Prevalence and factors associated with diabetic retinopathy, a multi-centric study in Kuwait

Diabetic retinopathy [DR] remains one of the major causes of vision loss and blindness in young adults despite the availability of effective treatment. To determine the prevalence of DR among adult diabetic patients attending primary health care centers in Kuwait and to identify factors that could be associated with DR. The current study is a part of a larger multi-centric one. The first phase of the study is a cross sectional one to determine the prevalence of DR among diabetic patients attending the selected primary health care centers. The second one was a nested case-control study, whereas all patients with DR [case group n = 216] were compared with all other diabetic patients without DR [control group n = 488] to determine the associated factors with cases. A pre-designed questionnaire included socio-demographic, clinical data, in addition to health care characteristics and personal practice. Basic univariate analyses were followed by multiple logistic regression analysis. The prevalence of DR among adult diabetic patients attending primary health care centers was 43.6%. Of the personal factors examined, age was the only significant determinant of DR [OR = 2.2, 95% CI: 1.1 - 5.2] and [OR = 4.6, 95% CI: 2.0 - 11.0] for age groups 50 - 59 and > 60 as compared with those < 40 years respectively. Among clinical factors, patients with type 2 - insulin treated diabetes were more prone to have DR [OR = 8.0, 95% CI: 3.5 - 19.4]. Duration of diabetes was a significant predictor of DR [OR = 2.6, 95% CI: 1.61 - 4.2] and [OR = 2.8, 95% CI: 1.5 - 5.5] for a duration of 10 - 19 and > 20 years as compared with < 10 years respectively. Also, poor glycemic state and uncontrolled hypertension were associated factors [OR = 2.0, 95% CI: 1.2 - 2.8] and [OR = 3.1, 95% CI: 2.0 - 4.9] respectively. Cardiovascular complications, neuropathy, nephropathy and diabetic foot were significantly associated with DR. Within patients' practice, regular follow-up was proved to be a protective factor [OR = 0.5, 95% CI: 0.3 - 0.8] Regular follow-up is the strongest modifiable risk factor for DR. Old patients with longer duration of diabetes particularly those having other types of long term diabetic complications and on insulin therapy are more prone and should be regularly screened for DR

Impact of patient satisfaction with health care on glycaemic control among diabetic patients

Patient satisfaction with medical care is an important factor affecting treatment outcome in a chronic disease like diabetes mellitus. This study was formulated to detect the impact of patient satisfaction on glycaemic control among diabetic patients. The cross-sectional design was selected. A sample size of 526 diabetic patients was selected from a diabetes clinic to reveal the impact of patient satisfaction on fasting blood glucose and glycated haemoglobin A1c. The structured interview technique was adopted to collect both socio-demographic and clinical data of diabetic patients in addition to a fasting blood sample. The overall satisfaction and communication domains have the highest satisfaction mean scores [14.27 +/- 1.878 and 13.65 +/- 1.476], while accessibility and waiting time domains have the lowest satisfaction scores [8.97 +/- 2.059 and 8.99 +/- 1.387]. Diabetics with higher total satisfaction score were practicing regular periodic check up [82.37 +/- 7.027 compared with 78.63 +/- 7.538, P < 0.001], diet control [82.55 +/- 6.632 compared with 80.88 +/- 7.596, P = 0.0113] and were adherent to treatment regimen [81.96 +/- 7.072 compared with 77.92 +/- 8.068, P < 0.001]. Diabetic patients achieving the targeted level of either fasting blood glucose [83.35 +/- 6.777 compared with 80.72 +/- 7.418, P <0.001] or HbA1c [85.66 +/- 5.211 compared with 80.48 +/- 7.415, P < 0.001] had a significantly higher total satisfaction score than those not achieving the targeted levels. Satisfied diabetics with administered health services were more adherent to healthy practices and had a better control on HbA1c the long term component of glycaemic control