Incidence of diabetic retinopathy and its predictors among adult patients with diabetes in Ethiopia: a frailty model

Abstract

Background: Diabetic retinopathy (DR) is becoming a more widespread public concern worldwide, leading to visual impairments. It has become the leading cause of blindness among working-age adults globally, despite established treatments that can reduce the risk by 60%. Objective: This study aimed to determine the incidence of diabetic retinopathy and its predictors among adult patients with diabetes in public hospitals in Central and Southern Ethiopia. Methods: A hospital-based follow-up study was conducted in selected public hospitals in Central and Southern Ethiopia. A total of 376 participants of newly diagnosed adult diabetes were enrolled from 2015-2023 and the follow-up the date was from date of enrolment to the development of events. The data were collected by reviewing their records and entered in Epi-data version 4.6.0.2 and exported to STATA version 14 for analysis. Descriptive statistics of the variables were obtained. The Weibull model with gamma frailty distribution was fitted. Bivariable and multivariable analyses were done, and variables with a p-value less than 0.05 and a corresponding 95% confidence interval in the final model were used. The model of adequacy was checked. Results: 376 adult diabetic patient records were reviewed with the mean baseline age (± standard deviation) of 34.8±10 years. The univariate frailty was statistically significant (Theta=0.236 (0.131, 0.496)). A total of 376 adult patients with diabetes were followed for 682.894 person-years. Overall, an incidence rate of 14.06/100 person-years. Proteinuria (AHR = 2.21: 95% CI: 1.45, 3.57), cardiovascular disease (AHR = 2.23: 95% CI: 1.34, 4.03), and type II DM (AHR = 2.87: 95% CI: 1.30, 6.13) were identified as significant predictors of diabetic retinopathy. Conclusion: Overall incidence rate of diabetic retinopathy was high. The most effective way to protect our vision from diabetic retinopathy is to manage diabetes effectively and offer support to high-risk individuals with diabetes. Therefore, healthcare professionals and relevant health authorities should target on addressing these factors in their initiatives to prevent diabetic retinopathy in diabetic patients.