Factors affecting diabetic retinopathy among Chinese adults: a meta-analysis / 预防医学

ABSTRACT

Objective@#To systematically evaluate the factors affecting diabetic retinopathy (DR) among Chinese adult patients with type 2 diabetes mellitus (T2DM), so as to provide insights into establishment of personalized risk prediction models for DR.@*Methods@# Case-control studies pertaining to factors affecting DR among Chinese adults were retrieved from international and national databases, including CNKI, Wanfang Data, SinoMed, PubMed, Web of Science, Embase and CINAHL from inception to March 31, 2023. A meta-analysis was performed using the software Stata 17.0, and subgroup analysis was performed to explore the source of heterogeneity. Sensitivity analysis was performed using the leave-one-out method, and the publication bias was evaluated using the Egger's test and trim-and-fill method. @*Results@#Totally 4 969 publications were retrieved, and 35 case-control studies were finally enrolled, including 32 high-quality publications (91.43%). The included studies involved 29 228 participants and 10 568 DR patients, and the prevalence of DR was 36.16%. Meta-analysis revealed that age (OR=1.06, 95%CI: 1.00-1.13), duration of T2DM (OR=1.09, 95%CI: 1.08-1.11), systolic blood pressure (OR=1.02, 95%CI: 1.01-1.03), glycated hemoglobin A1c (OR=1.38, 95%CI: 1.26-1.50), fasting blood glucose (OR=1.57, 95%CI: 1.07-2.31), urinary albumin to creatinine ratio (OR=1.50, 95%CI: 1.10-2.04), serum uric acid (OR=1.01, 95%CI: 1.00-1.01), urine microprotein (OR=2.01, 95%CI: 1.96-2.07), triglyceride (OR=1.77, 95%CI: 1.42-2.21), and total cholesterol (OR=1.82, 95%CI: 1.50-2.21) were risk factors for DR, and glomerular filtration rate (OR=0.98, 95%CI: 0.97-0.98) and C-peptide (OR=0.79, 95%CI: 0.68-0.93) were protective factors for DR. Sensitivity analysis of age effects was not robust. Following adjustment for glomerular filtration rate with the trim-and-fill method, there was still a publication bias, and the publication bias of other influencing factors had no impact on pooled effects. @*Conclusions@#Age, course of T2DM, systolic blood pressure, glycated hemoglobin A1c, fasting blood glucose, urinary albumin to creatinine ratio, serum uric acid, urine microprotein, triglyceride and total cholesterol were risk factors, and glomerular filtration rate and C-peptide were protective factors for DR among Chinese adults.