Prevalence of retinopathy and associated risk factors among high- and low-risk patients with type 2 diabetes mellitus: An observational study.

OBJECTIVES: To assess the prevalence and risk factors of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM) of different risks, based on the level of glycated hemoglobin (HbA1c). METHODS: A cross-sectional study was conducted in in the chronic illness clinics in Saudi Arabia between January 2019 and February 2020. Data were extracted from 428 T2DM patients' medical records and random sampling were carried out using a ratio of 1:3, matched for gender and duration of DM. Patients with HbA1c level ≥9% were classified as 'high-risk' and HbA1c ≤7% as 'low-risk'. Retinopathy was confirmed by an ophthalmologist using fundus photography. RESULTS: The prevalence of DR in high-risk patient was 88.1% and 22.1% in low-risk patients. The prevalence of macular oedema was higher in the high-risk compared to low-risk patients (15.8% versus 4.9%, p<0.001). Patients' mean age was 61±11 years and duration of diabetes was 13±7 years. Hemoglobin A1c and low-density lipoprotein (LDL) levels were significantly higher in high-risk patients (p<0.0001) in bivariate but not multivariate analysis. CONCLUSION: High HbA1c and LDL levels were associated with DR risk. Further multicentre studies involving large samples are required to assess the risk factors associated with DR progression.

Sociodemographic and clinical predictors of refractory type 2 diabetes patients: Findings from a case-control study.

OBJECTIVES: To identify the sociodemographic and clinical predictors of uncontrolled diabetic patients, to identify high-risk and people with impaired glycemic control, to establish more effective strategies for reducing morbidity and mortality. METHODS: This case-control study of 8209 enrolled patients were included from the diabetes registry by Chronic Illness Center (CIC), Family and Community Medicin, Prince Sultan Military Medical City, Riyadh Saudi Arabia between February 2019 and February 2020. Cases are defined as patients with type II refractory diabetes having persistent HbA1c >9, not reach adequate glycemic control despite intensified therapy under specialist care (CIC) for at least 6 months. Controls were defined as patients with Hba1c ≤9. Multivariable regression analysis was used to identify predictors for patients with the persistent outcome of HbA1c >9%. RESULTS: Overall, a total of 1152 cases and 4555 controls were included. Patients with refractory diabetes were younger (mean: 58.5, standard deviation [SD]: 11.7) and females (63.4%). Duration of diabetes (13.3, SD: 7.4, p<0.001) and the mean value of low-density lipoprotein (LDL) (2.7, SD: 0.91, p<0.001) were significantly higher in the refractory group. The findings from the final model revealed that with every unit increase in age (odds ratio [OR]: 0.97, [95% confidence interval [CI]: 0.96-0.98]) and body mass index the odds of having refractory diabetes significantly reduced by 0.97 times (OR: 0.97, [95% CI: 0.95-0.99]). While with every unit increase in the duration of diabetes (OR: 1.03, [95% CI: 1.01-1.05]), systolic blood pressure (OR: 1.01, [95% CI: 1.00-1.02]) and LDL (OR: 1.42, [95% CI: 1.23-.62]) the odds of having refractory diabetes significantly increased by 1.03 and 1.42 times respectively compared to controls when adjusted for gender, albumin creatinine, diastolic blood pressure. CONCLUSION: The findings from this study helped classify the predictors of refractory patients with diabetes. Understanding refractory patients' predictors may help to develop new therapeutic strategies to boost their glycemic status safely.