Abstract:

Objective To investigate the association of self-management behaviors (SMB) and diabetic retinopathy (DR) in patients with type 2 diabetes(T2DM) in community. Design Cross-sectional study. Participants A total of 252 patients with T2DM in annual health examination in Yinhu community health care centers in Shenzhen. Methods All patients were surveyed using the summary of diabetes self-care activities questionnaire (SDSCA), and divided into behavior good, medium and poor according to the results, and tested fasting blood-glucose (FBG) and glycosylated haemoglobin(HbA1c ). Patients were classified into diabetic without retinopathy (DWR), non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) according to fundus examination. The differences of the levels of SMB and blood glucose between DR and DWR were compared. Main Outcome Measures The levels of SMB, FBG and HbA1c. Results 228 cases of 252 patients with T2DM completed the surveys and the response rate was 90%. There were 62 cases(27.2%) with DR. The duration of diabetes was more than 10 years in 34 cases (54.8%) with DR and 65 cases (39.2%) with DWR (χ2=4.519, P=0.034). Of 228 cases with T2DM, the level of SMB was satisfactory and good in 20.6%, medium in 50.9%, and poor in 28.5%. Of 228 cases with T2DM, 29.4% had achieved an ideal level of FBG and 28.5% had an ideal level of HbA1c. The good rate of the level of SMB in cases with DR and DWR was 11.3% and 24.1% respectively(χ2=4.524, P=0.033). Of the cases with DR, 19.4% and 17.7% had achieved an ideal level of FBG and HbA1c, and of the cases with DWR the corresponding rate was 33.1% and 32.5% respectively(χ2=4.129, P=0.042; χ2=4.844, P=0.028). The poor rate of SMB was 15.0%, 20.2% and 41.4% respectively in patients with duration of diabetes less than 5 years, 5~10 years and more than 10 years respectively, and 25.9%, 28.0% and 66.7% in patients which classified as DWR, NPDR and PDR(χ2=16.764, P=0.002; χ2=9.132, P=0.010). In the multifactor Logistic regression model, diet behavior (OR=0.241, 95%CI:0.163~0.287), exercise behavior (OR=0.536, 95%CI: 0.481~0.692), following directions to take medications (OR=0.056, 95%CI:0.018~0.172), FBG≤7.0 mmol/L (OR=2.255, 95%CI:1.315~3.873), HbA1c≤7.0% (OR=1.376, 95%CI:1.197~1.584) and duration of diabetes(OR=0.573, 95%CI: 0.038~0.714) were associated with higher risk of DR. Conclusion Higher risk of DR is associated with longer duration of diabetes, poor diet, less exercise, lower obedience to use medicine, lower rate of the control of FBG and HbA1c to normal level. This study suggested that improving the levels of SMB would be benefitial to controlling glucose levels and reduced the risk of DR in patients with T2DM in community. （Ophthalmol CHN，2016, 25： 326－329）

Key words: type 2 diabetes, diabetic retinopathy, community, self-management behaviors