Prevalence and severity of diabetic retinopathy in type 2 diabetes with and without iron deficiency anemia: A hospital based comparative study

Session Details

Session Title: Free Paper Session 19: Vascular Diseases & Diabetic Retinopathy V

Session Date/Time: Saturday 09/09/2017 | 16:30-18:00

Paper Time: 17:00

Venue: Room 120

First Author: : K.Sharma INDIA

Co Author(s): :    A. Bosco   A. R                          

Abstract Details

Purpose:

Iron deficiency anaemia (IDA) is an under recognized condition in diabetics and its association with severity of Diabetic Retinopathy(DR) is debatable. The role of iron indices in IDA i.e. lower levels of Transferrin saturation and serum ferritin playing a protective role in DR has been hypothesized. Glycosylated haemoglobin (HbA1c) levels in IDA maybe falsely low leading to the possibility of increased severity of DR in the presence of good blood sugar control. The purpose of the study was to determine the relationship between DR and IDA using the iron indices as independent markers and predictors for the severity of DR

Setting:

The study population consisted of 300 patients aged over 45 years, with Type 2 Diabetes of more than 5 years duration who presented to the Ophthalmology Department of Indira Gandhi Government General Hospital, Puducherry, India during the period of two years

Methods:

This was a cross sectional comparative hospital based study. The patient’s demographic details and diabetic history along with anthropometric measurements were recorded. Hematological investigations were performed to determine levels of haemoglobin, Fasting blood sugar, 2-hour post-prandial blood sugar, HbA1c, serum iron, serum ferritin, and Transferrin saturation, total iron binding capacity (TIBC), Mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC) and packed cell volume (PCV). A comprehensive anterior and posterior segment examination was undertaken. Fundus evaluation was performed by two ophthalmologists using non contact slit lamp biomicroscopy using 78D or 90 D lens and indirect ophthalmoscopy with 20D lens and Fundus fluorescin angiography. DR and Clinically Significant macular edema (CSME) was categorized on the basis of the ETDRS classification while Type 2 Diabetes and IDA were according to standard definitions.

Results:

In the study of 300 patients, there were 135 males to 165 females, with maximum number of study participants in age group of 51-60 years. Total prevalence of DR was 30 %, while NPDR was 74.4%, PDR 6.6% and CSME 24.4%. 43.3% of all patients with DR were in age group of 61-70 years while 11% of those with Vision threatening diabetic retinopathy(VTDR) were between 51-60 years. Duration of Type 2 diabetes between 5-10 years had a significant association with presence of DR (Χ² = 78.63; P = 0.000**). Males were 1.37 times more likely to have DR as compared to females. (Χ² = 8.482; P = 0.004**). Prevalence doubled in males with IDA. Significant number of patients with low serum iron and ferritin had DR while the percentage of those with VTDR was nearly equal in both groups. (χ²= 267.26; P = 0.550). Correlation between severity of DR, Transferrin saturation (Χ² = 38.23; P = 0.004**) and Total iron binding capacity(TIBC) (Χ² = 57.33; P = 0.000**) was significant. Patients with severe forms of DR had lower hematocrit values. HbA1c level of more than 8% had 2.21 times higher risk of developing DR (t-Value = 4.243, p-Value = 0.000**)

Conclusions:

• IDA had a major impact on the severity of DR • Men with IDA were more likely than the women to have DR • A statistically significant correlation was found between TIBC and transferrin saturation and severity of DR • Patients with poorly controlled diabetes had severe DR • The prevalence of VTDR was seen to have increased among patients with lesser duration of diabetes • Prevalence of diabetic retinopathy in elderly patients aged over 70 years declines possibly due to elderly patients seeking medical attention for other life saving systemic pathologies while giving lesser importance to vision saving treatment • Patients with poor glycemic control are also likely to have coexisting poor nutritional status. These patients should be counseled regarding general health and improvement in dietary practices

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