Systemic Risk Factors of Diabetic Macular Edema among Patients with Type 2 Diabetes Mellitus in Hua Hin Hospital, Prachuap Khiri Khun Province

Abstract

Background: Diabetes is a chronic disease that is commonly found and a significant public health problem in Thailand. Many peoples with diabetic mellitus have diabetic retinopathy. Patients with diabetic retinopathy may experience some cases with diabetic macular edema, which requires treatment through intraocular injections, leading to relatively high treatment costs. This has led to the study of risk factors associated with the development of diabetic macular edema to aid in its prevention or reduction.

Objective: The objective of this study is to investigate the risk factors for diabetic retinopathy (DR) in type 2 diabetes patients at Hua Hin Hospital, Prachuap Khiri Khun Province.

Method: This study is an analytical retrospective study based on data collected from the medical records of type 2 diabetes patients at Hua Hin Hospital, Prachuap Khiri Khun Province. The data was collected from January 1st, 2021 to December 31st, 2022, totaling 451 patients. Data collection form consists of variables such as gender, age, duration of diabetes, glycated hemoglobin levels (HbA1c), diabetic retinopathy severity levels based on fundus examination (NPDR and PDR), blood pressure levels, blood lipid levels, glomerular filtration rate (GFR), proteinuria status and statin medication use. Descriptive statistics including percentages (%), mean values and standard deviations were used to analyze the data. Additionally, t-test independent test, Chi-square test and Binary logistic regression analysis.

Results: Among the total of 451 type 2 diabetes patients at Hua Hin Hospital, Prachuap Khiri Khun Province who were screened for Diabetic retinopathy using fundus examination; it was found that there was a prevalence of Diabetic macular edema (DME) in approximately 10.4%. From the study, when single variables were used for multivariate analysis (Binary logistic regression), a statistically significant relationship was found that the occurrence of macular swelling was related to the duration of diabetes and the level of diabetic retinopathy. Furthermore, the duration time being more than or equal to 10 years increased risk of DME development 9.76 times compared with those having diabetes only within a range from one year up to five years. Meanwhile, severe non-proliferative diabetic retinopathy (severe NPDR) degree and proliferative diabetic retinopathy (PDR) increased risk of DME development 55.43 and 42.53 times respectively, compared with mild non-proliferative diabetic retinopathy NPDR (Mild NPDR). On the other hand, glycated hemoglobin levels, blood pressure levels, blood lipid levels, glomerular filtration rate (GFR), proteinuria status and statin medication use did not show a significant relationship with the development of DME.

Conclusion: The prevalence of DME in type 2 diabetes patients at Hua Hin Hospital, Prachuap Khiri Khun Province was 10.4%. Duration of diabetes disease onset period and diabetic retinopathy severity levels were significantly associated with the development of DME.