BMJ Open · 4 authors, 3 centres
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This cross-sectional study of 391 diabetes patients in Southern Ethiopia found a 10.7% prevalence of sight-threatening diabetic retinopathy (STDR). Key modifiable predictors included poor glycemic control, hypertension, low physical activity, and diabetic peripheral neuropathy. The findings highlight the need for regular eye exams and management of blood glucose, blood pressure, and physical activity to prevent vision loss.
**Background:** Diabetic retinopathy (DR) is a microvascular complication of diabetes and a leading cause of preventable visual impairment worldwide. Sight-threatening diabetic retinopathy (STDR) includes severe non-proliferative DR, proliferative DR, and diabetic macular edema. In Ethiopia, the national prevalence of DR is 19.48%, but data on STDR are limited, especially in the Sidama region. This study aimed to determine the prevalence and predictors of STDR among patients with diabetes at Adare General Hospital in Southern Ethiopia.
**Methods:** A hospital-based cross-sectional study was conducted from 30 May to 15 July 2022. A systematic random sample of 391 adult diabetes patients (≥18 years) was enrolled (response rate 91.4%). Data were collected via interviewer-administered questionnaires, medical record review, and eye examinations. Fundus examination was performed using slit-lamp biomicroscopy with a 90-diopter lens after pupil dilation with 1% tropicamide. DR was graded per the Early Treatment Diabetic Retinopathy Study (ETDRS) criteria. STDR was defined as severe non-proliferative DR, proliferative DR, or diabetic macular edema. Glycemic control was classified as good (fasting blood sugar <152 mg/dL) or poor (≥152 mg/dL). Physical activity was categorized as low (<150 min/week) or high (≥150 min/week). Binary logistic regression was used to identify predictors, with adjusted odds ratios (AOR) and 95% confidence intervals (CI).
**Key Results:** The median age of participants was 49 years (IQR: 40–58); 50.4% were male, 69.6% had type II diabetes, and the median diabetes duration was 6 years (IQR: 3–9). The overall prevalence of DR was 15.3% (95% CI: 11.8% to 18.9%), and the prevalence of STDR was 10.7% (95% CI: 7.7% to 14.1%). STDR was more common in those aged ≥49 years (15.7%), rural residents (15.4%), and type II diabetes patients (12.1%). In multivariable analysis, six factors were significantly associated with STDR: rural residence (AOR=2.17, 95% CI: 1.05 to 4.46), diabetes duration ≥6 years (AOR=2.43, 95% CI: 1.06 to 5.57), poor glycemic control (AOR=2.80, 95% CI: 1.03 to 7.64), low physical activity (AOR=2.85, 95% CI: 1.01 to 8.05), hypertension (AOR=3.25, 95% CI: 1.48 to 7.15), and diabetic peripheral neuropathy (AOR=3.32, 95% CI: 1.18 to 9.33). Age, educational status, and BMI were not significant in the final model.
**Clinical Implications:** The 10.7% prevalence of STDR in this Ethiopian hospital is substantial and aligns with other African studies (range 5.2%–36.0%). The identified modifiable predictors—poor glycemic control, hypertension, low physical activity, and diabetic peripheral neuropathy—offer clear targets for intervention. The strong association with rural residence underscores disparities in access to eye care and diabetes education. Given that advanced treatments (laser, intravitreal injections) are not available at this hospital, the study emphasizes the urgent need for regular eye screening, improved glycemic and blood pressure management, and promotion of physical activity to prevent vision loss. Limitations include the single-center design, use of fasting blood glucose instead of HbA1c, and cross-sectional nature, which precludes causal inference.