The incident rate of diabetic retinopathy : controlled diabetes mellitus versus uncontrolled condition

Abstract

Background Information: Diabetes mellitus is the leading cause of diabetic retinopathy, putting every patient diagnosed with diabetes mellitus at risk of developing Diabetic retinopathy. Therefore Diabetic retinopathy is considered to be a major chronic micro-vascular complication. The onset and progression of DR is slow and gradual, advancing from mild non-proliferative DR (NPDR), to moderate NPDR. By good glycemic control, diabetics may decrease the prevalence of developing DR. Therefore adequate glucose control measures are required. Research Question: Is the Incident Rate (IR) of Diabetic Retinopathy less in individuals with controlled diabetes mellitus as opposed to those with uncontrolled diabetes mellitus? PICO Elements: The population studied compromised of adults suffering from Diabetes. The intervention being reviewed is glycemic control. The comparison is between uncontrolled and controlled blood glucose levels, and the expected outcome is a reduction in the IR of DR in patients having a controlled blood glucose level. Method: A systematic literature search was conducted to retrieve relevant literature from various databases using keywords, synonyms, boolean operators, and limiters. Eligibility criteria compromised of peer-reviewed literature in English from 2008 onwards, having full text, including all PICO elements, and study design. Medical health professionals who expertise in this field were contacted to broaden the knowledge on the subject and possibly retrieve any unpublished studies on the subject. The PRISMA checklist enabled the identification of relevant articles. The 6 key studies chosen, 5 cross-sectional studies and 1 cohort study, were critically appraised using a Critical Appraisal Skills Programme (CASP) tool as a guideline. This process was then illustrated using a PRISMA flow diagram. Results: The chosen literature provided consistent results and identified that glucose control does reduce the IR o DR. However, various methodological limitations were identified. Implications and Recommendations: Recommendations for further research include sustaining the development for more local research, and having larger sample sizes when conducting a study. Implementation of local staff training to raise awareness should also be implemented.