Skip to main content

Is there a relationship between body mass index and diabetic retinopathy in type II diabetic patients? A cross sectional study

Journal of Diabetes & Metabolic Disorders volume 17, pages 63–69 (2018)Cite this article

Abstract

Background

Type 2 diabetes mellitus (T2DM) is one of the most important leading causes of disability, premature mortality and Diabetic Retinopathy (DR) that is one of the diabetes-related complications in diabetic patients and the most common cause of vision loss in diabetic patients. The aim of the study was to evaluate the association between DR and body mass index (BMI) in those patients with T2DM.

Methods

This was a central-based, cross-sectional study on 518 diabetic patients. Their medical history and the laboratory data were collected. All the patients received examination of diabetic retinopathy by professional ophthalmologist. Based on their optic fundi findings, they were classified into five groups: No retinopathy, Mild Non-proliferative Diabetic Retinopathy (NPDR), Moderate NPDR, Severe NPDR, Proliferative diabetic retinopathy (PDR). To analysis data SPSS v18 software used. Frequency, percent, mean and standard deviation were used for population description. t test, spearman correlation, partial correlation, analysis of variance (ANOVA) and Chi-square test (χ2) were used for analytic analysis. Multivariate logistic regression was used to estimate the odds ratio.

Results

518 patients with T2DM 198 male (38%), 320 female (62%) included in this study. The mean age of patients was 61.02 ± 10.18 years. The mean age at onset was 49.06 + 10.52 years and the mean duration of diabetes was 12.09 ± 7.81 years. There was a strong relationship between duration of diabetes and DR (P = 0.001). There were strong significant association between the development of DR and Insulin therapy (OR = 5.975). Correlation analysis between Retinopathy and BMI showed that BMI had inverse relationship with DR when BMI considered as a continuous variable (p-value = 0.009 and correlation coefficient = −0.467).

Conclusion

BMI in diabetic patient is one of the most important clinical parameter for their health and disease progression. We conclude that BMI had inverse relationship with DR when BMI considered as a continuous variable.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

Abbreviations

DR:

diabetic retinopathy

T2DM:

type 2 diabetes mellitus

BMI:

body mass index

NPDR:

Non-proliferative Diabetic Retinopathy

PDR:

Proliferative diabetic retinopathy

HbA1c:

Glycosylated hemoglobin

DM:

diabetes mellitus

IDF:

International Diabetes Federation

MI:

myocardial infarction

BP:

Blood pressure

SBP:

systolic blood pressure

DBP:

diastolic blood pressure

NIH:

National Institute of Health

LDL:

low-density lipoprotein

HDL:

high-density lipoprotein

References

  1. Roglic G, et al. The burden of mortality attributable to diabetes: realistic estimates for the year 2000. Diabetes Care. 2005;28:2130–5.

    Article  PubMed  Google Scholar 

  2. Beaglehole R, Epping-Jordan J. Preventing chronic diseases, a vital investment. Geneva: World Health Organization; 2005.

    Google Scholar 

  3. World Health Organization. Prevention of diabetes mellitus. Report of a WHO study group. Geneva: World Health Organization No 844; 1994.

  4. Tseng CH, Tseng CP, Chong CK, et al. Increasing incidence of diagnosed type 2 diabetes in Taiwan: analysis of data from a national cohort. Diabetologia. 2006;49(8):1755–60.

    Article  PubMed  Google Scholar 

  5. Guariguata L, Whiting D, Weil C, Unwin N. The international diabetes federation diabetes atlas methodology for estimating global and national prevalence of diabetes in adults. Diabetes Res Clin Pract. 2011 Dec 31;94(3):322–32.

    Article  PubMed  Google Scholar 

  6. US Centers for Disease Control and Prevention. National Diabetes Fact Sheet: general information and National Estimates on diabetes in the United States. Atlanta, GA: centers for disease control and Prevention; 2005.

  7. Klein R, et al. The Wisconsin epidemiological study of diabetic retinopathy: II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol. 1984;102(4):520–6.

    Article  PubMed  CAS  Google Scholar 

  8. Heydari B, Yaghoubi G, Yaghoubi MA, Miri MR. Prevalence and risk factors for diabetic retinopathy: an Iranian eye study. Eur J Ophthalmol. 2012;22:393–7.

    Article  PubMed  Google Scholar 

  9. UK Prospective Diabetes Study (UKPDS) Group, author. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837–53.

    Article  Google Scholar 

  10. Stratton IM, Kohner EM, Aldington SJ, Turner RC, Holman RR, Manley SE, et al. UKPDS 50: risk factors for incidence and progression of retinopathy in type II diabetes over 6 years from diagnosis. Diabetologia. 2001;44:156–63.

    Article  PubMed  CAS  Google Scholar 

  11. UK Prospective Diabetes Study Group. Author. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ. 1998;317:703–13.

    Article  PubMed Central  Google Scholar 

  12. Tyrberg M, Nyström L, Arnqvist HJ, Bolinder J, Gudbjörnsdottir S, Landin-Olsson M, et al. Hyperglycemia and tobacco use are modifiable risk factors for onset of retinopathy 9 and 17 years after the diagnosis of diabetes-a retrospective observational nation-wide cohort study. Diabetes Res Clin Pract. 2017 Aug 24;133:21–9.

    Article  PubMed  CAS  Google Scholar 

  13. Younis N, Broadbent D, Vora J, Harding S. Incidence of sight-threatening retinopathy in patients with type 2 diabetes in the Liverpool diabetic eye study: a cohort study. Lancet. 2003;361:195–200.

    Article  PubMed  Google Scholar 

  14. Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiologic study of diabetic retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. Arch Ophthalmol. 1984;102:527–32.

    Article  PubMed  CAS  Google Scholar 

  15. Yau JW, Rogers SL, Kawasaki R, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012;35:556–64.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Matthews DR, Stratton IM, Aldington SJ, Holman RR, Kohner EM. Risks of progression of retinopathy and vision loss related to tight blood pressure control in type 2 diabetes mellitus: UKPDS 69. Arch Ophthalmol. 2004;122(11):1631–40.

    Article  PubMed  Google Scholar 

  17. Schrier RW, Estacio RO, Mehler PS, Hiatt WR. Appropriate blood pressure control in hypertensive and normotensive type 2 diabetes mellitus: a summary of the ABCD trial. Nat Clin Pract Nephrol. 2007;3(8):428–38.

    Article  PubMed  Google Scholar 

  18. Dowse GK, Humphrey AR, Collins VR, et al. Prevalence and risk factors for diabetic retinopathy in the multiethnic population of Mauritius. Am J Epidemiol. 1998;147:448–57.

    Article  PubMed  CAS  Google Scholar 

  19. Cheung N, Obesity WTY. Eye diseases. Surv Ophthalmol. 2007;52:180–95.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Chaturvedi N, Fuller JH. Mortality risk by body weight and weight change in people with NIDDM. The WHO multinational study of vascular disease in diabetes. Diabetes Care. 1995;18:766–74.

    Article  PubMed  CAS  Google Scholar 

  21. Lee ET, Lee VS, Lu M, Russell D. Development of proliferative retinopathy in NIDDM: a follow-up study of American Indians in Oklahoma. Diabetes. 1992;41:359–67.

    Article  PubMed  CAS  Google Scholar 

  22. West KM, Erdreich LJ, Stober JA. A detailed study of risk factors for retinopathy and nephropathy in diabetes. Diabetes. 1980;29:501–8.

    Article  PubMed  CAS  Google Scholar 

  23. Nilsson SV, Nilsson JE, Frostberg N, Emilsson T. The Kristianstad survey. II. Studies in a representative adult diabetic population with special reference to comparison with an adequate control group. Acta Med Scand Suppl. 1967;469:1–42.

    PubMed  CAS  Google Scholar 

  24. Kornerup T. Studies in diabetic retinopathy: an investigation of 1,000 cases of diabetes. Acta Med Scand. 1955;153:81–101.

    Article  PubMed  CAS  Google Scholar 

  25. Klein R, Klein BE, Moss SEI. Obesity related to microvascular and macrovascular complications in diabetes? The Wisconsin epidemiologic study of diabetic retinopathy. Arch Intern Med. 1997;157:650–6.

    Article  PubMed  CAS  Google Scholar 

  26. Kaštelan S, Tomić M, Gverović Antunica A, Ljubić S, Salopek Rabatić J, Karabatić M. Body mass index: a risk factor for retinopathy in type 2 diabetic patients. Mediat Inflamm 2013 Nov 20;2013.

  27. Narendra V, John RK, Raghuram A, Ravindran RD, Nirmalan PK, Thulasiraj RD. Diabetic retinopathy among selfreported diabetics in southern India: a population-based assessment. Br J Ophthalmol. 2002;86:1014–8.

    Article  Google Scholar 

  28. National Institute of Diabetes and Digestion and Kidney Diseases. Clinical Guidelines on the Identification, Evaluation, and Treatment of overweight and obesity in adults: The Evidence Report. Bethesda (MD): National Heart, Lung, and Blood Institute; 1998 Sep. Report No.: 98–4083 Am J Clin Nutr 68(4):899–917.

  29. Wilkinson CP, Ferris FL, Klein RE, Lee PP, Agardh CD, Davis M, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. 2003 Sep 30;110(9):1677–82.

    Article  PubMed  CAS  Google Scholar 

  30. World Health Organization. Global strategy for noncommunacable disease prevention and control. Geneva. Switzerland: World Health Organization; 1997.

    Google Scholar 

  31. Rahmanian M. Et al. dual burden of body weight among Iranian children and adolescents in 2003 and 2010: the CASPIAN-III study. Arch Med Sci. 2014;10(1):96–103.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Keen H, Lee ET, Russell D, Miki E, Bennett PH, Lu M. The appearance of retinopathy and progression to proliferative retinopathy: the WHO multinational study of vascular disease in diabetes. Diabetologia. 2001;44(2):S22–30.

    Article  PubMed  CAS  Google Scholar 

  33. van Leiden HA, et al. Blood pressure, lipids, and obesity are associated with retinopathy: the Hoorn study. Diabetes Care. 2002;25:1320–5.

    Article  PubMed  Google Scholar 

  34. Tolonen N, et al. Associations and interactions between lipid profiles, retinopathy and nephropathy in patients with type 1 diabetes: the Finn Diane study. J Intern Med. 2013;274:469–79.

    Article  PubMed  CAS  Google Scholar 

  35. Rooney D, et al. Body mass index and retinopathy in Asian populations with diabetes mellitus. Acta Diabetol. 2014;52(1):73–80.

    Article  PubMed  Google Scholar 

  36. Raman R, Rani PK, Gnanamoorthy P, Sudhir RR, Kumaramanikavel G, Sharma T. Association of obesity with diabetic retinopathy: Sankara Nethralaya diabetic retinopathy epidemiology and molecular genetics study (SN-DREAMS report no. 8). Acta Diabetol. 2010;47:209–15.

    Article  PubMed  Google Scholar 

  37. Lu J, Hou X, Zhang L, Jiang F, Hu C, Bao Y, et al. Association between body mass index and diabetic retinopathy in Chinese patients with type 2 diabetes. Acta Diabetol. 2015:1–8.

  38. Logue J, Walker JJ, Leese G et al (2013) Association between BMI measured within a year after diagnosis of type 2 diabetes and mortality. Diabetes Care. 2013;36:887–93.

  39. He BB, Wei L, Gu YJ et al. Factors associated with diabetic retinopathy in Chinese patients with type 2 diabetes mellitus. Int J Endocrinol 2012.

  40. Manaviat MR, Afkhami M. Shoja MR retinopathy and microalbuminuria in type II diabetic patients. BMC Ophthalmol. 2004;1:4–9.

    Google Scholar 

Download references

Acknowledgements

The authors would like to thank Fatemeh Haghighi and saeedeh jam for their assistance in collecting data and statistical analysis.

Author information

Affiliations

  1. Faculty of Medicine, International Campus of Shahid Sadoghi University of Medical Sciences, Yazd, Iran

    Zahra Sarrafan-chaharsoughi

  2. Geriatric Ophthalmology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

    Masoud Reza Manaviat

  3. Yazd diabetes research center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

    Nasim Namiranian

  4. Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

    Pouria Yazdian-Anari

  5. Yazd Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

    Masoud Rahmanian

Authors
  1. Zahra Sarrafan-chaharsoughi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masoud Reza Manaviat
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nasim Namiranian
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pouria Yazdian-Anari
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masoud Rahmanian
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contribute in this study equally.

Corresponding author

Correspondence to Masoud Rahmanian.

Ethics declarations

Ethics approval and consent to participate

This analytic cross-sectional study was performed in the Yazd Diabetes research center.

Consent for publication

All the authors consent for publication.

Competing interests

The authors declare that they have no conflict of interest.

Human and animal rights disclosure

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 [5].

Informed consent disclosure

Informed consent was obtained from all patients for being included in the study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sarrafan-chaharsoughi, Z., Manaviat, M.R., Namiranian, N. et al. Is there a relationship between body mass index and diabetic retinopathy in type II diabetic patients? A cross sectional study. J Diabetes Metab Disord 17, 63–69 (2018). https://doi.org/10.1007/s40200-018-0339-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40200-018-0339-5

Keywords

  • Diabetic retinopathy
  • Body mass index
  • Type 2 diabetes mellitus