Higher prevalence of retinopathy in diabetic patients of south Asian ethnicity compared to white Europeans in the community: a cross sectional study

  1. Neil T Raymond, MSc1,
  2. Lakshminarayanan Varadhan, MRCP2,
  3. Dilini R Reynold, MD, Postgraduate student3,
  4. Kate Bush, BM4,
  5. Sailesh Sankaranarayanan, MRCP, Consultant Diabetes2,
  6. Srikanth Bellary, MRCP, Consultant Diabetes & Acute Medicine5,
  7. Anthony H Barnett, FRCP, Professor of Medicine5,
  8. Sudhesh Kumar, FRCP, Professor of Medicine6 and
  9. J Paul O'Hare, FRCP, Reader in Clinical Medicine (J.P.O-Hare{at}warwick.ac.uk) on behalf of UKADS retinopathy study group6
  1. 1Associate Professor of Epidemiology, Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, CV4 7AL
  2. 2SHO Diabetes, University Hospital Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX
  3. 3Warwick Medical School, University of Warwick, Coventry, CV4 7AL
  4. 4ST2 Ophthalmology, Southampton General Hospital, Southampton, SO16 6YD
  5. 5Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS
  6. 6Clinical Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, CV4 7AL

    Abstract

    Objective: To compare prevalence and risk factors for diabetic retinopathy among UK residents of south Asian or white European ethnicity.

    Research Design and Methods: Community based cross-sectional study involving 10 General Practices. 1035 patients with Type 2 diabetes were studied, 421 south Asian and 614 white European ethnicity. Diabetic retinopathy, sight threatening retinopathy, maculopathy and previous laser photocoagulation therapy were assessed, following grading of retinal photographs. Data were collected on risk factors including age, duration and treatment of diabetes, blood pressures, serum total cholesterol and HbA1c.

    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 pressures, HbA1c (7.9 vs. 7.5%, P<0.0001) and total cholesterol (4.5 vs. 4.2mmol/L, P<0.0001). Diabetic retinopathy was detected in 414 (40%) patients, south Asian 189 (45%) vs. white European 225 (37%), P=0.0078. Sight threatening retinopathy was detected in 142 (14%) patients; south Asian 68 (16%) vs. white European 74 (12%); P=0.0597. After adjustment for confounders, there were significantly elevated risks of any retinopathy and maculopathy for south Asian vs. white European patients.

    Conclusions: Patients of south Asian ethnicity had significantly higher prevalence of diabetic retinopathy and maculopathy, with significantly elevated systolic and diastolic blood pressures, HbA1c 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

      • Received August 13, 2008.
      • Accepted December 9, 2008.

    This Article

    1. Published online before print December 15, 2008, doi: 10.2337/dc08-1422
    1. » Abstract
    2. Full Text (PDF)
    3. All Versions of this Article:
      1. dc08-1422v1
      2. 32/3/410most recent

    Current Issue

    1. November 2009, 32 (11)
    1. Current Issue
    1. Alert me to new issues of Diabetes Care