Avaliação da prevalência da retinopatia diabética em indivíduos com diabetes tipo 1 nas regiões geográficas do Brasil: estudo multicêntrico nacional

Abstract

Diabetic Retinopathy has a significant impact in every healthcare system. Despite that fact, there are few precise current estimates of the prevalence of DR in Brazil s different geographic regions. This study aims to determine the prevalence of diabetic retinopathy in Brazil s five continental regions and its determinant factors. Methods: This multi center, cross-sectional, observational study, conducted from August 2011 to December 2014, included patients with type 1 diabetes from the 5 Brazilian geographic regions (South, Southeast, North, Northeast and Midwest). During a clinical visit, a structured questionnaire was applied, blood sampling was collected and each patient underwent mydriatic binocular indirect ophthalmoscopy evaluation. Data was obtained from 1644 patients, aged 30.2 ± 12 years (56.1% female, 54.4% Caucasian), with a duration of diabetes of 15.5 ± 9.3 years. The prevalence of diabetic retinopathy was 242 (36.1%) in the Southeast, 102 (42.9%) in the South, 183 (29.9%) in the North and Northeast and 54 (41.7%) in the Midwest. In the matter of DME, prevalence in the Midwest region was higher [9 (7.1%) vs 17 (2.5%) in the Southeast, 3 (1.3%) in the South and 10 (1.6%) in the North and Northeast, p=0.007]. Multinomial regression showed no difference in the prevalence of non-proliferative diabetic retinopathy in each geographic region, although, prevalence of proliferative diabetic retinopathy (p=0.022) and diabetic macular edema (p=0.003) were higher in the Midwest. Stepwise analyses revealed duration of diabetes, level of HbA1c and hypertension as independent variables. The prevalence of non-proliferative diabetic retinopathy in patients with type 1 diabetes was no different among each geographic region of Brazil. The Midwest presented higher prevalence of proliferative diabetic retinopathy and diabetic macular edema. Duration of DM and glycemic control is of central importance to all. Hypertension is another fundamental factor to every region, at special in the South and Southeast. Glycemic control and patients in social and economic vulnerability deserves special attention in the North and Northeast of Brazil.