Prevalence and Metabolic Determinants of Diabetic Retinopathy in Type 2 Diabetes: A Cross-Sectional Study from a Tertiary Center in Yemen
Background: In conflict-affected regions, such as Yemen, structural barriers to healthcare lead to chronic glycemic mismanagement and accelerated microvascular damage. This study aimed to determine the prevalence of various stages of diabetic retinopathy (DR) and identify the metabolic determinants associated with disease severity in a tertiary care setting.
Methods: A cross-sectional study of 202 patients with type 2 diabetes was conducted at Al-Thawra General Hospital, Sana’a. Retinopathy was staged using the International Clinical Diabetic Retinopathy (ICDR) scales and the 4-2-1 rule. Metabolic determinants, including HbA1c levels, disease duration, and systemic comorbidities, were analyzed using univariate testing and multivariate logistic regression. Discriminatory performance was evaluated using Receiver Operating Characteristic (ROC) curves.
Results: The cohort (mean age 64.63 years) exhibited poor metabolic control (mean HbA1c 10.07%). The overall prevalence of vision-threatening DR was high: 27.2% of patients exhibited proliferative DR (PDR), while non-proliferative DR (NPDR) stages were distributed as mild (20.8%), moderate (24.8%), and severe (27.2%). Diabetic macular edema was identified in 19.8% of patients. Univariate analysis associated the duration of diabetes (p < 0.001), HbA1c (p < 0.001), and hypertension (p = 0.010) with disease severity. In the multivariate model, only disease duration remained a significant independent predictor (aOR 1.072 per additional year, 95% CI: 1.007–1.141, p = 0.028), overshadowing current HbA1c (p = 0.506). ROC analysis confirmed that duration (AUC 0.643) provided superior discriminatory performance compared to HbA1c (AUC 0.604).
Conclusion: In settings where poor metabolic control is near-universal, cumulative disease duration outweighs current HbA1c levels as a determinant of retinopathy severity, suggesting a saturation effect of glucose-induced damage. Screening protocols in humanitarian zones should prioritize intensive surveillance for patients with diabetes duration exceeding 15 years, with an urgent focus on male patients in the second decade of disease
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