Retino-Renal Dissociation in Type 2 Diabetes Mellitus: An Observational Cross Sectional Study at a Tertiary Care...

Diabetic retinopathy, the diabetes-specific long-term microvascular complication is an important predictor of diabetic nephropathy. Diabetes induced retinopathy mostly proceeds nephropathy in patients with Type1 diabetes; however, this sequence is not consistent in patients with Type 2 diabetes and has significant discordance.

It was a hospital-based prospective, observational study conducted at Indira Gandhi Medical College, Shimla Himachal Pradesh a tertiary care center in the sub-Himalayan region of India from July 2016 to June 2017. A total of 141 patients were recruited in this study period.

141 patients with type 2 diabetes, 83(58.9%) males,58(41.1%) females were recruited in the study. The mean duration of diabetes in this study was 5.78±6.21 years. Mean HbA1C in our study was 9.66±3.04%. 79(56.0%) patients in our study had HbA1C more than 9.0% while 39(27.7%) had HbA1C between 7.0- 9.0%. only 23 (16.3%) patients had HbA1C less than 7.0%. A total of 118 (83.7%) patients had poor glycaemic control. Out of a total of 141 patients, DKD (albuminuria and/or reduced eGFR) was present in 67 (47.52%) patients. 33 had diabetic retinopathy.

The relationship between retinopathy and nephropathy in type 2 diabetic patients is not as clear as in type 1 diabetic patients. Patients with type 2 diabetes do not have diabetic nephropathy always and non-diabetic renal disease is also quite common. The absence of retinopathy, rapid progression diabetes, presence of RBC, and cast are some of the atypical findings, and patients presenting with them should be subjected to renal biopsy to rule out non-diabetic renal disease (NDRD).