Elsevier

Ophthalmology

Volume 119, Issue 10, October 2012, Pages 2119-2124
Ophthalmology

Original article
Prevalence and Risk Factors of Diabetic Retinopathy in Migrant Indians in an Urbanized Society in Asia: The Singapore Indian Eye Study

Presented at: the Association for Research in Vision and Ophthalmology, May 2, 2011, Fort Lauderdale, Florida.
https://doi.org/10.1016/j.ophtha.2012.04.027Get rights and content

Purpose

To describe the prevalence of and risk factors for diabetic retinopathy (DR) in Indian persons living in a newly urbanized society in Asia.

Design

Population-based study.

Participants

Ethnic Indians aged ≥40 years living in Singapore.

Methods

The Singapore Indian Eye Study was conducted between 2007 and 2009. All participants underwent an extensive ophthalmic examination, including retinal photographs obtained after pupil dilation. These images were graded for the presence and severity of DR using the modified Airlie House classification system. Diabetes was defined as hemoglobin A1c level of ≥6.5%, use of diabetic medication, or a physician diagnosis of diabetes. Risk factors were measured using questionnaires, clinical assessments, or laboratory tests.

Main Outcome Measures

Any DR, diabetic macular edema (DME), or vision-threatening DR (VTDR).

Results

Among the 3400 participants, the age-standardized prevalence was 33.6% (95% confidence interval [CI], 31.4–35.8) for diabetes and 10.5% (95% CI, 9.3–11.8) for DR. Among those with diabetes only, the age-standardized prevalence was 30.4% (95% CI, 26.5–34.8) for any DR, 7.2% (95% CI, 5.3–9.7) for DME, and 7.1% (95% CI, 5.4–9.5) for VTDR. In multivariate analysis, independent risk factors for any DR were younger age (odds ratio [OR], 0.98; 95% CI, 0.96–1.00, per year increase), longer diabetes duration (OR, 1.09; 95% CI, 1.07–1.11 per year increase), higher hemoglobin A1c (OR, 1.23; 95% CI, 1.13–1.34 per percent increase), higher systolic blood pressure (OR, 1.01; 95% CI, 1.00–1.02 per 1-mmHg increase), lower diastolic blood pressure (OR, 0.97; 95% CI, 0.96–0.99 per 1-mmHg increase), history of previous stroke (OR, 2.16; 95% CI, 1.12–4.16), and insulin treatment (OR, 2.99; 95% CI, 1.84–4.87). Similar independent risk factors, except for blood pressure, were found for VTDR. Additionally, persons with lower income and living in smaller houses were associated with VTDR.

Conclusions

One in 3 migrant Indians living in newly urbanized Asian societies have diabetes and 1 in 10 has DR. This is similar to rates reported in Western populations and significantly higher than those reported in India.

Financial Disclosure(s)

The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Section snippets

Study Design and Procedure

The Singapore Indian Eye Study (SINDI) is a population-based, cross-sectional study among 3400 Indian adults aged ≥40 years living in Singapore.14, 15, 16, 17 The term “Singaporean Indians” refers broadly to people from the India subcontinent, including Indian, Pakistani, Bangladeshi, and Sri Lankan origin (e.g., Tamils, Malayalis, Punjabis, Bengalis, and Singhalese) who migrated to Singapore, mostly in the 19th century. Detailed population selection and methodology have been published

Results

Of the 3400 participants, 38.1% (n = 1295) had diabetes; 1.2% (n = 16) were type 1 diabetes and the rest, type 2 diabetes. The age-standardized prevalence of diabetes was 33.6% (95% confidence interval [CI], 31.4–35.8). Persons with diabetes were more likely to be older; male; born outside of Singapore; have higher BMI, HbA1c, and blood pressure values; and have lower total cholesterol, and high- and low-density lipoprotein cholesterol levels; but were less likely to be smokers (all P<0.05).

Discussion

In this large-scale, population-based study, we showed that both diabetes and DR affect a significant proportion in Asian Indian immigrants in a newly urbanized society—approximately one-third of the population had diabetes and one-third of those with diabetes had DR, which equates to approximately 10% of the general adult population having DR. These prevalence estimates are as high as those reported in Western countries (e.g., 32.4% in the Blue Mountains Eye Study in Australia and 33.2% in the

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    Funded by Biomedical Research Council (BMRC), 08/1/35/19/550 & National Medical Research Council (NMRC), STaR/0003/2008, Singapore.

    Manuscript no. 2011-1546.

    Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

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