# Prevalence and Associated Factors of Diabetic Retinopathy in Type 2 Diabetes Mellitus Patients at a Specialized Hospital in Asmara, Eritrea: A Cross‐Sectional Study

## TL;DR

This study finds that nearly 40% of Type 2 diabetes patients in Eritrea have diabetic retinopathy, with longer diabetes duration and kidney issues being key risk factors.

## Contribution

The study provides the first detailed assessment of diabetic retinopathy prevalence and risk factors in Eritrea, a region where such data is scarce.

## Key findings

- Diabetic retinopathy prevalence was 39.5% among Type 2 diabetes patients in Eritrea.
- Reduced kidney function and longer diabetes duration were strongly associated with retinopathy.
- Insulin use and elevated C-reactive protein levels also correlated with increased retinopathy risk.

## Abstract

Diabetic retinopathy (DR) is a progressive microangiopathy affecting the retinal microvasculature and is a leading cause of preventable blindness in adults globally. Despite its significance, DR remains under‐investigated in sub‐Saharan Africa. This study was aimed at determining the prevalence of DR and its associated factors in Type 2 diabetes mellitus (T2DM) patients attending a specialized hospital in Asmara, Eritrea.

A cross‐sectional study was conducted involving 309 T2DM patients from the diabetes follow‐up clinic at Halibet Referral Hospital, Asmara. Data were collected through structured questionnaires, clinical records, and biochemical analysis of blood samples. Ophthalmologic evaluation for DR was performed by eye specialists using ophthalmoscopy. Statistical analysis, including logistic regression, was performed to identify factors associated with DR.

The mean age of the participants was 57.8 ± 11.47 years, with an average disease duration of 12.14 ± 7.42 years. The prevalence of DR was 39.5% (95% CI: 34.03–44.9). Among these, 17.6% (95% CI: 11–25.1) had vision‐threatening DR. Factors significantly associated with DR included reduced estimated glomerular filtration rate (eGFR < 60 mL/min/1.73 m2) (aOR = 1.84, 95% CI: 1.05–3.20; p = 0.033), insulin use (aOR = 0.523, 95% CI: 0.295–0.93; p = 0.039), and longer duration of diabetes (> 8 years) (aOR = 0.24, 95% CI: 0.006–0.935; p = 0.040). Other factors associated with DR in the adjusted model were abnormal waist circumference (aOR = 0.298, 95% CI: 0.11–0.83; p = 0.021) and C‐reactive protein positivity (aOR = 2.65, 95% CI: 1.05–6.66; p = 0.039).

The prevalence of DR among T2DM patients in Eritrea is high. Longer disease duration, reduced eGFR, and insulin use were significantly associated with DR. Early detection and management of these risk factors may help mitigate the burden of DR in diabetic patients.