Diabetic retinopathy (DR) is one of the impending complications of the diabetes mellitus (DM) which results in blindness and is the main reason of the eyesight impairment of the DM patients aged 25-74, and, therefore, needs a thorough studying and prediction. DR is the most frequent effect of universal diabetic microangiopathy with the unfavorable prognosis which nowadays is medical and social issue for many countries across the world. Epidemiological data regarding diabetic retinopathy in Ukraine and results of the correlation between the social and medical factors and diabetic retinopathy of T2D patients study are presented in the article. To prevent the development of DR and to provide it’s timely diagnostics a number of systemic approaches shall be applied in Ukraine, such as: elaboration and approval of the national protocols for rendering the specialized medical care for the specialty of “endocrinology”, the approval of the national action plan concerning the diabetes mellitus, creation of the center for analytics and prediction of efficiency of rendering the specialized medical care for DM patients, introduction of the new efficient models and programs of DR screening.

Blindness; Diabetes mellitus type 2; Diabetic retinopathy; Diabetic retinopathy screening; Fundus oculi; Laser treatment

Diabetic Retinopathy (DR) is one of the impending complications of the Diabetes Mellitus (DM) which results in blindness and is the main reason of the eyesight impairment of the DM patients aged 2574 [1], and, therefore, needs a thorough studying and prediction.

DR is the most frequent effect of universal diabetic microangiopathy with the unfavorable prognosis which nowadays is medical and social issue for many countries across the world. According to the International Diabetes Federation (IDF), the total degree of incidence of DR among DM patients within 2015-2019 was about 27%. The lowest incidence was in Europe: 20.6% and South-East Asia: 12.5%, and the highest in Africa: 33.8%, Middle East and North Africa : 33.8%, and the Western Pacific: 36.2% [2].

The incidence of DR grows with the diabetes duration. Within first 20 years of disease almost all type 1 DM patients and more than 60% of type 2 DM patients developed the retinopathy. Epidemiological Survey of DR (WESDR) confirmed those 3.6% younger patients (T1D) and 1.6% of elderly patients (T2D) lost their eyesight. In younger age group 86% of blindness was caused by DR. In elderly age group where other opthalmologic disorders were spread, one third of officially fixed blindness incidents was connected with DR. [3,4] in 2012 the consolidated meta-analysis of the separate subjects (n=22896) within 10 years, observations from 1980 to 2008 showed that 35.4% DM patients, including T1D patients and 25.2% T2D panties had the DR symptoms. Total incidence of Proliferative DR (PDR) was 7%, diabetic macular edema: 7% and eye-threatening DR: 12%.

The additional risk factors of DR development include the glycemic control level, type of diabetes (historically at T1D DR develops more frequently than with T2D), and presence or absence of the comorbide conditions, such as arterial hypertension, smoking, dyslipidemia, nephropathy, and pregnancy, [5,6] Currently, the stable tendency to the increase of DM incidence among the population is observed (predicted growth of DM incidence is as follows: from 463 mln. in 2019 to 700 mln. in 2045 due to the population growth, ageing, urbanization, reduction of physical activity and unfavorable dietary changes) [7]. In connection with this, considering the increase of DM incidence and improvement of the diagnostic possibilities, the increase of diagnosed DR is observed. The incidence of the eye sight loss after this complication also maintains a stable growing tendency. Total amount of people with the eyesight disorders and blindness falling on DR in 2015 according to MDF’s predictions was 2015 and in 2020 this index should have grown up to 3.2 mln. [8]. As long as, according to the calculations, by 2045 700 mln. people in the world will suffer from DM which will constitute approximately10% of adult population of the planet, out of which 245mln. will suffer from hypertension and 77mln. from DR which is sight-threatening, this will have the destructive socio-economic consequences [9].

According to the statistical indexes of activity of endocrinologic services of Ukraine for 2002-2016 the tendency to the growth of diagnosed DR in Ukraine is observed from 121,938 cases in 2002 to 158,333 incidents in 2016. However, as a result of realization of two National Target-Oriented Programs “Diabetes Mellitus”, the reduction of DR incidence was observed among teenagers from 656 in 2002 to 123 in 2016 [10].

Lately due to the introduction of the state register of DM patients in need of insulin therapy, the degree of incidence of the eyesight loss among the patients receiving insulin became known. Thus, in 2018 the following amount of people suffering from blindness was recorded: 1,702 (T1D) and 5,370 (T2D), which amounted to 2.92 and 3.95 percent correspondingly from the total amount of patients with the diabetes and insulin therapy, while in 2019 the following amount of patients with blindness was fixed: 1,849 (T1D) and 6,266 (T2D), which amounted to 3.14 and 4.52 percent correspondingly and in 2020 1,936 (T1D) and 6,689 (T2D) which amounted to 3.19 and 4.59 percent correspondingly from the total amount of diabetic patients [10].

Unfortunately, the statistical data concerning all types of DM starting from 2017 when the related form of reporting was canceled have become unaccessible.

Since the data have not been collected as of now, we believe that the studies performed on the basis of Ukrainian Scientific and Practical Center for Endocrine Surgery Transplantation of Endocrine Organs and Tissues is very topical from the point of view of studying the dynamic of DR development in different groups.

To study the correlation between the social and medical factors and diabetic retinopathy of T2D patients.

2,264 T2D patients were involved in the study (1,186 men and 1,078 women) who received medical aid at Ukrainian Scientific and Practical Center for Endocrine Surgery, Transplantation of the Endocrine Organs and Tissues of the Ministry of Health care of Ukraine.

The patients were subdivided into groups according to the age (72 men and 26 women aged under 40, 201 men and 65 women aged 40-49, 382 mend and 290 women aged 50-59, 395 mend and 463 women aged 60-69, 125 men and 208 women aged 70-79, 11 men and 26 women aged 80 and more), from the DM duration from the moment of diagnostics (121 men and 82 women with DM diagnosed for the first time, 307 men and 235 women with DM duration 1-5 years, 348 men and 303 women with DM duration of 6-10 years, 203 men and 208 women with DM duration of 11-15 years, 125 men and 151 women with DM duration 16-20 years, 68 men and 87women with DM duration over 20 years, not included into the study 14 men and 12 women whose DM duration was impossible to establish, place of the patients residence (160 men and 164 women from villages, 1026 men and 914 women from the cities, social status of the patients (425 men and 711 women pensioners, 90 men and 77 women with disabilities, 271 men and 92 women unemployed of working age, 400 men and 198 women employed, 786 men аnd 880 women from the most vulnerable population (MVP, pensioners+disabled people+unemloyed people, BMI (147 men and 125 women with BMI 18.5-24.9 kg/m2, 398 men and 281 women with BMI 25-29.9 kg/m2, 325 men and 293 women with BMI 30-34.9 kg/m2, 135 men and 160 women with BMI 35-39.9 kg/m2, 53 men and 96 women with BMI over 40 kg/m2, not included into the studying 4 men and 2 women with BMI less than 18.5 kg/ m2 due to the indexes toll low for the analysis, and 124 men and 121 women, whose BMI cannot be determined), level HbА1с (57 men and 30 women with HbА1с up to 6.0%, 185 men and 104 women with HbА1с 6.1-7.0%, 204 men and 174 women with HbА1с 7.1-8.0%, 209 men and 199 women HbА1с 8.1-9.0%, 190 men and 165 women with HbА1с 9.1-10.0%, 271 men and 340 women with HbА1с over 10.0%, not included into the studying 70 men and 66 whose level of HbА1с has not been determined for different reasons), DM complications and their combinations (163 men and 104 women with Miocardial Infarction (ІМ), 1,023 men and 974 without ІМ, 91 men and 107 women with the blood-stroke, 1,095 men and 971 women without the blood stroke, 448 men and 257 women with the diabetic foot disease (DFD), 738 men and 821 women without DFD, 32 men and 13 women with ІМ+blood-stroke, 98 men and 32 women with ІМ+DFD, 54 men and 32 women with blood-stroke+DFD, 20 men and 5 women with ІМ+DFD+blood-stroke, 645 men and 678 women without any macro-vascular events, 326 men and 318 women with the diabetic angiopahy of lower extremities (DAP), 860 men and 760 women without DAP, 953 men and 874 women with DDNP, 233 men and 204 women without DDNP, 246 men and 187 women with diabetic Distal Nephropathy (DNP), 940 men and 891 women without DNP, 257 men and 292 women with Diabetic Encephalopathy (DEP), 929 men and 786 without DEP, 654 men and 665 women with diabetic retinopathy (DRP), comorbidities (310 men and 240 women with dislipidemy, 876 men and 838 women without dislipidemy, 401 men and 439 women with Arterial Sclerosis of Head and Neck (ASHN), 785 men and 639 without ASHN, 358 mend and 285 women with the Arterial Sclerosis of Lower Extremities (ASLE), 828 men and 793 women without ASLEК, 200 men and 178 women with ASHN+ASLE, 621 men and 528 women without atherosclerosis of peripheric vessels, 986 men and 944 women with Cardio-Vascular Diseases (CVD), 200 men and 134 women without CVD, 865 men and 862 women with Arterial Hypertension (AH), 321 men and 216 women without AH, 53 men and 95 women with oncological diseases, 1133 men and 983 women without oncological diseases, 392 men and 634 women with other endocrine diseases, 794 men and 444 women without other endocrine diseases, 508 men and 542 women with obesity, 561 men 421 without obesity.

Medical and social factors were studied with the application of the comparative data analysis. For statistical processing of data Statistika 10.0 (StatSoft) software was applied.

The study showed statistically higher frequency of DRP in all studied groups of women (61.69% vs.55.14% in all studied groups of men р=0,002) and women aged under 40 and 60-69, pensioners, with the DM duration of 11-15 years, cities, HbА1с 7.1-8.0%, 9.1-10.0% and over 10,0%, DDNP and women without ІМ, blood-stroke, DFD, macro-vascular events, ALE, DNP, DEP, dislipidemy, ASHN, ASLE, CVD, AH, oncological and other endocrinologic diseases and men aged 80 and more, with statistically the same indexes of men and women in other categories of patients Table 1.

Table 1: DRP incidence of T2D patients depending upon the social and medical factors, n (%).

Not determined statistical differences of the DRP incidence of patients of different sexes pensioners, disabled people, unemployed people, IM, blood-stroke, IM+DFD, blood-stroke+DFD, DEP, ASHN+ASLE, CVD, AH, oncological and other endocrinology diseases, obesity, and patients without IM, blood-stroke, ALE, DEP, dislipidemy, ASLE, atherosclerosis of peripheric vessels, AH, oncological and other endocrinology diseases, obesity; men depending upon BMI and level of HbА1с, employed people, with IM+bloodstroke, IM+DFD+blood-stroke, ASHN and men without ASHN; women depending upon the patients’ age and place of residence, with DFD, ALE, DDNP, dislipidemia, and women without DFD, macrovascular events, ALE and CVD.

However, the statistical differences of DRP incidence were established depending upon other social and medical factors, in particular, almost double growth of DRP incidence with the increase of DM duration. Noteworthy is the different level of impact on DRP incidence of the ALE and ASLE condition, for men living in the rural areas, CVD, ALE, and DDNP, for women BMI 30-34.9kg/ m2, HbА1с 7.1-8.0%, IM+blood-stroke, IM+DFD+blood-stroke and absence of ASHN condition.

At the same time it was found that the development of DRP was accompanied by the statistically longer average duration of DM, incidence of DDNP, DNP and ASLE of the patients of different sex, higher average age of the patients, proportion of the village residents, average IM, incidence of DFD, CVD, and AH of men, higher proportion of MVP among women, but statistically lower incidence of dislipidemy of men and ASHN of women with the statistically similar indexes of the patients of different sexes concerning other studied indexes Table 2.

Table 2: Social and medical factors of T2D patients with DRP.

Note: Р is the probability of differences of the inter-group comparisons as compared to the index of all patients without DRP