title: Higher prevalence of retinopathy in diabetic patients of South Asian ethnicity compared with white Europeans in the community: a cross-sectional study.
abstract: OBJECTIVE
  The purpose of this study was to compare prevalence and risk factors for diabetic retinopathy among U.K. residents of South Asian or white European ethnicity.
  
  
  METHODS
  This was a community-based cross-sectional study involving 10 general practices; 1,035 patients with type 2 diabetes were studied: 421 of South Asian and 614 of white European ethnicity. Diabetic retinopathy, sight-threatening retinopathy, maculopathy, and previous laser photocoagulation therapy were assessed after grading of retinal photographs. Data were collected on risk factors including age, duration, and treatment of diabetes, blood pressures, serum total cholesterol, and A1C.
  
  
  RESULTS
  Patients of South Asian ethnicity had significantly higher systolic (144 vs. 137 mmHg, P < 0.0001) and diastolic (84 vs. 74 mmHg, P < 0.0001) blood pressure, A1C (7.9 vs. 7.5%, P < 0.0001), and total cholesterol (4.5 vs. 4.2 mmol/l, P < 0.0001). Diabetic retinopathy was detected in 414 (40%) patients (189 South Asian [45%] versus 225 white European [37%]; P = 0.0078). Sight-threatening retinopathy was detected in 142 (14%) patients (68 South Asian [16%] versus 74 white European [12%]; P = 0.0597). After adjustment for confounders, there were significantly elevated risks of any retinopathy and maculopathy for South Asian versus white European patients.
  
  
  CONCLUSIONS
  Patients of South Asian ethnicity had a significantly higher prevalence of diabetic retinopathy and maculopathy, with significantly elevated systolic and diastolic blood pressure, A1C, and total cholesterol; lower attained age; and younger age at diagnosis. Earlier onset of disease and higher levels of modifiable risk factors make early detection of diabetes, annual referral for retinal screening, and intensive risk factor control key elements in addressing this health inequality.
authors.affiliation: Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Neil T
authors.initials: NT
authors.lastname: Raymond
authors.forename: Lakshminarayanan
authors.initials: L
authors.lastname: Varadhan
authors.forename: Dilini R
authors.initials: DR
authors.lastname: Reynold
authors.forename: Kate
authors.initials: K
authors.lastname: Bush
authors.forename: Sailesh
authors.initials: S
authors.lastname: Sankaranarayanan
authors.forename: Srikanth
authors.initials: S
authors.lastname: Bellary
authors.forename: Anthony H
authors.initials: AH
authors.lastname: Barnett
authors.forename: Sudhesh
authors.initials: S
authors.lastname: Kumar
authors.forename: J Paul
authors.initials: JP
authors.lastname: O'Hare
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People / Q000208:ethnology*; D001794:Blood Pressure; D002784:Cholesterol / Q000097:blood; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000453:epidemiology / Q000208:ethnology*; D003930:Diabetic Retinopathy / Q000097:blood / Q000453:epidemiology / Q000208:ethnology* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D006113:United Kingdom / Q000453:epidemiology / Q000208:ethnology; D044465:White People / Q000208:ethnology*
chemical_list: D002784:Cholesterol