[Relationship between pulse pressure, visual impairement and severity of diabetic retinopathy in sub-Saharan Africa]. / Relation entre pression pulsee, troubles visuels et severite de la retinopathie diabetique en Afrique sub-Saharienne.

OBJECTIVE: To determine the relationship between pulse pressure, traditional risk factors, vision impairment and different clinical forms of diabetic retinopathy. METHODS: A cross-sectional study was conducted between December 1st, 2004 and July 16th, 2005 within the care centers of Kinshasa, DRC. The origin population (n=3010 diabetics) served to estimate the diabetic retinopathy prevalence while a random sample of 301 diabetics participated to this analytic study: age>or=20 years, anthropometry, components of blood pressure, fasting glycaemia, optometry, fundoscopy, stages of diabetic retinopathy. RESULTS: The rate of diabetic retinopathy was 31.6% 95 CI: 26.3-36.9 in Kinshasa town. In the random sample, diabetic retinopathy was non proliferative in the majority (90%). Subjective decrease of acuity was associated with diabetic retinopathy in the sample (OR=2.7; 95% CI 1.1-5.4; p<0.05), among women (OR=2.7; 95% CI 1.3-5.7; p<0.05), and in patients with type 2-diabetes (OR=2; 95% CI 1.1-3.4; p<0.05). Objective decrease of acuity was associated with diabetic retinopathy in the study sample (OR=3.6; 95% CI 1.1-12.6; p<0.05). Visual impairment was significantly associated with diabetic retinopathy in women (OR=3.6; 95% CI 1.1-12.6; p<0.05) and proliferative diabetic retinopathy. Pregnancy after diabetes mellitus onset was a significant risk factor of diabetic retinopathy for women (OR=3.2; 95% CI 1.1-13.2; p<0.05). Using logistic regression analysis, family history of diabetic retinopathy (OR=3.2; 95% CI 1.2-8.8; p<0.05), diabetes duration >/=4 years (OR=3.4; 95% CI 1.4-8.5; p<0.01), and pulse pressure>or=60 mmHg (OR=5; 95% CI 2-12.8; p<0.001) were the independent and significant predictors of diabetic retinopathy. CONCLUSION: Urgent programme of prevention and control of diabetic retinopathy and its risk factors is needed.

Risk factors of poor control of HBA1c and diabetic retinopathy: Paradox with insulin therapy and high values of HDL in African diabetic patients

To determine the risk factors of poor control of glycated haemoglobin and diabetic retinopathy. The agreement between poor control of glycated haemoglobin [HbA1c] >7% and poor control of glycemia >/= 126 mg/dL to classify diabetic retinopathy was also assessed The study was a cross-sectional survey carried out on 300 African diabetic patients admitted to Lomo Medical Center, Kinshasa, Congo, between July 2005 and December 2007. Patients [150 type 1 and 151 type 2] were interviewed and underwent a complete medical assessment. HbA1c levels, anthropometry, blood pressure components, lipid profile, type of diabetes, severity and complications were determined for each patient. All patients were examined for evidence and severity of diabetic retinopathy by an ophthalmologist The rates of arterial hypertension, uncontrolled hypertension, poor control of HbA1c, poor control of glycemia, higher pulse pressure and diabetic retinopathy were 73.3%, 81.8%, 68%, 57%, 47.7% and 33.3%, respectively. Type 1 diabetes, diabetes duration >/= 4 years, female sex, underweight, diabetic retinopathy, diabetic nephropathy, elevated total cholesterol and higher levels of HDL-cholesterol were significantly associated with poor control of HbA1c. There was a poor agreement of 52% and kappa statistic of 0.19 [p < 0.0001] between poor control of HbA1c and poor glycemic control to classify diabetic retinopathy. In all diabetic patients, aged >/= 60 years, female sex, diabetes duration >/= 4 years, type 1 diabetes, higher pulse pressure, underweight, poor control of HbA1c, smoking, stroke, diabetic nephropathy and low HDL-cholesterol are significantly associated with the presence and the severity of diabetic retinopathy. However, in 87 diabetic patients with a history of intravenously administered insulin, duration diabetes >/= 4 years and good control of HbA1c < 7% are significantly associated with the presence of diabetic retinopathy. There was a J-shaped relationship between poor control of glycemia >/= 126mg/dL and the severity of non proliferative diabetic retinopathy. Urgent and efficient diabetes care and diabetes monitoring are needed in sub-Saharan Africa