Background. Diabetic retinopathy (DR) remains to be the leading cause of blindness worldwide. Traditionally, risk factors such as diabetes duration, HbA1c levels, hypertension and dyslipidemia have been closely linked to the development of this condition. However, recent research suggests that these factors account for only a portion of DR cases. Emerging studies highlight additional potential risk factors including diabetic nephropathy, insulin use, and body mass index -though data on these factors remain limited and at times contradictory. While there have been a few local studies exploring some of these variables, none have comprehensively examined how these factors collectively influence the occurrence and severity of diabetic retinopathy. This study aims to asses both the factors associated with presence and occurrence of diabetic retinopathy.

Methodology. This analytical cross-sectional study included patients with diabetes (n=201, aged 18 years and older) who underwent fundus photography at The Medical City Ortigas between January 1, 2022, and December 31, 2022. Data collection involved a thorough review of patient records, which provided demographic information and details on potential risk factors. The presence and severity of diabetic retinopathy (DR) were assessed based on fundus photography results, as interpreted by ophthalmologists. To evaluate the statistical significance of the association between risk factors and DR status, logistic regression analysis was done.

Results. Duration of diabetes (odds ratio [OR] 1.07; 95% CI, 1.01-1.13 per year increase), HBA1c (OR 1.4; 95% CI, 1.1-1.86), fasting blood sugar (OR 1.4; 95% CI, 0.977-0.998), hypercholesterolemia (OR 5.02; 95% CI 1.67-16.44) and presence of nephropathy (OR 3.39; 95% CI 1.49-8) were correlated with diabetic retinopathy.

In terms of severity, mild non proliferative diabetic retinopathy was associated with a lower creatinine eGFR (OR 1.03; 95% CI 1.003-1.06) while HBA1c (OR 1.42; 95% CI 1.02-2.05), presence of nephropathy (OR 10.35; 95% CI 2.08-74.22) and hypercholesterolemia (OR 20.64; 95% CI 3.4-182.8) were associated with moderate to severe non proliferative diabetic retinopathy. Insulin use (OR 6.48; 95% CI 1.22-47.82), elevated microalbumin creatinine ratio (OR 1.001; 95% CI 1.001-1.002) and presence of macroalbuminuria (OR 93.69; 95% CI 9.83-12538.71) were associated with proliferative diabetic retinopathy.

Conclusion. The presence of diabetic retinopathy was significantly associated with several clinical factors. Each additional year of diabetes mellitus duration was associated with a 1.07-fold increase in the likelihood of DR. Additionally, each 1% increase in HbA1c was linked to a 1.40-fold increase in DR risk. The presence of diabetic nephropathy and hypercholesterolemia were also strong predictors, associated with a 3.39-fold and 5-fold increase in the likelihood of DR, respectively. Glycemic control, dyslipidemia and nephropathy appear to be associated with more severe forms of diabetic retinopathy. Clinicians handling diabetes patients with this patient profile should be wary of this diabetes complication.

Keywords. Diabetic Retinopathy, Risk factors, severity

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