Retinopathy in type 1 diabetes mellitus: Major differences between rural and urban dwellers in northwest Ethiopia

Shitaye Alemu, Abere Dessie, Asamere Tsegaw, Christopher C. Patterson, Eldryd H. O. Parry, David I. W. Phillips, Elisabeth R. Trimble*

*Corresponding author for this work

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Aim: To audit levels of diabetes-related eye disease in Type 1 diabetes mellitus (T1DM) patients in northwest Ethiopia. In particular to establish whether, despite identical clinical goals, major differences between the physically demanding life-style of rural subsistence farmers and the sedentary life-style of urban dwellers would influence the prevalence of diabetes-related eye complications. 

Methods: A robust infrastructure for chronic disease management that comprehensively includes all rural dwellers was a pre-requisite for the investigation. A total of 544 T1DM were examined, representing 80% of all T1DM patients under regular review at both the urban and rural clinics and representative of patient age and gender (62.1% male, 37.9% female) of T1DM patients from this region; all were supervised by the same clinical team. Eye examinations were performed for visual acuity, cataract and retinal changes (retinal photography). HbA1c levels and the presence or absence of hypertension were recorded. 

Results/conclusions: Urban and rural groups had similar prevalences of severe visual impairment/blindness (7.0% urban, 5.2% rural) and cataract (7.3% urban, 7.1% rural). By contrast, urban dwellers had a significantly higher prevalence of retinopathy compared to rural patients, 16.1% and 5.0%, respectively (OR 2.9, p <. 0.02, after adjustment for duration, age, gender and hypertension). There was a 3-fold greater prevalence of hypertension in urban patients, whereas HbA1c levels were similar in the two groups. Since diabetic retinopathy is closely associated with microvascular disease and endothelial dysfunction, the possible influences of hypertension to increase and of sustained physical activity to reduce endothelial dysfunction are discussed.

Original languageEnglish
Pages (from-to)191–198
Number of pages8
JournalDiabetes Research and Clinical Practice
Volume109
Issue number1
Early online date20 Apr 2015
DOIs
Publication statusPublished - Jul 2015

Fingerprint

Ethiopia
Type 1 Diabetes Mellitus
Hypertension
Cataract
Life Style
Patient Advocacy
Eye Diseases
Photography
Vision Disorders
Diabetic Retinopathy
Diabetes Complications
Blindness
Disease Management
Visual Acuity
Chronic Disease
Exercise

Keywords

  • Africa
  • Cataract
  • Hypertension
  • Maculopathy
  • Retinopathy
  • Rural

Cite this

Alemu, Shitaye ; Dessie, Abere ; Tsegaw, Asamere ; Patterson, Christopher C. ; Parry, Eldryd H. O. ; Phillips, David I. W. ; Trimble, Elisabeth R. / Retinopathy in type 1 diabetes mellitus: Major differences between rural and urban dwellers in northwest Ethiopia. In: Diabetes Research and Clinical Practice. 2015 ; Vol. 109, No. 1. pp. 191–198.
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abstract = "Aim: To audit levels of diabetes-related eye disease in Type 1 diabetes mellitus (T1DM) patients in northwest Ethiopia. In particular to establish whether, despite identical clinical goals, major differences between the physically demanding life-style of rural subsistence farmers and the sedentary life-style of urban dwellers would influence the prevalence of diabetes-related eye complications. Methods: A robust infrastructure for chronic disease management that comprehensively includes all rural dwellers was a pre-requisite for the investigation. A total of 544 T1DM were examined, representing 80{\%} of all T1DM patients under regular review at both the urban and rural clinics and representative of patient age and gender (62.1{\%} male, 37.9{\%} female) of T1DM patients from this region; all were supervised by the same clinical team. Eye examinations were performed for visual acuity, cataract and retinal changes (retinal photography). HbA1c levels and the presence or absence of hypertension were recorded. Results/conclusions: Urban and rural groups had similar prevalences of severe visual impairment/blindness (7.0{\%} urban, 5.2{\%} rural) and cataract (7.3{\%} urban, 7.1{\%} rural). By contrast, urban dwellers had a significantly higher prevalence of retinopathy compared to rural patients, 16.1{\%} and 5.0{\%}, respectively (OR 2.9, p <. 0.02, after adjustment for duration, age, gender and hypertension). There was a 3-fold greater prevalence of hypertension in urban patients, whereas HbA1c levels were similar in the two groups. Since diabetic retinopathy is closely associated with microvascular disease and endothelial dysfunction, the possible influences of hypertension to increase and of sustained physical activity to reduce endothelial dysfunction are discussed.",
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Retinopathy in type 1 diabetes mellitus: Major differences between rural and urban dwellers in northwest Ethiopia. / Alemu, Shitaye; Dessie, Abere; Tsegaw, Asamere; Patterson, Christopher C.; Parry, Eldryd H. O.; Phillips, David I. W.; Trimble, Elisabeth R.

In: Diabetes Research and Clinical Practice, Vol. 109, No. 1, 07.2015, p. 191–198.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Retinopathy in type 1 diabetes mellitus: Major differences between rural and urban dwellers in northwest Ethiopia

AU - Alemu, Shitaye

AU - Dessie, Abere

AU - Tsegaw, Asamere

AU - Patterson, Christopher C.

AU - Parry, Eldryd H. O.

AU - Phillips, David I. W.

AU - Trimble, Elisabeth R.

PY - 2015/7

Y1 - 2015/7

N2 - Aim: To audit levels of diabetes-related eye disease in Type 1 diabetes mellitus (T1DM) patients in northwest Ethiopia. In particular to establish whether, despite identical clinical goals, major differences between the physically demanding life-style of rural subsistence farmers and the sedentary life-style of urban dwellers would influence the prevalence of diabetes-related eye complications. Methods: A robust infrastructure for chronic disease management that comprehensively includes all rural dwellers was a pre-requisite for the investigation. A total of 544 T1DM were examined, representing 80% of all T1DM patients under regular review at both the urban and rural clinics and representative of patient age and gender (62.1% male, 37.9% female) of T1DM patients from this region; all were supervised by the same clinical team. Eye examinations were performed for visual acuity, cataract and retinal changes (retinal photography). HbA1c levels and the presence or absence of hypertension were recorded. Results/conclusions: Urban and rural groups had similar prevalences of severe visual impairment/blindness (7.0% urban, 5.2% rural) and cataract (7.3% urban, 7.1% rural). By contrast, urban dwellers had a significantly higher prevalence of retinopathy compared to rural patients, 16.1% and 5.0%, respectively (OR 2.9, p <. 0.02, after adjustment for duration, age, gender and hypertension). There was a 3-fold greater prevalence of hypertension in urban patients, whereas HbA1c levels were similar in the two groups. Since diabetic retinopathy is closely associated with microvascular disease and endothelial dysfunction, the possible influences of hypertension to increase and of sustained physical activity to reduce endothelial dysfunction are discussed.

AB - Aim: To audit levels of diabetes-related eye disease in Type 1 diabetes mellitus (T1DM) patients in northwest Ethiopia. In particular to establish whether, despite identical clinical goals, major differences between the physically demanding life-style of rural subsistence farmers and the sedentary life-style of urban dwellers would influence the prevalence of diabetes-related eye complications. Methods: A robust infrastructure for chronic disease management that comprehensively includes all rural dwellers was a pre-requisite for the investigation. A total of 544 T1DM were examined, representing 80% of all T1DM patients under regular review at both the urban and rural clinics and representative of patient age and gender (62.1% male, 37.9% female) of T1DM patients from this region; all were supervised by the same clinical team. Eye examinations were performed for visual acuity, cataract and retinal changes (retinal photography). HbA1c levels and the presence or absence of hypertension were recorded. Results/conclusions: Urban and rural groups had similar prevalences of severe visual impairment/blindness (7.0% urban, 5.2% rural) and cataract (7.3% urban, 7.1% rural). By contrast, urban dwellers had a significantly higher prevalence of retinopathy compared to rural patients, 16.1% and 5.0%, respectively (OR 2.9, p <. 0.02, after adjustment for duration, age, gender and hypertension). There was a 3-fold greater prevalence of hypertension in urban patients, whereas HbA1c levels were similar in the two groups. Since diabetic retinopathy is closely associated with microvascular disease and endothelial dysfunction, the possible influences of hypertension to increase and of sustained physical activity to reduce endothelial dysfunction are discussed.

KW - Africa

KW - Cataract

KW - Hypertension

KW - Maculopathy

KW - Retinopathy

KW - Rural

U2 - 10.1016/j.diabres.2015.04.010

DO - 10.1016/j.diabres.2015.04.010

M3 - Article

VL - 109

SP - 191

EP - 198

JO - Diabetes Research and Clinical Practice

JF - Diabetes Research and Clinical Practice

SN - 0168-8227

IS - 1

ER -