Risk factors for diabetic retinopathy in self-reported rural population with diabetes

Background: Diabetes and its related microvascular complications like diabetic retinopathy (DR) are showing increased prevalence in India. However, the magnitude of DR in rural population with diabetes needs exploration. Aim: To estimate the prevalence and risk factors for the presence and severity of diabetic retinopathy in the self-reported rural population with diabetes. Settings and Design: In a cross-sectional study, a total of 26,519 participants (age ≥ 30 years) attended 198 diabetic retinopathy screening camps conducted in three southern districts of Tamilnadu, India, between February 2004 and April 2006. Materials and Methods: All the participants underwent a dilated eye examination to detect DR by indirect ophthalmoscopy. Systemic and ocular risk factor estimation was done in a comprehensive examination. Statistical Analysis: Univariate and stepwise regression analyses were done to identify the independent risk factors associated with the presence and severity of retinopathy. Results: The prevalence of diabetic retinopathy was 17.6% among the self-reported rural population with diabetes. The prevalence of referable (sight threatening) retinopathy was 5.3%. Risk factors associated with the development of any DR were male gender (OR= 1.37), longer duration of diabetes (per year, OR= 1.07), lean body mass index (OR= 1.30), higher systolic blood pressure (per 10 mm Hg, OR= 1.18), and insulin treatment (OR= 1.34; P < 0.0001). Risk factors associated with referable retinopathy included longer duration of diabetes (per year, OR= 1.22), lean body mass index (OR= 1.25), higher systolic blood pressure (per 10 mm Hg, OR= 1.03), and insulin treatment (OR= 1.36; P < 0.0001). Conclusion: The study identified risk factors associated with DR in the rural population with diabetes. The results suggested that there was a need for formulating effective preventive strategies to minimize avoidable blindness due to diabetes, in rural areas.