Study On The Risk Factors Of Early Retinopathy In Patients With Type 2 Diabetes Mellitus

ObjectiveTo investigate the risk factors for early occurrence of diabetic retinopathy(DR)in patients with type 2 diabetes mellitus(T2DM)by analyzing their clinical data and laboratory test results,so as to provide scientific basis for the prevention of DR.MethodsClinical data of patients that were admitted to XX hospital during January 2015 to January 2017 and diagnosed with DR in the department of endocrinology were collected using the HIS system,and those who met the inclusion criteria were enrolled in this study.Basing on the incubation period before occurrence of DR,the subjects were divided into a early occurrence group(Group A)and a late occurrence group(Group B).General information and laboratory test results of the subjects were collected and compared between the two groups to analyze the correlation between occurrence of DR and the clinical indexes.General information of the patients included:age,gender,ethnicity,family history of diabetes,age of onset,history of smoking,history of alcohol consumption,systolic blood pressure,diastolic blood pressure,body mass index BMI,insulin use,compliance of oral drug use,presence of combined hypertension,presence of combined diabetic nephropathy.Laboratory tests included:fasting blood glucose(FBG),glycosylated hemoglobin(HbAlc),blood lipids(total cholesterol/TC,triglyceride/TG,high density lipoprotein/HDL-c,low density lipoprotein/LDL-c),renal function indicators(serum creatinine/CR,blood urea nitrogen/BUN),urinary microprotein and others.Statistical analysis was performed using SPSS 20.0 statistical software,count data were represented as percentage(%),comparison between the two groups were analyzed by x2 test.Measurement data were first tested for normality,those in normal distribution were represented as mean ± standard error,and compared between the two groups by t test.The risk factors for early occurrence of DR were analyzed by univariate and multivariate unconditional logistic regression,and OR value and 95%confidence interval(95%CI)were calculated.P<0.05 was considered statistically significant.Results1.General information of the subjects:280 patients were included in this study,with an average incubation period of 10 years before occurrence of DR.The two groups of subjects showed no significant differences in age,gender,ethnicity,history of alcohol consumption,insulin use,and compliance in oral drug use(P>0.05),but showed significant differences in family history of diabetics,history of smoking,age of onset,diastolic blood pressure,and body mass index/BMI(P<0.05).2.Laboratory test results of the subjects The two groups of subjects showed no significant differences in glycosylated hemoglobin(HbAlc),blood urea nitrogen/BUN(P>0.05);but showed significant differences in FBG,blood lipid indexes(total cholesterol/TC,triglyceride/TG,high density lipoprotein/HDL-c,low density lipoprotein/LDL-c),serum creatinine/CR,and urinary microprotein.2.Analysis of risk factors for early occurrence of DR among patients with T2DM by univariate regressionDiastolic blood pressure,BMI,age of onset,family history of diabetes,smoking history,FBG,serum lipid indexes(Total cholesterol/TC,triglyceride/TG,high density lipoprotein/HDL-c,low density lipoprotein/LDL-c),CR,and urinary microprotein were analyzed by univariant unconditional logistic regression,and all these indicators were found to be correlated with DR occurrence(P<0.05)and were considered risk factors for early occurrence of DR.4.Analysis of risk factors for early occurrence of DR among patients with T2DM by multivariate regression Multivariate regression results suggested significant correlation between DR occurrence and diastolic blood pressure(OR =1.152,95%CI:1.015～3.872),BMI(OR = 5.332,95%CI:3.105～8.772),age of onset(OR = 2.443,95%CI:1.048～6.118),family history of diabetes mellitus(OR = 1.533,95%CI:1.205～5.892),smoking history(OR = 1.984,95%CI:1.128～7.112),FBG(OR ＝1.571,95%CI:1.042 to 8.466),TC(OR = 1.417,95%CI:1.025 to 9.547),TG(OR =1.875,95%CI:1.007 to 3.667),HDL-c(OR= 1.663,95%CI:1.041 to 8.547),LDL-c(OR = 1.446,95%CI:1.002 to 7.815),CR(OR = 1.638,95%CI:1.003 to 7.325),urinary microprotein(OR = 1.554,95%CI:1.002 to 7.815)(P<0.05 for all),which are considered risk factors for early occurrence of DR.Among them,BMI was strongly correlated with early occurrence of DR,and onse age of T2MD,smoking history,and TG level were moderately correlated.Conclusion and suggest1.The modifiable risk factors for early occurrence of DR among T2MD patients include blood pressure,smoking,BMI,blood glucose and lipid levels.So,body weight,blood pressure,blood glucose,blood lipids,CR,urinary microprotein level shall be well managed to reduces the risk of early occurrence of DR.2.The unmodifiable risk factors for early occurrence of DR among T2MD patients include age of onset and family history of diabetes.Heath education and regular screening shall be enhanced among these patients,so that T2MD patients can notice the early symptoms of DR and get medical treatment early,which greatly improve the outcome of these patients.Prompt monitoring and control of the risk factors for early occurrence of DR would help prevent or delay occurrence of DR and improve patients’ quality of life.Through the contrast analysis of the different course of type 2 diabetes mellitus complicated with retinopathy(diabetic retinopathy,DR)in patients with clinical data and laboratory indexes;and to explore the risk factors of early concurrent DR in type 2 diabetes and to provide a scientific basis for the prevention or delay of DR occurrence in patients with type 2 diabetes.