Casmuti Casmuti, Intan Zainafree, Widya Hary Cahyati, Dina Nur Anggraini Ningrum, Muhamad Zakki Saefurrohim, Abdul Hakam, Irma Zaimatuddunia, Henky Yoga Prasetya, Alek Jusran, Muhamad Irsam

Factors of Diabetic Retinopathy among Type 2 Diabetes Mellitus Patients in Central Java Province, Indonesia

Introduction

Factors of diabetic retinopathy among type 2 diabetes mellitus patients in central java province, indonesia. Explore factors associated with diabetic retinopathy in Type 2 DM patients in Central Java, Indonesia. Key factors include DM diet, age, duration of DM, hypertension, blood glucose, and HbA1c.

Abstract

One of the microvascular complications of type 2 diabetes mellitus is diabetic retinopathy. The prevalence of diabetes mellitus in Central Java Province in 2022 by 10% increased to 12.52% in the third quarter of 2023. This prevalence rate has not reached the SDG's target, namely there is no increase in diabetes prevalence by 0%. The purpose of this study is to analyze factors associated the incidence of diabetic retinopathy in type 2 DM patients at Central Java Provincial Hospital in 2023. This research is quantitative research with a nested case control study design, using electronic medical record data from the Central Java Provincial Hospital in 2023. The variables in this study were gender, age, education level, employment status, marital status, health insurance status, BMI, DM diet, duration of DM, hypertension, other diseases, current blood glucose, and HbA1c. The analysis used was univariate, bivariate, and multivariate analysis (logistic regression). The results showed that there was association between age ≥70 years (p=0.006), DM diet (p<0.0001, OR=20.914), duration of DM (p=0.003, OR=3.010), hypertension (p=0.013, OR=2.619), other diseases including cataracts (p=0.040, OR=9.00), glaucoma (p=0.007), CHD (p=0.040, OR=9.00), and cardiomegaly (p=0.016), current blood glucose (p=0.045, OR=2.478), and HbA1c (p<0.0001, OR=6.152). DM diet is the most dominant factor associated with diabetic retinopathy in type 2 DM patients.

Review

This study addresses a highly relevant public health issue, examining the factors associated with diabetic retinopathy (DR) among type 2 diabetes mellitus (DM) patients in Central Java Province, Indonesia, where DM prevalence is on the rise and has not met SDG targets. The use of a nested case-control design leveraging electronic medical record data from a provincial hospital for 2023 is an efficient approach to investigate this complex multifactorial condition. The research employed comprehensive statistical analyses, including univariate, bivariate, and multivariate logistic regression, to explore a broad range of socio-demographic, clinical, and lifestyle variables. The identification of age, DM diet, duration of DM, hypertension, specific comorbidities (cataracts, glaucoma, CHD, cardiomegaly), current blood glucose, and HbA1c as significant associated factors provides valuable insights, with the DM diet notably highlighted as the most dominant factor. While the study offers important contributions, several methodological aspects warrant critical consideration. The reliance on electronic medical record data from a single provincial hospital, while practical, inherently limits the generalizability of the findings beyond this specific institution and potentially introduces biases from data recording inconsistencies or incompleteness. The retrospective nature of the nested case-control design, while identifying associations, may struggle to definitively establish causality for all factors. Furthermore, the abstract's reporting of "other diseases" as a composite factor, followed by specific conditions like cataracts and CHD with identical p-values and odds ratios, is somewhat ambiguous and requires clarification to ensure accurate interpretation. A crucial limitation is the lack of detail regarding how "DM diet" was assessed from the electronic medical records, especially given its extraordinarily high odds ratio (OR=20.914); the precision and depth of this variable's measurement are vital for interpreting its reported dominance. Finally, the abstract does not specify the sample size, which is fundamental for evaluating the study's statistical power and the robustness of its conclusions. Despite these limitations, the findings hold significant clinical and public health implications, reinforcing the critical importance of rigorous glycemic control (HbA1c, current blood glucose), hypertension management, and especially strict adherence to a DM diet in preventing and managing diabetic retinopathy. The strong association with diet underscores the need for enhanced dietary counseling and education programs for type 2 DM patients in Indonesia. Future research would benefit from expanding to multi-center studies across Central Java or even nationally to improve generalizability. Prospective cohort studies could provide stronger evidence for causality and offer more granular data on dietary habits and other lifestyle factors. Additionally, future investigations should explicitly clarify the methodology for assessing composite variables like "other diseases" and provide detailed information on sample size and specific diagnostic criteria for diabetic retinopathy to enhance the transparency and reproducibility of the research.

Full Text

Comments

You need to be logged in to post a comment.