Prevalence and Risk Factors of Diabetic Retinopathy in Type 2 Diabetic Patients Attending Tertiary Care Hospitals in Punjab

Hospital-Based Evidence from Pakistani Diabetic Patients

Authors

  • Mustafa Khalid Waheed Lahore Medical & Dental College (LM&DC), Lahore, Pakistan Author
  • Muhammad Ibrahim Tahir Lahore Medical & Dental College (LM&DC), Lahore, Pakistan Author
  • Sadaf Sada Lahore Medical & Dental College (LM&DC), Lahore, Pakistan Author
  • Amna Imran Lahore Medical & Dental College (LM&DC), Lahore, Pakistan Author
  • Saleha Nadeem Al-Aleem Medical College, Lahore, Pakistan Author
  • Muhammad Talha Lahore Medical & Dental College (LM&DC), Lahore, Pakistan Author

DOI:

https://doi.org/10.69750/dmls.02.07.0125

Keywords:

Diabetic retinopathy, Type 2 diabetes mellitus, Risk factors, Punjab, Pakistan, Microvascular complications

Abstract

Background: Diabetic retinopathy (DR) is one of the most frequent microvascular consequences of type 2 diabetes mellitus, accounting for a significant portion of avoidable blindness globally. In low- and middle-income countries like Pakistan, where diabetes incidence is growing and regular screening is restricted, DR is a serious public health concern.

Objective: The purpose of this research was to assess the prevalence, forms, and risk factors of diabetic retinopathy in patients with type 2 diabetes mellitus treated at tertiary care facilities in Punjab, Pakistan.

Methods: A cross-sectional study was carried out from June 2023 to May 2025 at Gulab Devi Hospital and Ghurki Trust Teaching Hospital in Lahore. 70 individuals with confirmed type 2 diabetes were recruited using sequential nonprobability sampling. After pupil dilatation, a fundus examination was conducted using indirect ophthalmoscopy. The clinical and biochemical information collected were age, gender, blood pressure, body mass index (BMI), HbA1c, lipid profile, diabetes duration, and nephropathy indicators. Data were evaluated using SPSS version 25, and p-values < 0.05 were deemed statistically significant.

Results: Diabetic retinopathy was seen in 34.3% of individuals (n = 24). Non-proliferative diabetic retinopathy (NPDR) accounted for 62.5% of cases, followed by proliferative diabetic retinopathy (PDR) at 25.0% and diabetic macular edema (DME) at 12.5%. Significant risk variables for DR were diabetes duration > 10 years (p < 0.001), poor glycemic control (HbA1c ≥ 8%; p = 0.010), hypertension (p = 0.036), BMI ≥ 27 kg/m² (p = 0.048), and diabetic nephropathy (p = 0.012). Elevated LDL cholesterol levels were more common among DR patients, but not statistically significant (p = 0.065).

Conclusion: Diabetic retinopathy affects a significant number of type 2 diabetes patients at Punjab's tertiary care facilities, often in severe, vision-threatening stages. The most important modifiable risk variables were poor glycemic management, prolonged illness duration, hypertension, obesity, and nephropathy. In Pakistan, regular eye examination, appropriate metabolic management, and early intervention are critical for preventing diabetic retinopathy-related vision loss.

Downloads

Download data is not yet available.

References

Yau JW, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2015;38(3):456-63. doi:10.2337/dc14-1909

Wong TY, Cheung CM, Larsen M, Sharma S, Simo R. Diabetic retinopathy. Nat Rev Dis Primers. 2016;2:16012. doi:10.1038/nrdp.2016.12

Lee R, Wong TY, Sabanayagam C. Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss. Eye Vis (Lond). 2015;2:17. doi:10.1186/s40662-015-0026-2

Zhang X, Saaddine JB, Chou CF, Cotch MF, Cheng YJ, Geiss LS, et al. Prevalence of diabetic retinopathy in the United States, 2005-2008. JAMA. 2017;304(6):649-56. doi:10.1001/jama.2010.1111

Cheung N, Mitchell P, Wong TY. Diabetic retinopathy. Lancet. 2016;376(9735):124-36. doi:10.1016/S0140-6736(09)62124-3

Thomas RL, Halim S, Gurudas S, Sivaprasad S, Owens DR. IDF Diabetes Atlas: A review of studies utilising retinal photography on the global prevalence of diabetes related retinopathy between 2015 and 2018. Diabetes Res Clin Pract. 2019;157:107840. doi:10.1016/j.diabres.2019.107840

Teo ZL, Tham YC, Yu M, Chee ML, Rim TH, Cheung N, et al. Global prevalence of diabetic retinopathy and projection of burden through 2045: Systematic review and meta-analysis. Ophthalmology. 2021;128(11):1580-91. doi:10.1016/j.ophtha.2021.04.027

International Diabetes Federation. IDF Diabetes Atlas, 10th ed. Brussels: IDF; 2021. doi:10.1016/j.diabres.2021.108029

Basit A, Fawwad A, Qureshi H, Shera AS. Prevalence of diabetes, pre-diabetes and associated risk factors: Second National Diabetes Survey of Pakistan (NDSP), 2016-2017. BMJ Open. 2018;8(8):e020961. doi:10.1136/bmjopen-2017-020961

Ul Haq I, Irfan M, Sadiq MA, Ameen SS, Sadiq NM. Prevalence of diabetic retinopathy in Pakistan: A systematic review and meta-analysis. PLoS One. 2019;14(6):e0218557. doi:10.1371/journal.pone.0218557

Akram MN, Asghar Z, Younas Z, Habib S. Frequency and risk factors of diabetic retinopathy in patients with type 2 diabetes in Pakistan. Pak J Med Sci. 2020;36(7):1554-8. doi:10.12669/pjms.36.7.2191

Ali N, Bashir B, Hafeez A, Malik AN. Risk factors of diabetic retinopathy among type 2 diabetes patients in Lahore, Pakistan. J Coll Physicians Surg Pak. 2018;28(7):488-92. doi:10.29271/jcpsp.2018.07.488

Farooq S, Khan M, Asghar Z, Ahmed A. Diabetic retinopathy: prevalence and associated risk factors in T2DM patients of Faisalabad, Pakistan. J Ayub Med Coll Abbottabad. 2019;31(4):592-7. doi:10.47192/jamc.31.4.11

Song P, Yu J, Chan KY, Theodoratou E, Rudan I. Prevalence, risk factors and burden of diabetic retinopathy in China: A systematic review and meta-analysis. J Glob Health. 2018;8(1):010803. doi:10.7189/jogh.08.010803

Teo ZL, Tham YC, Cheung N, et al. Metabolic risk factors and diabetic retinopathy. Diabetes Care. 2020;43(1):168-76. doi:10.2337/dc19-0859

Kuo JZ, Chiu CJ, Schmid KE. An updated overview on the risk factors of diabetic retinopathy. Diabetes Metab J. 2017;41(6):423-37. doi:10.4093/dmj.2017.41.6.423

Grauslund J, Andersen N, Andresen JL, et al. Evidence-based ophthalmic screening interval for diabetic retinopathy: 10-year incidence and progression rates. Diabetologia. 2018;61(9):2142-51. doi:10.1007/s00125-018-4679-3

Sivaprasad S, Gupta B, Crosby-Nwaobi R, Evans J. Prevalence of diabetic retinopathy in various ethnic groups: A worldwide perspective. Surv Ophthalmol. 2017;57(4):347-70. doi:10.1016/j.survophthal.2012.01.004

Scanlon PH. The English national screening programme for diabetic retinopathy 2003–2016. Acta Diabetol. 2017;54(6):515-25. doi:10.1007/s00592-017-0974-1

Tan GS, Cheung N, Simó R, Cheung GC, Wong TY. Diabetic macular oedema. Lancet Diabetes Endocrinol. 2017;5(2):143-55. doi:10.1016/S2213-8587(16)30052-4

Solomon SD, Chew E, Duh EJ, Sobrin L, Sun JK, VanderBeek BL, et al. Diabetic retinopathy: A position statement by the American Diabetes Association. Diabetes Care. 2017;40(3):412-8. doi:10.2337/dc16-2641

Wang W, Lo AC. Diabetic retinopathy: Pathophysiology and treatments. Int J Mol Sci. 2018;19(6):1816. doi:10.3390/ijms19061816

Virgili G, Menchini F, Murro V, et al. Optical coherence tomography (OCT) for detection of macular oedema in diabetic retinopathy. Cochrane Database Syst Rev. 2019;2019(5):CD008081. doi:10.1002/14651858.CD008081.pub3

Cheloni R, Gandolfi SA, Signorelli C, Odone A. Global prevalence of diabetic retinopathy: Protocol for a systematic review and meta-analysis. BMJ Open. 2019;9(3):e022188. doi:10.1136/bmjopen-2018-022188

Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045. Diabetes Res Clin Pract. 2019;157:107843. doi:10.1016/j.diabres.2019.107843

Kohner EM, Porta M. Microvascular disease: Diabetic retinopathy. In: Holt RIG, Cockram C, Flyvbjerg A, Goldstein BJ, editors. Textbook of Diabetes. 5th ed. Wiley-Blackwell; 2017. doi:10.1002/9781118924853.ch58

Rema M, Mohan V, Deepa R, Ravikumar R. Association of hypertension with diabetic retinopathy in type 2 diabetes: Chennai Urban Rural Epidemiology Study (CURES) Eye Study. Diabetes Res Clin Pract. 2015;110(1):58-63. doi:10.1016/j.diabres.2015.07.003

Ting DS, Cheung CY, Lim G, Tan GSW, Quang ND, Gan A, et al. Development and validation of a deep learning system for detection of diabetic retinopathy in retinal fundus photographs. JAMA. 2017;318(22):2211-23. doi:10.1001/jama.2017.18152

Abràmoff MD, Lavin PT, Birch M, Shah N, Folk JC. Pivotal trial of an autonomous AI-based diagnostic system for detection of diabetic retinopathy in primary care offices. NPJ Digit Med. 2018;1:39. doi:10.1038/s41746-018-0040-6

Chatziralli I, Kanonidou E, Papazisis L, Dimitriadis P, Papadopoulou E. The effect of dyslipidemia on diabetic retinopathy: A meta-analysis. Eur J Ophthalmol. 2019;29(6):640-8. doi:10.1177/1120672118802837

Fu H, Baskaran M, Xu Y, Lin S, Wong DWK, Liu J, et al. Deep learning for diabetic retinopathy detection and risk factor stratification. Asia Pac J Ophthalmol (Phila). 2019;8(6):493-500. doi:10.1097/APO.0000000000000264

Sun JK, Aiello LP. The cardiovascular burden of diabetic retinopathy: Beyond microvascular disease. Cardiovasc Endocrinol Metab. 2020;9(1):13-22. doi:10.1097/XCE.0000000000000198

Bukhsh A, Khan TM, Nawaz MS, Ahmed HS, Chan KG, Goh BH, et al. Association of diabetic retinopathy with dyslipidemia in Pakistani patients with type 2 diabetes mellitus. BMC Endocr Disord. 2017;17(1):67. doi:10.1186/s12902-017-0217-2

Khandekar R, Al Lawatti J, Al Raisi A, Al Busaidi T, Al Hatmi H. Diabetic retinopathy in Oman: Prevalence and risk factors. Middle East Afr J Ophthalmol. 2015;22(4):318-23. doi:10.4103/0974-9233.164615

Nentwich MM, Ulbig MW. Diabetic retinopathy—ocular complications of diabetes mellitus. World J Diabetes. 2015;6(3):489-99. doi:10.4239/wjd.v6.i3.489

Downloads

Crossmark - Check for Updates PlumX Metrics

Published

21-09-2025

How to Cite

Waheed, M. K. ., Tahir, M. I. ., Sada, S., Imran, A., Nadeem, S. ., & Talha, M. (2025). Prevalence and Risk Factors of Diabetic Retinopathy in Type 2 Diabetic Patients Attending Tertiary Care Hospitals in Punjab: Hospital-Based Evidence from Pakistani Diabetic Patients. DEVELOPMENTAL MEDICO-LIFE-SCIENCES, 2(7), 4-12. https://doi.org/10.69750/dmls.02.07.0125

Share