Diabetic retinopathy : prevalence and risk factors of its development

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Хайдарова F., Акшей K., Янгиева N., Абасханова N., & Султанов B. (2002). Diabetic retinopathy : prevalence and risk factors of its development. in Library, 3(3), 31–34. извлечено от https://inlibrary.uz/index.php/archive/article/view/14385
Хера Акшей, Медицинский институт последипломного образования

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Аннотация

The late complications of the DM are one of the basic  reasons  of  premature  physical  inability  and lethality  of  the  DM  patients,  which  puts  essential harm  to  the  health  of  the  population  and  the economy as a whole (2). Proceeding from it in the foreground the problem of prophylaxis of the given DM complications is put forward.


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Tropical Ophthalmology I

31

D

IABETIC

R

ETINOPATHY

:

P

REVALENCE

A

ND

R

ISK

F

ACTORS

O

F

I

TS

D

EVELOPMENT

D

R

P

H

. F. A. K

HAIDAROVA

,

D

R

.

A

KSHEY

K

HERA

D

R

.

P

H

.

N.R.Y

ANGIEVA

,

D

R

.

N.K

H

.

A

BASKHANOVA

,

D

R

. B.A. S

ULTANOV

Tashkent

Medical Institute of Post Graduate Study First Tashkent

State Medical Institute Tashkent. Uzbekistan.

Key words: diabetes mellitus (DM),

complications, diabetic retinopathy (DM), and risk
factors

The late complications of the DM are one of the

basic reasons of premature physical inability and
lethality of the DM patients, which puts essential
harm to the health of the population and the
economy as a whole (2). Proceeding from it in the
foreground the problem of prophylaxis of the given
DM complications is put forward.

For the development of effectual measures of

prophylaxis it is necessary to study features of a
course, prevalence and to reveal the factors
promoting the development of the late
complications of the DM.

Diabetic retinopathy (DR) is one of the specific

complications of the DM characterized by a high
ratio of blindness.

The purpose of the present work was the study

of the frequency of the late complications of the DM
on the population of the DM patients in Tashkent
city conditions and the study of the risk factors
promoting their development.

The given article is devoted to the analysis of

the received information on the prevalence of the
DR and the factors of its development.

In the City Endocrinology Dispensary a single

time research in the epidemiology of the late DM
complications is performed. The Cohort method is
used for selection of observation units. Cohort was

formed in accordance with all basic attributes of
general set: typicalness by sex, age (18-75 years) and
type of DM.

For processing the selective totality of the

representative group of DM patients the formula of
unrepeated random selection offered by R.N
Biryukova was used.

All surveyed were interrogated on the

specially developed card. The card is developed on
the basis of an information medical sheet offered by
the European regional bureau of the WHO and is
adapted according to purposes and research
problems.

The card includes the items of information on

the patient, duration of disease and treatment (diet
observance, reception of tablet sugar reduce
preparations and insulin,


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Tropical Ophthalmology I

32

duration of reception of preparations, dose of short-
active and prolonged forms of insulin, frequency of
injections per day).

Analyzed anthropometrical and biochemical

parameters, the presence and expressivities of
changes in the fundus of the eye, function of
kidneys, vascular system, nervous and genital
systems as the most often displays of late
complications revealed presence in anamnesis
hereditary history on DM and hypertensive disease.
In women we analyzed the quantity of pregnancies
in anamnesis and their results. We determined the
coma presence in anamnesis, both hypoglycemic
and hyperglycemic. We estimated the risk factors
and their character. Found out the level of
knowledge in the patient about DM and the degree
of realization by himself of self-checking.

Diagnostics and screening of diabetic

nephropathy performed by qualitatively defining
proteinuria with the help of the Phan test of the

«Lachema»

firm. The test was considered positive, if

the albumin concentration in urine was more than
300mg/ day.

Diagnostics and screening of the peripheral

neuropathy performed on the basis of the definition
of vibrating sensitivity with the help of the
graduated tuning fork. The research was performed
on a horizontal patient' s condition.

Diabetic^ retinopathy diagnostics performed

by way of selection data from medical cards and if
necessary examining the fundus of the eye with the
help of direct ophthalmoscopy after the dilation of
pupil.

Revealed

changes

classified

by

ophthalmosopic criteria were offered by E. Koner
and M. Porta.

Ischemic heart disease (IHD), vessels

macroangiopathy of the lower extremities was
established on the basis of combination of the
positive answers on the standard Rouse's
questionnaire with the presence of stenocardia,
myocardial

infarction,

alternating

lameness

syndrome, and, also if necessary on the basis of ECG
and reovasography examinations.

The total number of patients: 1201 persons, out

of them men - 40.5% (486), women - 59.5% (715).

Patients suffering from insulin-dependent DM
(IDDM) - 201, from non-insulin dependent DM
(NIDDM) - 1000.

By the presence of IDDM the greatest number

of patients are registered till 40 years (70.1%), and
with NIDDM - more senior than 50 years old (
75.6%).

The distribution of those surveyed on the

duration of DM has shown, that the greatest
quantity of the patients was with the disease
duration of 6-10 years.

On a compensation degree patients were

distributed as follows - with IDDM:

1.

with the compensated course - 2.4 %,

2.

with the sub compensated course - 39.3%,

3.

with the decompensated course - 58.2%.

With NIDDM
1.

13.3%,

2.

47.8% ,

3.

38.9% accordingly.

As shown the received data total frequency

of the DR for all the surveyed population of the DM
patients has made up 95% (950).

From the total number of patients IDDM has

made up 78.6% (158) cases, NIDDM - 79.2% (792),
i.e. between them there is not ? significant
difference. Our data is compared of the data of the
literature.

The analysis of DR prevalence among the

IDDM patients in view of age has shown, that there
is a natural growth of its parameters with an
increase in the age of the patients. So, in the age
group of 50-59 the parameters of DR prevalence
were significantly more (p<0.01) than in the group
of people


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Tropical Ophthalmology I

33

from 30-39. As for NIDDM, the parameters of DM
prevalence in all age groups significantly did not
differ (p>0.05). It is acceptable to consider, that the
development and progression of the DR is in direct
dependence on DM. According to our data, both
with IDDM, and with NIDDM, the DR frequency
steadily accrues depending on the duration of the
disease. So with the NIDDM duration till 5 years -
DR frequency has made - 62.4%, and with the
duration of disease more than 15 years - 100%
(p<0.001), with IDDM - till 5 years - 57.4%, after 15
years -100% accordingly.

The hyperglycemia importance as a risk factor

for DR development proves to be true both under
clinical and experimental supervision. To a number
of the authors it is proved, that low glycemic control
is the basic harbinger of development clinically
expressed diabetic retinopathy (4) . The analysis of
the received information has shown, that there is a
direct dependence between a compensation degree
and diabetic

nephropathy prevalence irrespective of a DM

type.

So in the compensated course of disease

frequency of clinically expressed DR has made 20%,
whereas in the decompensated course -96.4%.

There are many works, which testify, that

hypertension and DR development are closely
interconnected at least in the IDDM patients (1). The
analysis of the received data has shown, that
hypertension is marked in 41.1% (65) of IDDM
patients having DR and in 50.3%(399) of NIDDM
patients accordingly.

Blood pressure also was significantly

increased depending on the stage of disease. So if
the average systolic pressure in DR1 has made
126.04 +20-mm Hg, in a stage of DR2

-

133.5+ 21mm

Hg, and DR3 - 158.57 + 27.2mm Hg. Similarly the
diastolic pressure changed - 83.3 + 13mm Hg, 84.16
+12 mm Hg and 94.28 +16mm Hg accordingly.

In our research in 57% of IDDM patients

having diabetic retinopathy, the hereditary history
on hypertension is noted, and in NIDDM - in 51.3%
of patients accordingly.

Diabetic microangiopathy, as a rule, damages

the capillaries of various organs and tissues. It is

necessary to note, that the nephroangiopathy
combination with the microangiopathy of other
localization is still insufficiently investigated. As a
rule, most often it is the combination of diabetic
nephroangiopathy with retinopathy. On analysis of
the received results it was revealed, that the
frequency

of

the

clinically

expressed

nephroangiopathy in:

DR1 - 36.7 + 2.7 % ,
DR2 - 76.6 +2.7% and
DR3 - 4.28 +2.6 % accordingly.
And the frequency of severe renal lesions and

retinopathies had the following combination: 1- 0%,
2 - 4.6 +1.2% and 3 - 57.1 + 2.3 % , that is obviously
traced interrelation and positive correlation
between diabetic nephroangiopathy retinopathy
depending on the degree of lesions both the vessels
of the kidneys and the vessels of the fundus of the
eye.

I

NFERENCE

The total frequency of the diabetic retinopathy

for the whole population of the DM patients has
made 95%.

The comparative analysis of the diabetic

retinopathy prevalence depending on a type of DM
has not revealed ? significant difference (p>0.05).

The DR frequency increases depending on the

duration of the disease irrespective of a DM(
?<0.001).

The DR frequency significantly increases

depending on the age at the IDDM, whereas at the
NIDDM the prevalence of the diabetic nephropathy
by age did not differ significantly ( p>0.05).

There is a direct correlation between the


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Tropical Ophthalmology I

34

compensation degree of the DM and DR frequency
( p<O.OOl).It shows, that a basis of an effective
treatment of the DR and its prophylaxis is the stable
compensation of a diabetes mellitus.

L

ITERATURE

1.

Contribution

of

hypertension

to

the

development of diabetic retinopathy: an
epidemiological study. /Maltseff A., Longo E.,
Carlone C. Et.al.// Giorn. It. Di. Diabetol. -
1995-V. 15. -P. 25-28.

2.

David M. Nathan .Long - Term complications of

diabetes mellitus The New Engl. J. Med. , 1993 .- V.
IC R- 1676-1683
3.

Development of diabetic retinopathy and its
associated risk factors in type

П

diabetes

patients in Osaka district. Japan, a long - term
prospective

4.

Glucose control and the renal and retinal
complications of insulin-dependen: diabetes ./
Chase H.P., Jackson W.E Hoops S.L. ,
Cockerham R.S.et. al. JAMA- 1989-V. 261,-
P.1155-60.

Библиографические ссылки

Contribution of hypertension to the development of diabetic retinopathy: an epidemiological study. /Maltseff A., Longo E., Carlone C. Et.al.// Giorn. It. Di. Diabetol. -1995-V. 15. -P. 25-28.

David M. Nathan .Long - Term complications of diabetes mellitus The New Engl. J. Med., 1993 .- V. IC R-1676-1683

Development of diabetic retinopathy and its associated risk factors in type П diabetes patients in Osaka district. Japan, a long - term prospective

Glucose control and the renal and retinal complications of insulin-dependen: diabetes ./ Chase H.P., Jackson W.E Hoops S.L., Cockerham R.S.et. al. JAMA- 1989-V. 261,-P.1155-60.

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