Correlation of Risk Factors with the Severity of Diabetic Retinopathy at a Rural Health Facility in Sindh Pakistan

Diabetes Mellitus (DM) and the resulting Diabetic Retinopathy (DR) is a significant health problem around the World. In 2019, the total number of diabetics worldwide was 463 million, and 35% had some DR. Objectives: To determine the correlation between the severity of Diabetic Retinopathy (DR) and the known risk factors. Methods: Analytical cross-sectional study design was used with convenience sampling in a primary, multispecialty day care health facility under the Baqai Foundation (Khushal Nagar) in a rural area of Sindh from 2020 - 2022. A total of 133 patients had some DR according to the International Classification of Diabetic Retinopathy Severity Scale (ICDRSS), which correlated with the different risk factors. Spearman rank correlation was used, and the result was considered significant when the P value was <.05. Results: The results showed a significant positive correlation between the severity of DR with Age, Random Blood Sugar, Hypertension, and Smoking. Glycated hemoglobin and hyperlipidemia were not significantly correlated, mainly because of the small sample size. (23 and 14 respectively). The patients who tried to have Lipid Profile and Glycated Hemoglobin done had stage four or five of ICDRSS. Conclusions: Most risk factors studied were positively correlated with the severity of DR. Besides the intended study, the findings highlighted the non-awareness of patients about DR and its consequences. Awareness campaigns and screening programs for DR and its risk factors are urgently required and tailored to our circumstances.
 


I N T R O D U C T I O N
Diabetes Mellitus (DM) and the resulting Diabetic Retinopathy (DR) is a signi cant health problem around the World.In 2019, the total number of diabetics worldwide was 463 million, and 35% had some DR.Objectives: To determine the correlation between the severity of Diabetic Retinopathy (DR) and the known risk factors.Methods: Analytical cross-sectional study design was used with convenience sampling in a primary, multispecialty day care health facility under the Baqai Foundation (Khushal Nagar) in a rural area of Sindh from 2020 -2022.A total of 133 patients had some DR according to the International Classi cation of Diabetic Retinopathy Severity Scale (ICDRSS), which correlated with the different risk factors.Spearman rank correlation was used, and the result was considered signi cant when the P value was <.05.

Results:
The results showed a signi cant positive correlation between the severity of DR with Age, Random Blood Sugar, Hypertension, and Smoking.Glycated hemoglobin and hyperlipidemia were not signi cantly correlated, mainly because of the small sample size.(23 and 14 respectively).The patients who tried to have Lipid Pro le and Glycated Hemoglobin done had stage four or ve of ICDRSS.Conclusions: Most risk factors studied were positively correlated with the severity of DR.Besides the intended study, the ndings highlighted the nonawareness of patients about DR and its consequences.Awareness campaigns and screening programs for DR and its risk factors are urgently required and tailored to our circumstances.and the random blood glucose (RBS) levels were determined at the Clinic.At the same time, for lipid pro le and glycated hemoglobin (HbA1C), the patients were asked to get it done, at a subsidized cost, from the laboratory of the Tertiary Center (Baqai Medical University).We excluded from the study any patient whose opaque media did not allow proper DR classi cation or was missing from the record for any reason.After the exclusion according to the set criteria, some degree of DR was found in 133 Patients (male and female included) with ages ranging from 32 to 78 years.The correlation of different risk factors was determined among these DR patients.Hence Stage 1 of the ICDRSS was not considered.The relevant institutional review board (IRB) obtained ethical approval for the study.This approval ensures that while conducting the study, ethical principles and protection of the rights and wellbeing of the participants are considered.The study ensured ethical considerations by obtaining a signed consent from the willing participants and assuring the con dentiality of their information.After data compilation, SPSS version 20.0 was used for the data analysis.

A R T I C L
Frequency and percentage were used for the demographic variables.Moreover, Spearman rank correlation was used to determine the correlation between DR severity and different risk factors, and the result was considered signi cant when the P value was <.05.Each risk factor was correlated separately and independently.Table 3 shows correlation between the severity of Diabetic Retinopathy with Age, Random Blood Sugar, Hypertension, and Smoking.Glycated hemoglobin and hyperlipidemia were not signi cantly correlated, mainly because of the small sample size.(23,14).The patients who tried to have Lipid Pro le and Glycated Hemoglobin had stage four or ve of ICDRSS.The main assessment of this study, although a simple correlation, is to bring into record whatever data was available from a health center in rural Sindh.In this study, males were 70.7% and females 23.3%; this may be due to males being more in number than females attending the OPD.Furthermore, the majority (60%) of the patients were 53-62.Similarly, a study conducted showed 57% male and 43% female, with the majority (25.4%) age group (50-54%)

R E S U L T S
[8].This study indicated a correlation of DR with age, random blood sugar, blood lipids, and smoking.On the other side, the association of risk factors with DR is consistent with other studies [12,13,15,16].Furthermore, a systematic review study stated that risk factors such as dyslipidemia and hyperglycemia are the main target of all clinicians to be controlled to prevent DR [2].The current study showed a correlation of DR with smoking.Some other studies' results revealed that DR and smoking were positively correlated, while it is often reported otherwise [17][18][19][20].The study's chief limitation was a lack of data about the patient's medical history, investigations, and follow-up.
Hence, considering the scanty data available for this study, a simple cross-sectional correlation study design was chosen instead of a more elaborate study.Despite being educated and warned, this oblivion and neglecting attitude of the patients seems mainly due to non-awareness about the consequences of neglecting DR in the early stages.It was an un-intended observation that the only patients who traveled for lipid pro le belonged to stages 4 & 5 of ICDRSS, indicating that willingness to make some effort was increased once patients lost sight signi cantly.This highlights the problem of non-awareness in patients about their health problems, which has often been discussed [21][22][23][24].However, nancial and domestic factors and time for travel must also have been operative.The role of risk factors in the prognosis of DR is established [25].However, to reduce the blindness burden, timely intervention is mandatory.To achieve this, awareness campaigns [26] and screening can make the task easier.Furthermore, the screening strategies employed by nancially advanced countries may not be feasible for low-income countries [27].Strategies for screening for DR have to be tailored according to our geo-political needs and resources, as some other regional countries are planning [27].

C O N C L U S I O N S
Most risk factors studied were positively correlated with the severity of DR.Besides the intended study, the ndings highlighted the non-awareness of patients about DR and its consequences.Awareness campaigns and screening programs for DR and its risk factors are urgently required, and tailored to our circumstances.

DOI:
https://doi.org/10.54393/pjhs.v4i08.989Khaliq A et al., Correlation of Risk Factors with the Severity of Diabetic Retinopathy D I S C U S S I O N

Table 2 :
Severity of DR through International Classi cation of Diabetic Retinopathy Severity Scale

Table 3 :
Correlation and Diabetic Retinopathy and Risk factors