Session Title: Vascular Diseases I
Session Date/Time: Friday 27/09/2013 | 08:00-10:00
Paper Time: 08:32
Venue: Hall C (Level 1)
First Author: P.Burgess MALAWI
Co Author(s): M. Garcia-Finana T. Allain N. Beare G. Msukwa
To report the prevalence of all grades of retinopathy and associations with systemic parameters in patients with diabetes in Southern Malawi
Two hospital based diabetes clinics providing primary and secondary care to a population affected by high levels of infectious disease including malaria and HIV
Subjects were systematically sampled from the diabetes clinic line for recruitment into a 24 month prospective cohort study. Clinical examination and biochemical testing was performed to assess visual acuity, glycemic control, systolic BP, HIV status, urine albumin-creatinine ratio, hemoglobin and LDL cholesterol. Retinopathy was graded using modified Wisconsin grading using 4-field mydriatic photography (dual grading with arbitration at an accredited reading center) and slit lamp biomicroscopy. Sight-threatening diabetic retinopathy (STDR) was defined as moderate preproliferative retinopathy or worse, circinate maculopathy or exudates within one disc diameter of the foveal center or clinically significant macular edema.
We report baseline data from this cohort study (n=357). The overall prevalence of any retinopathy, STDR and proliferative diabetic retinopathy (PDR) was 50.1% (44.9 – 55.3, 95% CI), 29.7% (24.9 – 34.4) and 7.3% (4.6 – 10.0), respectively. 3.6% of subjects had VA worse than 6/18 (20/60) in the better eye. Multiple logistic regression analysis indicated that the presence of STDR at baseline was associated with systolic BP (mmHg)(OR 1.021; 1.011-1.031 95% CI ; p<0.001) and fasting glucose (mmol/L) (OR 1.072; 1.027-1.119 95%CI; p=0.001). No significant association with HIV status was observed.
There is an urgent need to develop diabetic eye services in Sub-Saharan Africa. This study provides critical baseline information on prevalence of all grades of retinopathy and visual impairment in patents attending mixed urban and rural diabetes clinics. Prevalence of STDR was over 6 times that reported in recent European studies; prevalence of PDR over ten times higher. Presence of STDR was associated with glycaemic control and systolic BP. This information is vital for policy makers planning the introduction and development of diabetes services in the region. It is in comparison with data such as this that the efficacy and cost-effectiveness of future interventions can be assessed.