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- DOI 10.18231/j.jchm.v.12.i.2.4
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Unravelling epidemiological trends and risk disparities in diabetic retinopathy
Diabetic retinopathy (DR) remains a leading cause of blindness worldwide, driven by the epidemic rise in diabetes mellitus. The epidemiology of DR is reflected as global trends in lifestyle, urbanization, and health disparities, with variation between populations and regions. Socioeconomic differences contribute to the burden of DR, making imperative need for integrated public health interventions. The pathogenesis of DR is multifactorial and is characterized by common risk factors including hyperglycaemia, diabetes duration, hypertension, dyslipidaemia, smoking, genetic predisposition, obesity, albuminuria, and pregnancy. Of these, control of glycemia plays an important role, with elevated levels of glycated haemoglobin (HbA1c) imparting a high risk for the development and onset of DR. Also, longer duration of diabetes has a very high correlation with greater prevalence of DR, affecting 100% of type 1 DM patients at 30 years and 90% of type 2 DM patients in the same duration. The disease is manifested as non-proliferative (NPDR) or proliferative (PDR) DR, by the presence of neovascularization. Diabetic macular oedema (DME) can occur at any time and results in serious vision loss. This review explores the multifaceted epidemiology and determinants of risk of DR, synthesizing current evidence to inform opportunities for tailored interventions. It is crucial to elucidate the multifactorial interaction of metabolic, vascular, genetic, and environmental determinants, to tailor prevention efforts, early detection, and effective management approaches. Policy and clinical practice based on evidence for these determinants are key to preventing the public health burden of DR and preserving vision in affected individuals.
References
- Abougalambou SSI, Abougalambou A.S. Prevalence and risk factors of microalbuminuria in type 2 diabetes mellitus outpatients at University Sains Malaysia Hospital', Diabetes & Metabolic Syndrome: Clin Res Rev. 2013;7(2):64-7.
- Abougalambou S.S.I, Abougalambou A.S. Risk factors associated with diabetic retinopathy among type 2 diabetes patients at teaching hospital in Malaysia', Diabetes & Metabolic Syndrome: Clin Res Rev, 2015;9(2):98-103.
- Addoor KR, Bhandary SV, Khanna R, Rao LG, Lingam KD, Binu, V., Shivaji, S. and Nandannaver M. Assessment of awareness of diabetic retinopathy among the diabetics attending the peripheral diabetic clinics in Melaka, Malaysia', Med J Malaysia, 2011:66(1):48-52.
- Al-Jarrah MA, Shatnawi H. 'Non-proliferative diabetic retinopathy symptoms detection and classification using neural network', J Med Eng Technol, 2017;41(6):498-505.
- Almutairi NM, Alahmadi S, Alharbi M, Gotah S. Alharbi M. The Association Between HbA1c and Other Biomarkers With the 68 Sadikan and Nasir / The Journal of Community Health Management 2025;12(2): Prevalence and Severity of Diabetic Retinopathy', Cureus, 2021;13(1).
- Anwar SB, Asif N, Naqvi SH, Malik S. 'Evaluation of multiple risk factors involved in the development of Diabetic Retinopathy', Pak J Med Sci, 2019;35(1):156.
- Association AD. Standards of medical care in diabetes-2006', Diab Care, 2006;29(1):S4.
- Beagley J, Guariguata L, Weil C., Motala AA. Global estimates of undiagnosed diabetes in adults', Diabetes research and clinical practice, 2014;103(2):150-60.
- Bourry J, Courteville H, Ramdane N, Drumez E, Duhamel A, Subtil D. et al. Progression of Diabetic Retinopathy and Predictors of Its Development and Progression During Pregnancy in Patients With Type Diabetes: A Report of 499 Pregnancies', Diab Care, 2021;44(1):181-7.
- Cardoso CR, Leite NC, Dib E, Salles GF. Predictors of development and progression of retinopathy in patients with type 2 diabetes: importance of blood pressure parameters', Sci Rep, 2017;7(1):1-10.
- Chang YC, Wu WC. Dyslipidemia and diabetic retinopathy', The review of diabetic studies: RDS, 2013;10(2-3):121.
- Cherchi S, Gigante A, Spanu MA, Contini P, Meloni G, Fois MA.et al. Sex-Gender Differences in Diabetic Retinopathy', Int J Diabetol, 2020;1(1):1-10.
- Chisha Y, Terefe W, Assefa H., Lakew S. Prevalence and factors associated with diabetic retinopathy among diabetic patients at Arbaminch General Hospital, Ethiopia: Cross sectional study', Plos one, 2017;12(3):e0171987.
- Chou Y, Ma J, Su X, Zhong Y. Emerging insights into the relationship between hyperlipidemia and the risk of diabetic retinopathy', Lipids Health Dis. 2020;19(1):1-12.
- Dedov I, Maslova O, Suntsov Y, Bolotskaia L, Milenkaia T, Besmertnaia L. Prevalence of diabetic retinopathy and cataract in adult patients with type 1 and type 2 diabetes in Russia, Review Diabetic Stud: RDS, 2009;6(2):124.
- Deshpande AD, Harris-Hayes M. Schootman M. Epidemiology of diabetes and diabetes-related complications', Physical therapy, 2008;88(11):1254-64.
- Egan AM, McVicker L, Heerey A, Carmody L, Harney F, Dunne FP. 'Diabetic retinopathy in pregnancy: a population-based study of women with pregestational diabetes', Journal of diabetes research,
- Elwali ES, Almobarak AO, Hassan MA, Mahmooud AA, Awadalla H. Ahmed MH. Frequency of diabetic retinopathy and associated risk factors in Khartoum, Sudan: population based study', Int J Ophthalmol, 2017;10(6):948.
- Endo H, Kase S, Ito Y, Takahashi M, Yokoi M, Katsuta S. Relationship between choroidal structure and duration of diabetes', Graefe's Arch Clin Experimen Ophthalmol, 2019;257(6):1133-40.
- Esteves J, Laranjeira AF, Roggia MF, Dalpizol M, Scocco C, Kramer CK, etal. Fatores de risco para retinopatia diabética', Arquivos Brasileiros de Endocrinologia & Metabologia, 2008;52(3):431-41.
- Gubitosi-Klug RA, Braffett BH, White NH, Sherwin RS, Service FJ, Lachin JM. etal. Erratum. Risk of Severe Hypoglycemia in Type 1 Diabetes Over 30 Years of Follow-up in the DCCT/EDIC Study. Diab care, 2021;44(1):298.
- Hammes H, Kerner W, Hofer S, Kordonouri O, Raile K, Holl R. et al. Diabetic retinopathy in type 1 diabetes—a contemporary analysis of 8,784 patients', Diabetologia, 2011;54(8):1977-84.
- Han X, Jiang Y, Niu Y, Zhu Y, Huang W, He M. Differential associations between body mass index with diabetes and vision- threatening diabetic retinopathy in an adult Chinese population', Brit J Ophthalmol 2021; 106(6):852-6.
- Hautala, N., Siiskonen, M., Hannula, V., Järvinen, K. and Falck, A. (2018) 'Early glycaemic control for maintaining visual function in type 1 diabetes: The Oulu cohort study of diabetic retinopathy', European journal of ophthalmology, 28(6), 684-9.
- Hussein Z, Taher SW, Singh HKG, Swee WCS. Diabetes care in Malaysia: problems, new models, and solutions', Annals of Global Health, 2015;81(6):851-62.
- Jew OM, Peyman M, Chen TC,Visvaraja S. Risk factors for clinically significant macular edema in a multi-ethnics population with type 2 diabetes', Int J Ophthalmol, 2012;5(4):499.
- Kajal Seema S, Binu S., Bhaskar M. An Observational Study on the Association between Diabetic Retinopathy and Serum Lipid Levels in a Tertiary Centre in Thiruvananthapuram'.2021;8(3):131-5.
- Kim YJ, Kim JG, Lee JY, Lee KS, Joe SG, Park JY. et al. Development and progression of diabetic retinopathy and associated risk factors in Korean patients with type 2 diabetes: the experience of a tertiary center', J Korean Med Sci, 2014;29(12):1699.
- Klein R. and Klein, B. E. (2021) 'Epidemiology of ocular functions and diseases in persons with diabetes'.
- Klein, R., Klein, B. E., Moss, S. E., Davis, M. D. and DeMets, D. L. (1984) 'The Wisconsin Epidemiologic Study of Diabetic Retinopathy: III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years', Archives of ophthalmology, 102(4), 527-32.
- Kramer CK, de Azevedo MJ, da Costa Rodrigues T, Canani LH, Esteves J. Smoking habit is associated with diabetic macular edema in type 1 diabetes mellitus patients', 2008;
- Letchuman G, Wan Nazaimoon W, Mohamad W, Chandran L, Tee G, Jamaiyah H. (2010) Prevalence of diabetes in the Malaysian national health morbidity survey III 2006', Med J Malaysia, 2010;65(3):180-6.
- Li C, Zheng W, Xin P, Li J, Fan L. Relationship between dyslipidemia and diabetes mellitus in adults in Tianjin. 2020;35(8):706-711.
- Li Q, Wang Z, Zhou W, Fan S, Ma R, Xue L. et al. Epalrestat protects against diabetic peripheral neuropathy by alleviating oxidative stress and inhibiting polyol pathway', Neural Regenerat Rese, 11(2):345.
- Liu L, Quang ND, Banu R, Kumar H, Tham YC, Cheng CY. Hypertension, blood pressure control and diabetic retinopathy in a large population-based study', Plos one, 2020;15(3):e0229665.
- Looker H, Nyangoma S, Cromie D, Olson J, Leese G, Black M. Diabetic retinopathy at diagnosis of type 2 diabetes in Scotland', Diabetol, 2012;55(9):2335-42.
- Looker H, Nyangoma S, Cromie D, Olson J, Leese G, Black M. Rates of referable eye disease in the Scottish national diabetic retinopathy screening programme. Brit J Ophthalmol, 2014;98(6):790-95.
- Makwana T, Takkar B, Venkatesh P, Sharma JB, Gupta Y, Chawla R. et al. 'Prevalence, progression, and outcomes of diabetic retinopathy during pregnancy in Indian scenario', Indian J Ophthalmol, 2018;66(4):541.
- Mallika P, Lee P, Cheah W, Wong J, Alwi SS, Hayati HN. Risk factors for diabetic retinopathy in diabetics screened using fundus photography at a primary health care setting in East Malaysia', Malaysian family physician: the official journal of the Academy of Family Physicians of Malaysia, 2011;6(2-3):60.
- Mazhar K, Varma R, Choudhury F, McKean-Cowdin R, Shtir CJ, Azen SP. et al. Severity of diabetic retinopathy and health-related quality of life: the Los Angeles Latino Eye Study', Ophthalmol, 2010;118(4):649-55.
- Mehlsen J, Erlandsen M, Poulsen PL,Bek T. Identification of independent risk factors for the development of diabetic retinopathy requiring treatment', Acta ophthalmologica, 2011;89(6):515-21.
- Mohammadi M, Raiegani AA, Jalali R, Ghobadi A, Salari N. The prevalence of retinopathy among type 2 diabetic patients in Iran: A systematic review and meta-analysis', Reviews in Endocrine and Metabolic Disorders, 2019;20(1):79-88.
- Morrison JL, Hodgson LA, Lim LL, Al‐Qureshi S. Diabetic retinopathy in pregnancy: a review', Clin Experimental OPphthalmol, 2015;44(4):321-34.
- Nentwich MM, Ulbig MW. Diabetic retinopathy-ocular complications of diabetes mellitus', World journal of diabetes, 2015;6(3):489.
- Ooyub S, Ismail F, Daud N.'Diabetes program in Malaysia-current and future', NCD Malaysia, 2004;3(2):6-12. 69 Sadikan and Nasir / The Journal of Community Health Management 2025;12(2):64-69
- Paik DW, Han K, Kang SW, Ham DI, Kim SJ, Chung TY. Differential effect of obesity on the incidence of retinal vein occlusion with and without diabetes: a Korean nationwide cohort study', Scientific reports, 2020;10(1):1-9.
- Rani P, Raman R, Chandrakantan A, Pal S, Perumal G. Sharma, T. Risk factors for diabetic retinopathy in self-reported rural population with diabetes', J Postgrad Med, 2009;55(2):92.
- Rasmussen K, Laugesen C, Ringholm L, Vestgaard M, Damm P, Mathiesen E. Progression of diabetic retinopathy during pregnancy in women with type 2 diabetes', Diabetologia, 2010:53(6):1076-83.
- Romero-Aroca P, Navarro-Gil R, Valls-Mateu A, Sagarra-Alamo R, Moreno-Ribas A, Soler N. 'Differences in incidence of diabetic retinopathy between type 1 and 2 diabetes mellitus: a nine-year follow-up study', British Journal of Ophthalmology, 2017;101(10):1346-51.
- Sasongko M, Wong T, Nguyen T, Shaw J, Jenkins A. Wang J. Novel versus traditional risk markers for diabetic retinopathy', Diabetologia, 2012;55(3):666-70.
- Scanlon PH. Pregnancy and the diabetic eye', Practical Manual of Diabetic Retinopathy Management, 2017;197-206.
- Shaikh, M. A. and Gillani S. Frequency of diabetic retinopathy in patients after ten years of diagnosis of type 2 diabetes mellitus', J Ayub Med Coll Abbottabad, 2010;22(3):158-60.
- Shi R, Zhao L, Wang F, Liu F, Chen Z, Li R, et al. Effects of lipid- lowering agents on diabetic retinopathy: a meta-analysis and systematic review', Int J Ophthalmol, 2018;11(2):287.
- Shriwas S, Isa AB, Reddy S, Mohammad M. Risk factors for Retinoopathyy in DiabetesDie Mellitu5 in KelantanM, alaysia', Med J Malaysia, 1996; 51(4):447-52.
- Śliwińska-Mossoń, M. and Milnerowicz, H. The impact of smoking on the development of diabetes and its complications', Diab Vascular Dis Res., 2017;14(4):265-76.
- Smith J, Wright D, Scanlon P, Lois N. Risk factors associated with progression to referable retinopathy: a type 2 diabetes mellitus cohort study in the Republic of Ireland', Diab Med, 2020;37(6):1000-1007.
- Solomon SD, Chew E, Duh EJ, Sobrin L, Sun JK, VanderBeek BL. etal. Diabetic retinopathy: a position statement by the American Diabetes Association', Diabetes care, 2017;40(3):412-8.
- Stratton I, Kohner E, Aldington S, Turner R, Holman R, Manley S. UKPDS 50: risk factors for incidence and progression of retinopathy in Type II diabetes over 6 years from diagnosis', Diabetologia, 2001;44(2):156-63.
- Sun S, Wang Y, Zhou Y, Ma W, Huang Y, Hu J. Serum Progesterone And Retinopathy in Male Patients With Type 2 Diabetes: A Cross‐ Sectional Study', J Diab Invest.2020;51(4):447-52.
- Tee E, Yap R. Type 2 diabetes mellitus in Malaysia: current trends and risk factors', Eur J Clin Nutr, 2017;71(7):844-9.
- Temple R, Aldridge V, Sampson M, Greenwood R, Heyburn P, Glenn A. Impact of pregnancy on the progression of diabetic retinopathy in Type 1 diabetes', Diab Med, 2001;18(7):573-7.
- Teo ZL, Tham YC, Yu M, Chee ML, Rim TH, Cheung N. Global prevalence of diabetic retinopathy and projection of burden through 2045: systematic review and meta-analysis', Ophthalmology, 2021;128(11):1580-91.
- Toda J, Kato S, Sanaka M, Kitano S. The effect of pregnancy on the progression of diabetic retinopathy', Japanese J Ophthalmol, 2016;60(6):454-8.
- Verier‐Mine O, Chaturvedi N, Webb D, Fuller J. Is pregnancy a risk factor for microvascular complications? The EURODIAB Prospective Complications Study', Diab Med. 2005;22(11):1503-9.
- Vestgaard M, Ringholm L, Laugesen C, Rasmussen K, Damm P, Mathiesen E. Pregnancy‐induced sight‐threatening diabetic retinopathy in women with Type 1 diabetes', Diabetic Medicine, 2010;7(4):431-5.
- Vilsboll T, Bain SC, Leiter LA, Lingvay I, Matthews, D., Simó, R., Helmark, I. C., Wijayasinghe, N. and Larsen M. Semaglutide, reduction in glycated haemoglobin and the risk of diabetic retinopathy', Diabetes, Obesity and Metabolism, 2018;20(4):889-
- Voigt M, Schmidt S, Lehmann T, Köhler B, Kloos C, Voigt UA. et al. Prevalence and progression rate of diabetic retinopathy in type 2 diabetes patients in correlation with the duration of diabetes', Exp Clin Endocrinol Diabetes, 126(9), 570-576.
- Wang B, Wang F, Zhang Y, Zhao SH, Zhao WJ, Yan SL. et al. Effects of RAS inhibitors on diabetic retinopathy: a systematic review and meta-analysis', The lancet Diab Endocrinol. 2015;3(4):263-74.
- Wang FH, Liang YB, Peng XY, Wang JJ, Zhang F, Wei WB. et al. Risk factors for diabetic retinopathy in a rural Chinese population with type 2 diabetes: the Handan Eye Study', Acta Ophthalmol. 2011;89(4), e336-e343.
- Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himme lfarb C. et al. ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/P CNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines', J Am College Cardiol, 2017;71(19):127-248.
- Wright A, Dodson P. Medical management of diabetic retinopathy: fenofibrate and ACCORD Eye studies', Eye, 2011;25(7):843-9.
- Yao J, Lim J, Lim GYS, Ong JCL, Ke , Tan TF. et al. Novel artificial intelligence algorithms for diabetic retinopathy and diabetic macular edema', Eye and Vision, 2024;11(1):23.
- Yau JW, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T. et al. Global prevalence and major risk factors of diabetic retinopathy', Diab care, 2012;35(3):556-64.
- Zhang X, Saaddine JB, Chou CF, Cotch MF, Cheng YJ, Geiss LS. et al. Prevalence of diabetic retinopathy in the United States, 2005- 2008', Jama, 2010;304(6):649-56.
- Zhou Y, Wang C, Shi K, Yin X. Relationship between dyslipidemia and diabetic retinopathy: a systematic review and meta-analysis', Medicine, 2018;97(36):
- Zhu W, Wu Y, Meng YF, Xing Q, Tao JJ, Lu J. Association of obesity and risk of diabetic retinopathy in diabetes patients: a meta-analysis of prospective cohort studies', Medicine, 2018;97(32):11807.
How to Cite This Article
Vancouver
Sadikan MZ, Nasir NAA. Unravelling epidemiological trends and risk disparities in diabetic retinopathy [Internet]. J Community Health Manag. 2025 [cited 2025 Oct 02];12(2):64-69. Available from: https://doi.org/10.18231/j.jchm.v.12.i.2.4
APA
Sadikan, M. Z., Nasir, N. A. A. (2025). Unravelling epidemiological trends and risk disparities in diabetic retinopathy. J Community Health Manag, 12(2), 64-69. https://doi.org/10.18231/j.jchm.v.12.i.2.4
MLA
Sadikan, Muhammad Zulfiqah, Nasir, Nurul Alimah Abdul. "Unravelling epidemiological trends and risk disparities in diabetic retinopathy." J Community Health Manag, vol. 12, no. 2, 2025, pp. 64-69. https://doi.org/10.18231/j.jchm.v.12.i.2.4
Chicago
Sadikan, M. Z., Nasir, N. A. A.. "Unravelling epidemiological trends and risk disparities in diabetic retinopathy." J Community Health Manag 12, no. 2 (2025): 64-69. https://doi.org/10.18231/j.jchm.v.12.i.2.4