A Clinical Study on Correlation of Albuminuria with Different Stages of Diabetic Retinopathy

Aim: To study the correlation of albuminuria with different stages of sight threatening diabetic retinopathy Objectives: Primary Objective � To study the association of albuminuria with sight threatening diabetic retinopathy. � To estimate the correlation of albuminuria with progression and treatment. response in different stages of sight threatening diabetic retinopathy. Secondary Objective: � To study the association of other systemic factors like HbA1c, Serum lipids with stages of sight threatening diabetic retinopathy Materials and methods: Prospective follow up case series done in SANTHIRAM MEDICAL COLLEGE AND GENERALHOSPITAL, NANDYAL. The study was done from JULY 2017 to MARCH 2019. Inclusion criteria: � Patients with Type 2 diabetes mellitus referred from physician in Santhiram medical college and general hospital for DR screening. � Patients with sight threatening diabetic retinopathy ( i. e. severe NPDR with or without macular edema, PDR with or without macular edema). � Patients willing to undergo treatment for diabetic retinopathy as and when required. � Patients willing to come for follow-ups. Exclusion criteria: � Pregnancy � Accelerated Hypertension � Patients with chronic kidney disease and patients on dialysis � Patients with urinary tract infection (UTI) � Patients with malignancies � History of recent ocular surgeries � Patients with ocular conditions that can lead to macular edema like retinal venous occlusion, intra-ocular surgery, inflammation, age related macular degeneration, serous chorioretinopathy etc SAMPLE SIZE � The study recruited a total of 125 patients of diabetes mellitus with sight threatening diabetic retinopathy. Study type: Prospective follow-up case series. METHODOLOGY � Written informed consent was taken from all patients prior to their inclusion in the study. � Subjects recruited after being diagnosed as having diabetic mellitus as per American diabetes association criteria (ADA) 60 by the physician of the institute with blood tests like HbA1c, Serum lipid profile and urine routine including albumin. � Patients underwent undilated and dilated fundus examination with 90 D and 20 D lens using slit lamp and Indirect ophthalmoscope after taking thorough history. � Diabetic retinopathy was identified on comprehensive clinical examination. � These subjects then underwent colour fundus photography, Optical Coherence Tomography (OCT) and Fluorescein angiography if required. � Based on the findings of clinical and imaging modalities, Diabetic retinopathy in the subjects was classified according to the ICDS classification. � Subjects were divided into three groups: Group 1 (severe NPDR), Group 2 (PDR) with or without macular edema. � A spot urine albumin concentration61 was measured for the subjects in each group � using Automatic calibrator machine in the hospital laboratory as advised by treating physician associated with the hospital. � Also, fasting and post prandial blood sugar, Serum creatinine, Serum triglycerides, High Density Lipoproteins (HDL), Total cholesterol levels were noted for each subject from previous health records retrospectively which is of less than 1 month duration. � Health records were taken from the hospital records as it is stored in the hospital medical record department. � Depending on the values, patients were categorised as normoalbuminuria (less than 20gm/L), micro albuminuria (20 - 200gm/L), and macro albuminuria ( � greater than200gm/L). � Patients were given treatment as required (Intravitreal injection for patients with macular edema, Pan retinal photocoagulation for PDR patients, close observation and follow up every 2-3 months for SNPDR and PDR group, monthly for CSME patients) � Patients were followed up at 6 months from the initial visit during which thorough fundus examination was performed along with repetition of the urine tests. RESULTS: � The study involved a total of 110 patients with Type 2 diabetes with vision threatening diabetic retinopathy. � The subjects were sorted into 2 groups which were � A) Pts with Severe NPDR with 55 patients with or without macular edema, � B) Pts with PDR with 55 patients with or without macular edema. � The patients underwent baseline evaluations on the first visit and were followed up after 6 months of first visit. The mean duration of diabetes in SNPDR group was 16.9 � 8.0 years and 17.0 � 8.9 years in PDR group. No significant difference was observed in the mean duration of diabetes between two groups. � The median BCVA in the SNPDR group was 6/12 (range being 6/6 to HM +ve) and PDR group was 6/24 (range being 6/7.5 to HM +ve). � A statistically significant difference was observed between the two groups in BCVA (p value= 0.030) Among the SNPDR group, 40 % of the subjects had CSME and in PDR group 38.1 % of the subjects of CSME. In our study, majority of patients had elevated HbA1C and Total serum Cholesterol in both the SNPDR and PDR g