• Vol. 38 No. 12, 1048–1055
  • 15 December 2009

Lack of Awareness amongst Community Patients with Diabetes and Diabetic Retinopathy: The Singapore Malay Eye Study



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Introduction: We assessed awareness of diabetes and diabetic retinopathy in a Singaporean Malay population. We hypothesised that poor awareness is associated with poorer control of diabetic retinopathy risk factors (glycaemic and blood pressure levels) and suboptimal treatment with laser therapy. Materials and Methods: A population-based survey of 3280 (78.7% response rate) persons among Singaporean Malays aged between 40 and 80 years old. Diabetes was defined in persons with random glucose ≥11.1mmoL/L, use of diabetic medication, or a previous physician diagnosis. Diabetic retinopathy was graded from retinal photographs following the modified Airlie House classification. Patient awareness was assessed via structured interviews. Glycosylated haemoglobin was measured from venous blood. Results: Of the 3280 study participants, 768 had diabetes, of whom 13.2% (n = 101) were unaware of their diabetes status. Participants unaware of their diabetes status had significantly higher mean glycosylated haemoglobin (9.7% vs 8.2%, P <0.001), systolic blood pressure (160.0 mmHg vs 153.7 mmHg, P = 0.01) and diastolic blood pressure (83.5 mmHg vs 78.5 mmHg, P <0.001), compared to participants who were aware. Of the 272 (35.4%) participants detected to have diabetic retinopathy, 83.4% (n = 227) were unaware of having retinopathy. Of the 77 with vision-threatening retinopathy, laser treatment had been performed in only 55.6% of those unaware of having retinopathy. Conclusion: In a sample of Malays with diabetes, high proportions were unaware of their disease. Unawareness was associated with poorer control of diabetic retinopathy risk factors. Only half of persons who were unaware that they had vision-threatening diabetic retinopathy had received laser treatment. These data highlight room for improvement in diabetic retinopathy prevention through better patient education and screening.

Diabetes is a major public health problem, and diabetic retinopathy is the leading cause of blindness in working-aged people.1 Previous studies have documented poor attainment of guidelines of glycosylated haemoglobin (HbA1c) and blood pressure control2 and eye care utilisation3-6 in the prevention of diabetic retinopathy. Studies have also documented poor knowledge of diabetes7 and diabetic retinopathy.8 One study of 1333 patients with Type 2 diabetes conducted in Tokyo’s Women’s Medical University in 2003 found that 32.0% did not know, and 16.5% were uncertain if they had diabetic retinopathy.8 Furthermore, patients who were unaware that they had diabetic retinopathy were less likely to be compliant to regular ophthalmic screening.

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