Diabetes Metab J.  2022 Jul;46(4):620-629. 10.4093/dmj.2021.0099.

Prevalence of Diabetic Retinopathy in Undiagnosed Diabetic Patients: A Nationwide Population-Based Study

• Jang HN
• Moon MK
• Koo BK

• KMID: 2531965
• DOI: http://doi.org/10.4093/dmj.2021.0099

Abstract

Background
We investigated the prevalence of diabetic retinopathy (DR) in patients with undiagnosed diabetes through a nationwide survey, compared to those with known diabetes.
Methods
Among the participants of the Korean National Health and Nutrition Examination Surveys (KNHANES) from 2017 to 2018, individuals aged ≥40 years with diabetes and fundus exam results were enrolled. Sampling weights were applied to represent the entire Korean population. Newly detected diabetes patients through KNHANES were classified under “undiagnosed diabetes.”
Results
Among a total of 9,108 participants aged ≥40 years, 951 were selected for analysis. Of them, 31.3% (standard error, ±2.0%) were classified under “undiagnosed diabetes.” The prevalence of DR in patients with known and undiagnosed diabetes was 24.5%±2.0% and 10.7%±2.2%, respectively (P<0.001). The DR prevalence increased with rising glycosylated hemoglobin (HbA1c) levels in patients with known and undiagnosed diabetes (P for trend=0.001 in both). Among those with undiagnosed diabetes, the prevalence of DR was 6.9%±2.1%, 8.0%±3.4%, 5.6%±5.7%, 16.7%±9.4%, and 42.6%±14.8% for HbA1c levels of <7.0%, 7.0%–7.9%, 8.0%–8.9%, 9.0%–9.9%, and ≥10.0% respectively. There was no difference in the prevalence of hypertension, dyslipidemia, hypertriglyceridemia, or obesity according to the presence or absence of DR.
Conclusion
About one-third of patients with diabetes were unaware of their diabetes, and 10% of them have already developed DR. Considering increasing the prevalence of DR according to HbA1c level was found in patients with undiagnosed diabetes like those with known diabetes, screening and early detection of diabetes and DR are important.

Keyword

Diabetes mellitus; Diabetic retinopathy; Mass screening; Prevalence; Young adult

Figure

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  Fig. 1. Prevalence of diabetic retinopathy according to duration of diabetes and glycosylated hemoglobin (HbA1c) value. (A) The prevalence of diabetic retinopathy (DR) according to duration of diabetes in the entire study population. (B) The prevalence of DR according to HbA1c levels in patients with known (black bar) and undiagnosed diabetes mellitus (DM; white bar). Values are presented as prevalence±standard error. aP values <0.05 compared with the prevalence of DR in the subjects with diabetes duration 0 to 1 year by logistic regression analysis without adjustment, bP values <0.05 compared with the prevalence of DR in known diabetic patients with the same HbA1c level by logistic regression analysis without adjustment.

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  Fig. 2. The cumulative prevalence of diabetic retinopathy according to glycosylated hemoglobin (HbA1c) value, in (A) total ages, (B) 40 to 49 years, (C) 50 to 59 years, (D) 60 to 69 years, and (E) ≥70 years. Values are presented as mean or prevalence±standard error. DM, diabetes mellitus; DR, diabetic retinopathy. aP values <0.05 compared with the prevalence of DR in known diabetic patients with the same HbA1c level.

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