The incidence of diabetes mellitus and diabetic retinopathy in a population-based cohort study of people age 50 years and over in Nakuru, Kenya

BMC Endocrine Disorders

Research Article

Kevin Wing¹  Hannah Kuper²  Andrew Bastawrous²  Allen Foster²  Hillary Rono³  Matthew Burton⁴  David Macleod⁵  Helen A. Weiss⁵  Peter Blows⁶  Tunde Peto⁷  Madeleine Bastawrous⁸  Wanjiku Mathenge⁹ 

[1] Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK;International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK;International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK;Kitale Eye Unit and Trans Nzoia County, London, Kenya;International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK;Moorfields Eye Hospital NHS Foundation Trust, London, UK;MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK;NIHR BMRC at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK;NIHR BMRC at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK;Centre for Public Health, Queen’s University Belfast, London, UK;Nuffield Department of Primary Care, University of Oxford, Oxford, UK;Rwanda International Institute of Ophthalmology and Dr Agarwal’s Eye Hospital, London, Rwanda;

关键词: Diabetic Retinopathy;    Cumulative Incidence;    Retinal Image;    Proliferative Diabetic Retinopathy;    Random Blood Sugar;   

DOI  :  10.1186/s12902-017-0170-x

 received in 2017-01-04, accepted in 2017-03-18,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe epidemic rise of diabetes carries major negative public health and economic consequences particularly for low and middle-income countries. The highest predicted percentage growth in diabetes is in the sub-Saharan Africa (SSA) region where to date there has been no data on the incidence of diabetic retinopathy from population-based cohort studies and minimal data on incident diabetes. The primary aims of this study were to estimate the cumulative six-year incidence of Diabetes Mellitus (DM) and DR (Diabetic Retinopathy), respectively, among people aged ≥50 years in Kenya.MethodsRandom cluster sampling with probability proportionate to size were used to select a representative cross-sectional sample of adults aged ≥50 years in 2007-8 in Nakuru District, Kenya. A six-year follow-up was undertaken in 2013–14. On both occasions a comprehensive ophthalmic examination was performed including LogMAR visual acuity, digital retinal photography and independent grading of images. Data were collected on general health and risk factors. The primary outcomes were the incidence of diabetes mellitus and the incidence of diabetic retinopathy, which were calculated by dividing the number of events identified at 6-year follow-up by the number of people at risk at the beginning of follow-up. Age-adjusted risk ratios of the outcomes (DM and DR respectively) were estimated for each covariate using a Poisson regression model with robust error variance to allow for the clustered design and including inverse-probability weighting.ResultsAt baseline, 4414 participants aged ≥50 years underwent complete examination. Of the 4104 non-diabetic participants, 2059 were followed-up at six-years (50 · 2%). The cumulative incidence of DM was estimated at 61 · 0 per 1000 (95% CI: 50 · 3–73 · 7) in people aged ≥50 years. The cumulative incidence of DR in the sample population was estimated at 15 · 8 per 1000 (95% CI: 9 · 5–26 · 3) among those without DM at baseline, and 224 · 7 per 1000 (116.9–388.2) among participants with known DM at baseline. A multivariable risk factor analysis demonstrated increasing age and higher body mass index to be associated with incident DM. DR incidence was strongly associated with increasing age, and with higher BMI, urban dwelling and higher socioeconomic status.ConclusionsDiabetes Mellitus is a growing public health concern with a major complication of diabetic retinopathy. In a population of 1 · 6 million, of whom 150,000 are ≥50 years, we estimated that 1650 people aged ≥50 develop DM per year, and 450 develop DR. Strengthening of health systems is necessary to reduce incident diabetes and its complications in this and similar settings.

【 授权许可】

CC BY   
© The Author(s). 2017