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Diabetic retinopathy in diabetic patients versus diabetic with co-morbid hypertensive patients.


Article Information

Title: Diabetic retinopathy in diabetic patients versus diabetic with co-morbid hypertensive patients.

Authors: Mohammad Alam

Journal: The Professional Medical Journal (TPMJ)

HEC Recognition History
Category From To
Y 2024-10-01 2025-12-31
Y 2023-07-01 2024-09-30
Y 2022-07-01 2023-06-30
Y 2021-07-01 2022-06-30

Publisher: Independent Medical College, Faisalabad- Pakistan

Country: Pakistan

Year: 2022

Volume: 29

Issue: 7

Language: English

DOI: 10.29309/TPMJ/2022.29.07.6861

Keywords: Diabetes mellitus (DM)Diabetic Retinopathy (DR)Non-proliferative Diabetic Retinopathy (NPDR)Proliferative Diabetic Retinopathy (PDR)

Categories

Abstract

Objectives: To find out severity of diabetic retinopathy in diabetic versus diabetic with co-morbid hypertensive patients in type II diabetes mellitus. Study Design: Comparative study. Setting: KDA Teaching Hospital Kohat. Period: March 2017 to December 2020. Material & Methods: This comparative study focused on severity of diabetic retinopathy was conducted on only type II diabetic patients versus type II diabetic with co-morbid hypertensive patients. Two groups A for diabetic and B for diabetic with co-morbid hypertension patients were made. Proper proforma of diabetic age and severity of diabetic retinopathy was designed for record. First 200 patients with only diabetes mellitus comprising of 123(61.5%) male and 77(38.5%) female were registered in group A and first 200 diabetic patients with co-morbid hypertension comprising of 97(48.5%) male and 103(51.5%) female were registered in group B. Proper informed consents obtained from all patients. Both A and B groups were subdivided into A 1 with diabetic age upto 10 years had 105(52.5%) patients, A 2 with diabetic age 11-20 years had 60(30%) patients, A 3 with diabetic age > 20 years had 35(17.5%) patients and B 1 with diabetic age upto 10 years had 117(58.5%) patients, B2 with diabetic age 11-20 years had 55(27.5%) patients and B3 with diabetic age >20 years had 28(14%) patients. Results: Group A. A 1 had 9(8.57%) patients with non-proliferative diabetic retinopathy. A 2 had 13(21.66%) with non-proliferative and 4(6.66) % with proliferative diabetic retinopathy patients. A 3 had 15 (42.85%) non-proliferative and 16(45.71%) proliferative diabetic retinopathy patients. Group B. B 1 had 14(11.96%) patients with non-proliferative diabetic retinopathy. B 2 had 16(29.09%) with non-proliferative and 10(18.18%) with proliferative diabetic retinopathy patients. B 3 had 12(42.85%) non-proliferative and 14(50)% proliferative diabetic retinopathy patients. Conclusion: Diabetic retinopathy is adversely affected by co-morbid hypertension.     


Research Objective

To determine the severity of diabetic retinopathy in type II diabetic patients compared to type II diabetic patients with co-morbid hypertension.


Methodology

A comparative study was conducted on type II diabetic patients and type II diabetic patients with co-morbid hypertension. Two groups were formed: Group A (diabetic patients) and Group B (diabetic patients with co-morbid hypertension). Each group consisted of 200 patients. Patients were further subdivided based on diabetic age (up to 10 years, 11-20 years, and >20 years). Diabetic retinopathy severity was assessed through fundus examination using an indirect ophthalmoscope and slit lamp indirect bimicroscopy.

Methodology Flowchart
                        graph TD;
    A[Recruit Type II Diabetic Patients] --> B[Divide into Groups];
    B --> C[Group A: Diabetic Patients];
    B --> D[Group B: Diabetic Patients with Hypertension];
    C --> E[Subdivide Group A by Diabetic Age];
    D --> F[Subdivide Group B by Diabetic Age];
    E --> G[Assess DR Severity for Group A Subgroups];
    F --> H[Assess DR Severity for Group B Subgroups];
    G --> I[Analyze Results for Group A];
    H --> J[Analyze Results for Group B];
    I --> K[Compare DR Severity between Groups];
    J --> K;
    K --> L[Draw Conclusions];                    

Discussion

The severity of diabetic retinopathy is directly proportional to diabetic age and is accelerated by co-morbid hypertension. Patients with hypertension alongside diabetes exhibit more progressive and severe retinopathy. The findings suggest that controlling hypertension is crucial for preventing the worsening of diabetic retinopathy.


Key Findings

In Group A (diabetic patients), the prevalence of proliferative diabetic retinopathy (PDR) increased with diabetic age, from 0% in A1 (up to 10 years) to 6.66% in A2 (11-20 years) and 45.71% in A3 (>20 years). In Group B (diabetic patients with co-morbid hypertension), the prevalence of PDR also increased with diabetic age, from 0% in B1 (up to 10 years) to 18.18% in B2 (11-20 years) and 50% in B3 (>20 years). The study observed a higher severity of diabetic retinopathy, particularly PDR, in diabetic patients with co-morbid hypertension compared to those without hypertension, especially in older diabetic age groups.


Conclusion

Diabetic retinopathy is a serious ocular complication whose severity is influenced by diabetic age and glycemic control. Co-morbid hypertension exacerbates the severity of diabetic retinopathy. Regular screening for diabetic retinopathy is recommended for all diabetic patients after 6 years of diabetic age, with concurrent hypertension requiring proper management.


Fact Check

1. Study Period: The study was conducted from March 2017 to December 2020. (Confirmed in the text).
2. Group Size: Each of the two main groups (diabetic and diabetic with hypertension) comprised 200 patients. (Confirmed in the text).
3. PDR in Group B3: In Group B3 (diabetic patients with co-morbid hypertension and diabetic age > 20 years), 50% of patients had proliferative diabetic retinopathy. (Confirmed in Table-V).


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