exudates and Diabetic-Retinopathy

The most common complication of diabetes mellitus (DM) is diabetic retinopathy (DR). The control of DR risk factors is essential for the effective prevention of DR. There is currently a lack of research to guide DR-related research in Malaysia. This concept paper aimed to review published studies and propose a conceptual framework (CF) as a guide for future research to determine the prevalence of DR and its risk factors across DM patients. After a review of prior research, this study has presented a CF that takes into account these four key elements: the patient's sociodemographic characteristics, comorbidities, complications, and diabetes conditions, namely, the length of the disease and glycaemic control. In the suggested CF, ethnicity was highlighted as a crucial risk factor for DR across lower- to middle-income countries (LMIC) and multiracial countries. In order to guide future studies, scientific guidance is essential. The proposed CF would help future research to conduct scientific research related to DR. Also, the proposed CF was tailored to suit research across LMIC and multiracial countries.

Topics: Comorbidity; Diabetes Mellitus, Type 2; Diabetic Retinopathy; Humans; Malaysia; Prevalence; Risk Factors

Topics: Administration, Topical; Aged; Analgesia, Patient-Controlled; Anti-Inflammatory Agents, Non-Steroidal; Case-Control Studies; Diabetic Retinopathy; Double-Blind Method; Female; Humans; Ketorolac Tromethamine; Laser Coagulation; Malaysia; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Placebos; Treatment Outcome; Visual Analog Scale

To compare tumour necrosis factor-alpha (TNF) and interleukin (IL)-6 levels in saliva between different stages of diabetic retinopathy (DR).. This comparative cross-sectional study was conducted between January 2018 and November 2020. This study included diabetes mellitus (DM) patients with no DR, non-proliferative DR (NPDR), and proliferative DR (PDR). None of the patients with DM were included in the control group. Unstimulated saliva samples were then collected. TNF-α and IL-6 levels were measured.. Altogether, 120 patients were included in the study (DM without DR, 33 patients; DM with NPDR, 30 patients; DM with PDR, 32 patients; non-DM, 25 patients). The mean IL-6 level in saliva was significantly higher in the DM group (0.033 ± 0.005 pg/ml) than in the non-DM group (0.027 ± 0.001 pg/ml) (p < 0.001 after adjusting for covariates). There was no significant difference in the mean salivary TNF-α between patients with DM and those without DM after adjusting for covariates. The mean IL-6 in saliva was significantly higher in the NPDR (0.036 ± 0.003 pg/ml) and PDR (0.093 ± 0.023 pg/ml) groups than in the no DR group (0.027 ± 0.001 pg/ml) (p < 0.001 and p < 0.001, respectively). Mean TNF-α in saliva was significantly higher in the NPDR (0.086 ± 0.022 pg/ml) and PDR (0.093 ± 0.023 pg/ml) groups than in the no DR group (0.049 ± 0.011 pg/ml) (p = 0.015 and p = 0.003, respectively).. There is an association between inflammatory biomarkers in saliva (IL-6 and TNF-α) and severity of DR among patients with DM, suggesting that these salivary biomarkers are potential biomarkers for screening, monitoring, and predicting the progression of DR.

Topics: Biomarkers; Cross-Sectional Studies; Diabetes Mellitus, Type 2; Diabetic Retinopathy; Humans; Interleukin-6; Malaysia; Saliva; Tumor Necrosis Factor-alpha

Vitrectomy surgery in proliferative diabetic retinopathy improves the vision-related quality of life. However, there is lack of data on the duration of maintenance of visual gains post vitrectomy. This study thus aimed to determine the survival time of visual gains and the prognostic factors of vision loss after vitrectomy surgery for complications of proliferative diabetic retinopathy. A retrospective cohort study was conducted in an ophthalmology clinic in Malaysia. We included 134 patients with type 2 diabetes mellitus on follow-up after vitrectomy for proliferative diabetic retinopathy. Visual acuity was measured using the log of minimum angle of resolution (LogMar). A gain of ≥0.3 LogMar sustained on two subsequent visits was considered evidence of visual improvement post vitrectomy. Subjects were considered to have vision loss when their post-operative visual acuity subsequently dropped by ≥0.3 LogMar. Kaplan-Meier analysis was used to determine the survival time of visual gains. Cox Proportional Hazard regression was used to determine the prognostic factors of vision loss. The median age of patients was 56.00 years (IQR ± 10.00). The median duration of diabetes mellitus was 14.00 years (IQR ± 10.00). Approximately 50% of patients with initial improvement post vitrectomy subsequently experienced vision loss. The survival time, i.e., the median time from surgery until the number of patients with vision loss formed half of the original cohort, was 14.63 months (95% CI: 9.95, 19.32). Ischemic heart disease was a significant prognostic factor of vision loss. Patients with underlying ischemic heart disease (adjusted HR: 1.97, 95% CI: 1.18, 3.33) had a higher risk of vision loss post vitrectomy, after adjusting for other factors. Approximately half the patients with initial visual gains post vitrectomy maintained their vision for at least one year. Ischemic heart disease was a poor prognostic factor for preservation of visual gains post vitrectomy.

Topics: Aged; Cohort Studies; Diabetes Mellitus, Type 2; Diabetic Retinopathy; Female; Humans; Malaysia; Male; Middle Aged; Myocardial Ischemia; Quality of Life; Retrospective Studies; Vision Disorders; Visual Acuity; Vitrectomy

The receptor for advanced glycation end-products (RAGE) has been implicated in the pathogenesis of diabetic microvascular complications. The aim of this study was to investigate the association between 2245G/A gene polymorphism of the RAGE gene and retinopathy in Malaysian type 2 diabetic patients.. 342 unrelated type 2 diabetic patients (171 with retinopathy (DR), 171 without retinopathy (DNR)) and 235 unrelated healthy subjects from all over Malaysia were recruited for this study. Genomic DNA was isolated from 3 ml samples of whole blood using a modified conventional DNA extraction method. The genotype and allele frequencies of 2245G/A were studied using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method.. A statistically significant difference in 2245A minor allele frequency was found between control (5.5%) and DR groups (15.2%) (p<0.001, OR=3.06, 95% CI 1.87 to 5.02) as well as between DNR (8.2%) and DR (15.2%) groups (p<0.01, OR=2.01, 95% CI 1.24 to 3.27). However, when the frequency was compared between control and DNR groups, there was no significant difference (p>0.05).. This is the first study that shows an association between the 2245A allele of the RAGE gene and development of diabetic retinopathy in the Malaysian population.

Topics: Adult; Aged; Asian People; Diabetes Mellitus, Type 2; Diabetic Retinopathy; Female; Gene Frequency; Genotype; Humans; Malaysia; Male; Middle Aged; Polymerase Chain Reaction; Polymorphism, Restriction Fragment Length; Polymorphism, Single Nucleotide; Receptor for Advanced Glycation End Products; Receptors, Immunologic

Conflicting results have been reported in different populations on the association between two particular RAGE gene polymorphisms (-429T/C and -374T/A) and retinopathy in diabetic patients. Therefore this study was designed to assess the association between both gene polymorphisms with retinopathy in Malaysian diabetic patients. A total of 342 type 2 diabetic patients [171 without retinopathy (DNR) and 171 with retinopathy (DR)] and 235 healthy controls were included in this study. Genomic DNA was obtained from blood samples and the screening for the gene polymorphisms was done using polymerase chain reaction-restriction fragment length polymorphism approach. Overall, the genotype distribution for both polymorphisms was not statistically different (p>0.05) among the control, DNR and DR groups. The -429C minor allele frequency of DR group (12.0%) was not significantly different (p>0.05) when compared to DNR group (16.1%) and healthy controls (11.3%). The -374A allele frequency also did not differ significantly between the control and DNR (p>0.05), control and DR (p>0.05) as well as DNR and DR groups (p>0.05). This is the first study report on RAGE gene polymorphism in Malaysian DR patients. In conclusion, -429T/C and -374T/A polymorphisms in the promoter region of RAGE gene were not associated with Malaysian type 2 DR patients.

Topics: Case-Control Studies; Diabetes Mellitus, Type 2; Diabetic Retinopathy; Gene Frequency; Genotype; Humans; Malaysia; Polymorphism, Single Nucleotide; Promoter Regions, Genetic; Receptor for Advanced Glycation End Products; Receptors, Immunologic

Diabetic retinopathy is the most common diabetic eye disease, occurring in about 60% of type 2 diabetic patients. Other than known clinical risk factors, the influence of genes has been suggested as part of the development of diabetic retinopathy. We investigated the association of Gly82Ser, 1704G/T and 2184A/G polymorphisms in the RAGE gene with retinopathy in type 2 diabetic patients in Malaysia. Ninety-eight unrelated retinopathy patients and 185 unrelated healthy controls from all over Malaysia were recruited in this study. The allele and genotype frequencies of the three gene polymorphisms were investigated using PCR-RFLP. The allele frequency of the three polymorphisms did not differ significantly between the control and the retinopathy group (P > 0.05). Analysis of the frequency of GA+AA, GT+TT and AG+GG in the retinopathy group did not reveal significant differences (P > 0.05) compared to the control group. We conclude that RAGE gene Gly82Ser, 1704G/T and 2184A/G polymorphisms are not associated with retinopathy development in the Malaysian population.

Topics: Adult; Aged; Alleles; Asian People; Diabetes Mellitus, Type 2; Diabetic Retinopathy; Female; Gene Frequency; Genetic Predisposition to Disease; Genotype; Humans; Malaysia; Male; Middle Aged; Polymorphism, Single Nucleotide; Receptor for Advanced Glycation End Products

Our purpose was to examine the relationship of retinal vascular parameters with diabetes and retinopathy in an older Asian population.. Retinal photographs from participants of a population-based survey of Asian Malay persons aged 40-80 years were analyzed. Specific retinal vascular parameters (tortuosity, branching angle, fractal dimension, and caliber) were measured using a semiautomated computer-based program. Diabetes was defined as random plasma glucose ≥ 11.1 mmol/liter, the use of diabetes medication, or physician-diagnosed diabetes. Retinopathy signs were graded from photographs using the modified Airlie House classification system.. A total of 2735 persons were included in the study. Persons with diabetes (n = 594) were more likely to have straighter (less tortuous) arterioles and wider arteriolar and venular caliber than those without diabetes (n = 2141). Among subjects with diabetes, those with retinopathy had wider venular caliber than those without retinopathy (211.3 versus 204.9 mm, p = .001). Among nondiabetic subjects, however, those with retinopathy had more tortuous venules than those without retinopathy [5.19(×10(4)) versus 4.27(×10(4)), p < .001].. Retinal vascular parameters varied by diabetes and retinopathy status in this older Asian cohort. Our findings suggest that subtle alterations in retinal vascular architecture are influenced by diabetes.

Topics: Adult; Aged; Aged, 80 and over; Asian People; Automation, Laboratory; Cross-Sectional Studies; Diabetic Retinopathy; Female; Humans; Image Interpretation, Computer-Assisted; Malaysia; Male; Middle Aged; Multivariate Analysis; Predictive Value of Tests; Retinal Vessels; Risk Factors; Severity of Illness Index; Singapore

This study aims to determine the risk factors associated with diabetic retinopathy (DR) among natives and non-natives Sarawakians who were seen at 3 public hospitals and one health clinic in Sarawak. It is a cross sectional study where data on patients with DM were collected by staff at these healthcare facilities and entered into the web-based Diabetic Eye Registry. Univariate and multivariate analysis was used to determine the association factors for DR. DR was significantly less associated with natives (24.4%) compared to non-native Sarawakians (34.1%) (p < 0.001). The odds of getting DR was higher in patients whose duration of DM was more than 20 years (OR = 2.6), who have renal impairment (OR = 1.7) and non-natives (OR = 1.4).

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Diabetes Mellitus; Diabetic Retinopathy; Female; Humans; Malaysia; Male; Middle Aged; Registries; Renal Insufficiency, Chronic; Risk Factors; Time Factors; Young Adult

In view of the alarming increase in the incidence of diabetes mellitus in Malaysia, we conducted a study to assess the awareness of complications of diabetes among the diabetics attending the peripheral clinics in Melaka. The study period was from January 2007 to December 2007. 351 patients were included in the study. 79.8% were aware of the complications of diabetes mellitus and 87.2% were aware that diabetes can affect the eyes. However, only 50% of the patients underwent an ophthalmological evaluation. Although awareness was good, the motivation to undergo the assessment was poor.

Topics: Diabetic Retinopathy; Humans; Incidence; Malaysia

Jering (Archidendron jiringa) is eaten in the tropics and traditionally extolled for treating diabetes, high blood pressure and eliminating bladder stones. Jering contains an unusual amino acid-djenkolic acid (S,S'-methylenebiscysteine)-which may form sharp crystals in the urinary tract, causing pain and haematuria. This study evaluates the beneficial and toxic effects of dietary jering on tissues and organs in normal and diabetic rats.. Dietary jering administered orally to diabetic rats significantly reduced the blood glucose in the streptozotocin-induced diabetic rats to normal levels after about 12 weeks. Jering improved the rats' appetite, body weight, organ oxidative status and number of active islets of Langerhans in both diabetic and normal rats, after 15 weeks of treatment. Although dietary jering showed beneficial effects to diabetic eye lens, lung and pancreas, it caused hypertrophy and lesions to the heart, kidney, liver, lung and pancreas of normal rats.. Chronic jering consumption showed toxic effects to the heart, kidney, liver and pancreas of normal rats but produced some beneficial effects to diabetic rats.

Topics: Animals; Body Weight; Cysteine; Diabetes Mellitus, Type 2; Diabetic Retinopathy; Diet; Fabaceae; Hyperglycemia; Hypertrophy; Kidney; Liver; Malaysia; Male; Myocardium; Oxidative Stress; Pancreas; Random Allocation; Rats; Rats, Sprague-Dawley; Seeds

Diabetic retinopathy (DR) is the commonest complication of diabetes mellitus (DM), and is the leading cause of blindness among working adults. Modification of the associated risk factors as well as early detection and treatment of sight-threatening DR can prevent blindness. Clinical practice guidelines recommend annual eye screening for patients with DM. The proportion of patients in Malaysia who adhere to this recommendation was initially unknown.. The Malaysian National Health and Morbidity Survey is a population-based survey conducted once every decade on the various aspects of health, behaviour and diseases. The DM questionnaire on eye screening was administered as face-to-face interviews with 2,373 patients with known DM who were aged 18 years and older.. In all, 55 percent of patients with known DM had never undergone an eye examination. Among patients who had undergone eye examinations, 32.8 percent had the last examination within the last one year, 49.8 percent within the last one to two years, and 17.4 percent more than two years ago. A significantly lower proportion of younger patients and patients who received treatment for DM from non-government facilities had previously undergone eye examinations.. The prevalence of DM observed among Malaysians aged 30 and above is 14.9 percent; thus, there is a significant number of people with potential blinding DR. Adherence to eye screening guidelines and the prompt referral of sight-threatening DR are essential in order to reduce the incidence of blindness among patients with DM.

Topics: Adolescent; Adult; Aged; Diabetic Retinopathy; Health Services Accessibility; Health Surveys; Humans; Malaysia; Male; Middle Aged; Prevalence; Young Adult

Diabetic Eye Registry, a web based registry hosted at the National Eye Database (www.acrm.org.my/end) collects data in a systematic and prospective nature on status of diabetic retinopathy (DR) among diabetics seen for the first time at Ministry of Health ophthalmology clinics. The 2007 report on 10,586 diabetics revealed that 63.3% of eyes examined had no DR, 36.8% had any form of DR, of which 7.1% had proliferative diabetic retinopathy. Up to 15.0% of eyes had vision threatening DR requiring laser or surgery at their first visit. Data on diabetic eye registry is useful in monitoring the quality of diabetic management, particularly in eye screening as reflected by the proportion of patients with severe DR needing intervention at the first visit to Ophthalmology clinics.

Topics: Adult; Aged; Databases, Factual; Diabetes Mellitus; Diabetic Retinopathy; Female; Humans; Malaysia; Male; Mass Screening; Middle Aged; Population Surveillance; Prevalence; Registries; Risk Factors

Two hundred and seventeen diabetic patients attending the eye clinic were examined to determine the prevalence of retinal changes, and the association between diabetic retinopathy and risk factors. A detailed fundus examination was done, after dilating the pupils, using 90 D lens and slitlamp biomicroscope. Diabetic retinopathy was detected in 112 patients (51.6%). Background retinopathy was seen in 40 out of 217 (18.4%), pre-proliferative retinopathy in 11 (5.1%), proliferative retinopathy in 61 (28.1%) and maculopathy in 58 (26.7%) patients. Factors significantly associated with occurrence of retinopathy were duration of diabetes, presence of hypertension and presence of systemic complications (diabetic foot ulcer, lower limb amputation, nephropathy, and peripheral neuropathy).

Topics: Adult; Aged; Aged, 80 and over; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Retinopathy; Female; Hospitals, University; Humans; Hypertension; Malaysia; Male; Middle Aged; Prevalence; Risk Assessment; Risk Factors

A cross sectional study was conducted to assess the level of awareness and knowledge of common eye diseases (cataract, glaucoma, diabetic retinopathy and refractive errors) among 473 academic staff (non-medical faculties) of University Malaya. The awareness of cataract was in 88.2%, diabetic retinopathy in 83.5%, refractive errors in 75.3% and glaucoma in 71.5% of the study population. The knowledge about all the above common eye diseases was moderate, except presbyopia which was poor. Multivariate analysis revealed that females, older people, and those having family history of eye diseases were significantly more aware and more knowledgeable about the eye diseases. Health education about eye diseases would be beneficial to seek early treatment and prevent visual impairment in the society.

Topics: Adult; Awareness; Cataract; Cross-Sectional Studies; Diabetic Retinopathy; Eye Diseases; Family Health; Female; Glaucoma; Humans; Knowledge; Malaysia; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Refractive Errors; Surveys and Questionnaires; Universities

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Diabetic Retinopathy; Humans; Malaysia; Middle Aged

Population studies all over the world have clearly showed that the prevalence of Type 2 diabetes mellitus (DM) is escalating at phenomenal scale and very likely we are heading towards epidemic proportions. In 1985, the estimated population of diabetic individuals in the world was 30 million but by 1995 this figure soared to 135 million. Based on current trends, epidemiologists predict that the population of diabetic individuals will swell up to a staggering 300 million by the year 2025. Almost half of that will be in the Asia Oceania region alone. Dr Hilary King of WHO pointed out that there will be a projected rise of about 42% in developed countries whereas the developing countries will see an escalation to the magnitude of 170% (H. King, R.E. Aubert, W.H. Herman, Global burden of diabetes, 1995-2025: prevalence, numerical estimates and projections, Diabetes Care 21 (1998) 1414-1431; WHO Health Report 1997, WHO Switzerland). There will be a 3-fold rise of the disease in Asia and much of these will be seen in China (40 million) and India (55 million) by virtue of the massive population of these countries. Nevertheless, the other rapidly developing Asian nations like Singapore, Malaysia, Thailand and those making up Indochina will experience the surge. At the same time the prevalence and incidence of diabetes complications will also increase. Based on recent WHO prediction (WHO Newsletter, The global burden of diabetes 1995-2025. World Diabetes 3 (1997) 5-6), it is estimated that by the year 2000 the following figures will be seen:Diabetes complications are major causes of premature death all over the world and most of these are avoidable. DCCT and UKPDS are landmark studies showing strong evidence that major complications can be drastically reduced by maintaining to near normoglycaemic control.

Topics: Adult; Asia; Asian People; Cardiovascular Diseases; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Angiopathies; Diabetic Nephropathies; Diabetic Retinopathy; Humans; Malaysia; Prevalence; Risk Factors; White People

Few attempts have been made to determine the risk factors for diabetic retinopathy which is a major cause of visual impairment and blindness. One hundred and forty patients of diabetes mellitus were studied to determine the prevalence and types of retinopathy, and its relation to various risk factors. Nearly half (48.6%) of the patients suffered from retinopathy. The significant associated risk factors were long duration of diabetes, proteinuria and elevated serum creatinine level. However, there was no significant association between the prevalence of retinopathy and high levels of serum cholesterol, C-peptide levels, associated hypertension, and glycaemic control of diabetes mellitus. An effective screening programme for detection of retinopathy in the patients of diabetes as a regular practice is encouraged.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Diabetic Retinopathy; Female; Humans; Infant; Infant, Newborn; Malaysia; Male; Middle Aged; Risk Factors

Topics: Adult; Aged; Diabetic Retinopathy; Female; Humans; Malaysia; Male; Middle Aged; Outpatient Clinics, Hospital

One hundred and thirty-two newly diagnosed Asian diabetic patients (39 Malay, 30 Chinese and 63 Indians) have been studied in Kuala Lumpur. The highest proportion of diabetic patients were Indian and the lowest were Chinese. Vascular complications were equally common in Asian diabetic patients as in Europeans; coronary heart disease was relatively more common in Indians and cerebral vascular disease in Chinese. Twenty percent of all Asian diabetic patients requiring admission to hospital also had coronary heart disease, 9% had cerebral vascular disease and 8% had gangrene or ulceration of the feet. In Kuala Lumpur, diabetes is a very important risk factor for coronary heart disease: 17% of all patients admitted to the General Hospital with coronary heart disease were already diabetic.

Topics: Adult; Aged; Blood Glucose; Cerebrovascular Disorders; Cholesterol; Coronary Disease; Diabetes Mellitus; Diabetic Angiopathies; Diabetic Retinopathy; Feeding Behavior; Female; Humans; Hypertension; Insulin; London; Malaysia; Male; Middle Aged; Obesity; Triglycerides; Uric Acid