title: Lack of awareness amongst community patients with diabetes and diabetic retinopathy: the Singapore Malay eye study.
abstract: BACKGROUND
  We assessed awareness of diabetes and diabetic retinopathy in a Singaporean Malay population. We hypothesised that poor awareness is associated with poorer control of diabetic retinopathy risk factors (glycaemic and blood pressure levels) and suboptimal treatment with laser therapy.
  
  
  METHODS
  A population-based survey of 3280 (78.7% response rate) persons among Singaporean Malays aged between 40 and 80 years old. Diabetes was defined in persons with random glucose >or=11.1mmoL/L, use of diabetic medication, or a previous physician diagnosis. Diabetic retinopathy was graded from retinal photographs following the modified Airlie House classification. Patient awareness was assessed via structured interviews. Glycosylated haemoglobin was measured from venous blood.
  
  
  RESULTS
  Of the 3280 study participants, 768 had diabetes, of whom 13.2% (n = 101) were unaware of their diabetes status. Participants unaware of their diabetes status had significantly higher mean glycosylated haemoglobin (9.7% vs 8.2%, P <0.001), systolic blood pressure (160.0 mmHg vs 153.7 mmHg, P = 0.01) and diastolic blood pressure (83.5 mmHg vs 78.5 mmHg, P <0.001), compared to participants who were aware. Of the 272 (35.4%) participants detected to have diabetic retinopathy, 83.4% (n = 227) were unaware of having retinopathy. Of the 77 with vision-threatening retinopathy, laser treatment had been performed in only 55.6% of those unaware of having retinopathy.
  
  
  CONCLUSIONS
  In a sample of Malays with diabetes, high proportions were unaware of their disease. Unawareness was associated with poorer control of diabetic retinopathy risk factors. Only half of persons who were unaware that they had vision-threatening diabetic retinopathy had received laser treatment. These data highlight room for improvement in diabetic retinopathy prevention through better patient education and screening.
authors.affiliation: Faculty of Medicine, University of New South Wales, Australia.
authors.forename: Olivia S
authors.initials: OS
authors.lastname: Huang
authors.forename: Wan Ting
authors.initials: WT
authors.lastname: Tay
authors.forename: E Shyong
authors.initials: ES
authors.lastname: Tai
authors.forename: Jie Jin
authors.initials: JJ
authors.lastname: Wang
authors.forename: Seang-Mei
authors.initials: SM
authors.lastname: Saw
authors.forename: V Swetha
authors.initials: VS
authors.lastname: Jeganathan
authors.forename: Mya
authors.initials: M
authors.lastname: Sandar
authors.forename: Tien Y
authors.initials: TY
authors.lastname: Wong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000628:therapy*; D003930:Diabetic Retinopathy / Q000628:therapy*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires