The Prevalence and Risk Factors of Diabetic Retinopathy: Screening and Prophylaxis Project in 6 Provinces of China

Abstract

Purpose

To investigate the prevalence and associated factors of diabetic retinopathy (DR) and advanced DR in Chinese adults with diabetes mellitus (DM).

Patients and Methods

A cross-sectional study was performed on 4831 diabetic patients from 24 hospitals from April 2018 to July 2020. Non-mydriatic fundus of patients were interpreted by an artificial intelligence (AI) system. Fundus photos that were unsuitable for AI interpretation were interpreted by two ophthalmologists trained by one expert ophthalmologist at Beijing Tongren Hospital. Medical history, height, weight, body mass index (BMI), glycosylated hemoglobin (HbA1c), blood pressure, and laboratory examinations were recorded.

Results

A total of 4831 DM patients were included in this study. The prevalence of DR and advanced DR in the diabetic population was 31.8% and 6.6%, respectively. In multiple logistic regression analysis, male (odds ratio [OR], 1.39), duration of diabetes (OR, 1.05), HbA1c (OR, 1.11), farmer (OR, 1.39), insulin treatment (OR, 1.61), region (northern, OR, 1.78; rural, OR, 6.96), and presence of other diabetic complications (OR: 2.03) were associated with increased odds of DR. The factors associated with increased odds of advanced DR included poor glycemic control (HbA1c >7.0%) (OR, 2.58), insulin treatment (OR, 1.73), longer duration of diabetes (OR, 3.66), rural region (OR, 4.84), and presence of other diabetic complications (OR, 2.36), but overweight (BMI > 25 kg/m²) (OR, 0.61) was associated with reduced odds of advanced DR.

Conclusion

This study shows that the prevalence of DR is very high in Chinese adults with DM, highlighting the necessity of early diabetic retinal screening.

Keywords:

• diabetes mellitus
• screening
• artificial intelligence
• glycemic control
• rural region

Data Sharing Statement

All data included in this study are available upon request by contact with the corresponding author.

Ethics Approval and Consent to Participate

This study was approved by the Ethics Committee for Clinical Research of Zhongda Hospital, Affiliated to Southeast University (No. 2016ZDSYLL092-P02). The written informed consent was obtained from each subject. The study was carried out in conformity to the Declaration of Helsinki (as revised in 2013).

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This work was supported by the Key Reasearch and Development Program in Jiangsu Province (grant No. BE2022828), National Key R&D program of China (grant No. 2016YFC1305700), Nanjing Special Fund for Health Science and Technology development (grant No.YKK18261), the Excellence Funds of Southeast University (grant No.1190001801) and the Key Research and Development Programs by Science and Technology Department of Jiangxi Province (grant No. 20181BBG70014).