Diabetes Mellitus and Retinopathy in Rural Bangladesh: A Population Based Study

Objective: The study aimed to estimate the prevalence of diabetes and retinopathy in people with normal and abnormal glucose metabolism in rural Bangladesh and to identify the associated risk factors for developing diabetes and retinopathy in this population. Methods: This population based cross-sectional study was conducted through screening in camp settings, which included a total of 836 participants (aged „d25 years) by following simple random procedure. Fasting blood glucose (FBG) and oral glucose tolerance test (OGTT) were performed for all participants to diagnosis diabetes according to the diagnostic criteria of World Health Organization. Retinopathy was determined by ophthalmoscopy and fundus photography. Anthropometric measurements (BMI and WHR), glycosylated hemoglobin, blood pressure, lipid profile and urine albumin creatinine ratio were also observed. Logistic regression analysis was used, without and with adjustment for potential confounders. Results: An increased prevalence of diabetes and retinopathy was found with 7.2% (95% CI 5.4-9.0) and 5.4% (95% CI 3.9-6.9) in the present study, respectively. Moreover, the prevalence of retinopathy among the diabetic, prediabetic and nondiabetic subjects were 21.6% (95% CI 11.2-32.0), 13% (95% CI 3.4-22.6) and 3.5% (95% CI 2.2-4.8), respectively. A superior agreement was observed between FBG and OGTT (Kappa value 0.86) among the study participants. After adjusting for potential confounders BMI, WHR, serum creatinine, triglyceride, total cholesterol and UACR were found as significant independent risk indicators for the occurrence of diabetes and age, BMI, hypertension, HbA1c, serum creatinine total cholesterol and UACR were also found as significant independent risk indicators for the occurrence of retinopathy in this population. Conclusion: The indices of obesity (increased BMI and WHR), hyperlipidemia (increased triglyceride and cholesterol), serum creatinine and urine ACR may at least in part explain the high prevalence of diabetes mellitus and retinopathy in this rural population of Bangladesh