PMID:28855195DOI:10.1136/bjophthalmol-2017-310316]
25 Ruta LM,Magliano DJ,Lemesurier R,Taylor HR,Zimmet PZ,Shaw JE.Prevalence of diabetic retinopathy in Type 2 diabetes in developing and developed countries.Diabet Med 2013;30:387-398[PMID:23331210 DOI:10.1111/dme.12119]
26 Williams R,Airey M,Baxter H,Forrester J,Kennedy-Martin T,Girach A.Epidemiology of diabetic retinopathy and macular oedema:a systematic review.Eye(Lond)2004;18:963-983[PMID:15232600DOI:10.1038/sj.eye.6701476]
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