Aims Diabetes is a major public health problem in migrants and ethnic minorities worldwide. We determined the incidence and risk factors of diabetic retinopathy (DR) in migrant Indians living in Singapore.
Methods We included data from 759 Indian adults with diabetes, who participated in the baseline (aged 40–80 years, 2007–2009) and 6-year follow-up 2012–2015 of the Singapore Indian Eye Study. Retinal photographs were graded for the presence and severity of DR using modified Airlie House Classification. Incidence was assessed in participants who were free of DR at baseline visit (n=501), while progression in those with DR but free of proliferative DR at baseline visit (n=189). Risk factors included demographic, lifestyle, socioeconomic, family history, genes, duration of diabetes, glycaemic control, insulin use, ocular and clinical factors.
Results The 6-year age-standardised DR incidence and progression were 21.89% and 33.45%, respectively. HbA1c (risk ratio (RR) 1.41, 95% CI 1.28 to 1.55 per unit increase), current smoking (RR 1.63, 95% CI 1.02 to 2.62) and insulin use (RR 2.63, 95% CI 1.44 to 4.82) were associated with higher incidence, whereas estimated cerebrospinal fluid pressure (RR 0.90, 95% CI 0.82 to 0.98) and body mass index (BMI) (RR 0.74, 95% CI 0.60 to 0.93) were associated with lower incidence of DR. Higher HbA1c (RR 1.26, 95% CI 1.13 to 1.42), BMI (RR 1.26, 95% CI 1.02 to 1.56) and estimated cerebrospinal fluid pressure (RR 1.11, 95% CI 1.02 to 1.21) were associated with DR progression. The population attributable risk of HbA1c >8% was 41.29% and 49.63% for DR incidence and progression.
Conclusion DR incidence and progression in migrant Indians living in Singapore was more than double that reported in Indians living in urban India. Consistent with past studies, poor glycaemic control was an important predictor for incidence and progression of DR.
- public health
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NK and MB are joint first authors.
Contributors All authors contributed to the intellectual development of this paper. CS designed the study. NGQ and AG performed the statistical analyses. KN wrote the initial and revised draft. MB assisted initial draft. CS supervised data analysis. TYW obtained funding. GT, NC, NT, CW, JJW, PM, EL, CYC, TYW and CS provided critical corrections to the manuscript. Final version of the paper has been seen and approved by all the authors.
Funding The study is funded by Singapore Ministry of Health’s National Medical Research Council (NMRC), NMRC/STaR/0003/2008, NMRC/STaR/0016/2013, NMRC/CIRG/1371/2013 and Biomedical Research Council (BMRC), 08/1/35/19/550. The funding organization had no role in the design or conduct of this research.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Both studies were approved by the Institutional Review Board of the Singapore National Eye Center.
Provenance and peer review Not commissioned; externally peer reviewed.
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