Prevalence and Risk Factors of Diabetic Retinopathy in Xuzhou, China: A Cross-Sectional Study

Background: The prevalence of diabetic retinopathy is not well studied in the Chinese diabetic population. This study investigated the prevalence and risk factors of diabetic retinopathy (DR) among primary care patients with type 2 diabetes mellitus in Xuzhou, China. Methods: 1578 Chinese patients with type 2 diabetes mellitus who were selected with a multi-stage stratified cluster method, retinal photographs were taken of both eyes. The levels of DR were assessed using fundus photography and the Diabetic Retinopathy Disease Severity Scale. Demographic and physiological characteristics were recorded. Participants completed the Pittsburgh Sleep Quality Index and the Zung Self-Rating Anxiety and Depression Scales. Multiple logistic regression was used to evaluate the factors associated with DR. Results: The rate of DR was 28.6%; 25.1% of patients (396/1578) had non-proliferative DR and 3.5% of patients (55/1578) had proliferative DR. Logistic regression analyses showed that HbA1c levels, diabetes duration, hypertension, smoking, anxiety, depression, poor sleep quality, and exercise were independently associated with DR. Conclusions: DR is common in patients with type 2 diabetes mellitus in China. Screening tests for DR should be incorporated into health care settings in China. Patients who have been registered for a long time, or have poor glycemic control, concomitant hypertension, psychological disorders, or sleep disorders, should be considered for early screening of DR.