Higher Prevalence of Retinopathy in Diabetic Patients of South Asian Ethnicity Compared With White Europeans in the Community
A cross-sectional study
- Neil T. Raymond, MSC1,
- Lakshminarayanan Varadhan, MRCP2,
- Dilini R. Reynold, MD3,
- Kate Bush, BM4,
- Sailesh Sankaranarayanan, MRCP2,
- Srikanth Bellary, MRCP5,
- Anthony H. Barnett, FRCP5,
- Sudhesh Kumar, FRCP6,
- J. Paul O'Hare, FRCP6 and
- on behalf of the UK Asian Diabetes Study Retinopathy Study Group
- 1Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, U.K
- 2SHO Diabetes, University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, U.K.
- 3Warwick Medical School, University of Warwick, Coventry, U.K.
- 4ST2 Ophthalmology, Southampton General Hospital, Southampton, U.K.
- 5Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, U.K.
- 6Clinical Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, U.K.
- Corresponding author: J. Paul O'Hare, j.p.o-hare{at}warwick.ac.uk
Abstract
OBJECTIVE—The purpose of this study was to compare prevalence and risk factors for diabetic retinopathy among U.K. residents of South Asian or white European ethnicity.
RESEARCH DESIGN AND METHODS—This was a community-based cross-sectional study involving 10 general practices; 1,035 patients with type 2 diabetes were studied: 421 of South Asian and 614 of white European ethnicity. Diabetic retinopathy, sight-threatening retinopathy, maculopathy, and previous laser photocoagulation therapy were assessed after grading of retinal photographs. Data were collected on risk factors including age, duration, and treatment of diabetes, blood pressures, serum total cholesterol, and A1C.
RESULTS—Patients of South Asian ethnicity had significantly higher systolic (144 vs. 137 mmHg, P < 0.0001) and diastolic (84 vs. 74 mmHg, P < 0.0001) blood pressure, A1C (7.9 vs. 7.5%, P < 0.0001), and total cholesterol (4.5 vs. 4.2 mmol/l, P < 0.0001). Diabetic retinopathy was detected in 414 (40%) patients (189 South Asian [45%] versus 225 white European [37%]; P = 0.0078). Sight-threatening retinopathy was detected in 142 (14%) patients (68 South Asian [16%] versus 74 white European [12%]; P = 0.0597). After adjustment for confounders, there were significantly elevated risks of any retinopathy and maculopathy for South Asian versus white European patients.
CONCLUSIONS—Patients of South Asian ethnicity had a significantly higher prevalence of diabetic retinopathy and maculopathy, with significantly elevated systolic and diastolic blood pressure, A1C, and total cholesterol; lower attained age; and younger age at diagnosis. Earlier onset of disease and higher levels of modifiable risk factors make early detection of diabetes, annual referral for retinal screening, and intensive risk factor control key elements in addressing this health inequality.
Footnotes
-
Published ahead of print at http://care.diabetesjournals.org on 15 December 2008.
N.T.R. and L.V. contributed equally to this study.
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.
-
- Accepted December 9, 2008.
- Received August 13, 2008.
- DIABETES CARE
