title: Prevalence and risk factors of diabetic retinopathy in subjects with suboptimal glycemic, blood pressure and lipid control. Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN-DREAMS, Report 33).
abstract: OBJECTIVE
  To assess the rate of achieving optimal metabolic control among subjects with type 2 diabetes, to elucidate the influence of suboptimal control on diabetic retinopathy (DR) and to analyze the risk factors associated with DR in the subjects with suboptimal control.
  
  
  METHODS
  A population-based, cross-sectional study was conducted in south India. The study population consisted of 1414 subjects with type 2 diabetes. Optimal control of glycosylated hemoglobin (HbA1c), blood pressure (BP) and lipids was defined as: optimal HbA1c <7%, suboptimal HbA1c ≥ 7%; optimal BP ≤ 130/80 mm Hg, suboptimal BP >130/80 mm Hg; optimal low-density lipoprotein (LDL-C) <100 mg/dl, suboptimal LDL ≥ 100 mg/dl.
  
  
  RESULTS
  Of the subjects, 13.6% achieved combined optimal target levels for all metabolic parameters. When compared to subjects with optimal control, those with suboptimal control of HbA1c (trend P < 0.0001) and systolic blood pressure (SBP, trend P = 0.007) were more likely to have DR. Subjects having a combination of suboptimal glycemic and BP control (P < 0.0001 for SBP, P = 0.004 for diastolic blood pressure (DBP)), and suboptimal glycemic, BP and LDL control (P < 0.0001 for SBP, P = 0.017 for DBP), were more likely to have DR when compared to the subjects having optimal control of respective combinations. The factors associated with DR in the subjects with suboptimal control were younger age (P = 0.014 for BP, P = 0.016 for HbA1c), male gender (P = 0.035 for BP, P = 0.027 for HbA1c, P = 0.043 for LDL), presence of anemia (P = 0.021 for BP, P = 0.036 for HbA1c) and microalbuminuria (P < 0.0001 for both BP and HbA1c).
  
  
  CONCLUSIONS
  We found high prevalence of suboptimal metabolic control among subjects with type 2 diabetes. Suboptimal glycemic and SBP control, and their combination was the most detrimental for the development of DR.
authors.affiliation: Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Raman
authors.forename: Aditi
authors.initials: A
authors.lastname: Gupta
authors.forename: Vaitheeswaran
authors.initials: V
authors.lastname: Kulothungan
authors.forename: Tarun
authors.initials: T
authors.lastname: Sharma
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure / Q000502:physiology*; D008078:Cholesterol, LDL / Q000097:blood*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D003930:Diabetic Retinopathy / Q000097:blood / Q000453:epidemiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D038321:Glycemic Index; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human