Diabetes mellitus (DM) is widely acknowledged as a significant public health issue on a global level due to its considerable increase in frequency in recent times [1]. In addition, apart from its corrosive effect on individuals, DM also presents a substantial economic burden on governments [2]. As per the guidelines provided by the World Health Organisation (WHO), Diabetes Mellitus (DM) is defined by a fasting plasma glucose level of 7.0 mmol/l (126 mg/dl) or higher or a two-hour plasma glucose level of 11.1 mmol/l (200 mg/dl) or higher [3]. The symptoms of diabetes mellitus (DM) sometimes present with less prominent manifestations in the early stages, leading to a significant number of patients being diagnosed after complications have already developed [4,5]. Inadequate insulin secretion and impaired insulin utilisation can lead to chronic hyperglycemia. This condition can potentially result in serious and life-threatening consequences, including cardiovascular diseases, retinopathy, nephropathy, and neuropathy [6]. According to the American Society of Retina Specialists, diabetic retinopathy (DR) is a diabetic complication characterised by the dysfunction of retinal blood vessels. The retina, a photosensitive tissue situated at the posterior portion of the eye, plays a crucial role in visual acuity and the perception of fine details [7]. The World Health Organisation (WHO) has reported a substantial rise in the global prevalence of diabetes in adults aged 18 years and above, as the supplied statistics indicate. The prevalence of the condition mentioned above has exhibited an upward trend, increasing from 4.7% in the year 1980 to 8.5% in the year 2014. The user's text is already academic and does not require any rewriting. Based on the publication of the ninth edition of the Diabetes Atlas by the International Diabetes Federation in 2019, it is anticipated that the worldwide prevalence of diabetes is approximately 463 million individuals. Moreover, it is anticipated that this figure will increase to 700 million by the year 2045,[9] with a more substantial expansion being recorded in developing countries. The existence of several complications associated with diabetes mellitus (DM) will place a substantial burden on the healthcare system. According to data presented by the World Health Organisation (WHO), the prevalence rate of diabetes in India in 2016 was around 7.8%, with an estimated total of 102.26 million cases. The observed prevalence rate exhibited a minor disparity between males, at 7.9%, and females, at 7.5%. The user's text does not provide any information to rework in an academic manner. The user did not provide any text to rewrite. Diabetes is a pathological condition that demonstrates a substantial association with the emergence of both microvascular and macrovascular problems. The consequences above include retinopathy, nephropathy, and neuropathy as examples of microvascular issues, whereas ischemic heart disease, peripheral vascular disease, and cerebrovascular disease are representative of macrovascular complications. As a result, these difficulties give rise to adverse consequences for multiple organs and tissues in the human body. According to the source cited in reference [11], Diabetic Retinopathy (DR) is a prominent cause of visual impairment among those diagnosed with diabetes. Previous research has demonstrated that the prevalence of diabetes is significantly higher in urban areas (11.2%, 95% CI: 10.6–11.8) compared to rural areas (5.2%, 95% CI: 4.9–5.4; P < 0•0001) [12]. Nevertheless, this discrepancy is not evident in the context of diabetic retinopathy (DR) [13]. According to the statistics at hand, it is evident that diabetic retinopathy (DR) constituted 1.07% of cases of blindness and 1.25% of instances of moderate to severe vision impairment (MSVI) in the year 2015. The user's text does not contain any information to rewrite academically. There exists a dearth of current scholarly investigations that explore the extent to which Diabetic Retinopathy (DR) is prevalent in various geographical areas of India. Identifying the regions with the highest demand for diabetic retinopathy (DR) screening and treatment programmes poses a significant problem. The prevailing estimations of diabetic retinopathy (DR) primarily originate from diabetes clinics, so introducing bias and limiting their applicability in the strategic advancement of ophthalmic care for individuals with diabetes among the wider population. Thus, the primary aim of this investigation was to ascertain the correlation between HbA1C levels and the occurrence and intensity of diabetic retinopathy in individuals with type II diabetes mellitus.

The current study was conducted as a cross-sectional examination. The research encompassed a cohort of 130 participants who were definitively diagnosed with diabetes and sought medical treatment. Out of the total participants, 76 individuals identified as female, whereas 54 identified as male. The selection of individuals was conducted using a randomisation procedure. The study's inclusion criteria were patients aged 15 years or older who attended the Diabetes Centre and CHCS for follow-up visits and had previously been diagnosed with either type 1 or type 2 diabetes mellitus. The exclusion criteria were persons who were below the age of 15 and had diabetes, patients with inadequate data, and individuals who had been diagnosed with gestational diabetes. The data was acquired by conducting face-to-face interviews with the participants. The interviews were conducted by researchers who administered questionnaires that solicited information regarding demographic and clinical factors. The demographic characteristics examined in this study included gender, age, nationality, residential location, educational attainment, occupation, marital status, financial position, smoking behaviour, and family medical history of diabetes mellitus or eye illnesses. The study incorporated various clinical variables, such as the categorisation of diabetes mellitus (DM), the duration of DM, the specific medication utilised for diabetes management, the existence of any complications related to DM, the presence of hypertension, renal dysfunction, and coronary artery disease (CAD). Furthermore, the inclusion of hypertension or antihyperlipidemic medications, the date of the most recent ocular examination, and the administration of focused laser treatment, pan-retinal laser treatment, anti-vascular endothelial growth factor injections, or ocular surgery were also considered. Informed permission was obtained from all participants in the study. The latest assessments of HbA1c, body mass index (BMI), triglycerides, total cholesterol, and serum creatinine were obtained from the records of each individual. The evaluation of diabetic patients' management of their diabetes mellitus (DM) was carried out by making use of the criteria set forth by the American Diabetes Association. Per the prescribed guidelines, a threshold of HbA1c level over 7.0% (53 mmol/mol) was employed as the criterion for establishing inadequate management of diabetes mellitus [15]. As per the guidelines set forth by the National Institute for Clinical Excellence, a state of optimal weight is characterised by a body mass index (BMI) falling within the range of 18.5 to 24.9 kg/m2. Individuals whose body mass index (BMI) falls within the range of 25 to 29.9 kg/m2 are considered to be in the overweight category, whilst those with a BMI equal to or exceeding 30 kg/m2 are categorised as obese [16]. Triglycerides were categorised as elevated if their concentration reached or exceeded 2.26 mmol/L, while total cholesterol was deemed elevated if it reached or exceeded 6.2 mmol/L [17]. The evaluation of visual acuity entailed the employment of a standardised chart referred to as the Snellen E chart. The measurement of intraocular pressure was conducted using two different tonometers: the Goldman application tonometer and a non-contact tonometer produced by Reichert Technologies Inc., situated in Depew, NY, USA. After the application of mydriatic eye drops (Tropicamide 1%, Alcon-Couvreur, Puurs, Belgium), ophthalmologists conducted a fundus examination using a slit light (Reichert Technologies) to assess the presence and severity of diabetic retinopathy (DR). The severity of diabetic retinopathy is classified into five stages according to the International Clinical Diabetic Retinopathy Disease Severity Scale. These stages include the absence of obvious diabetic retinopathy, mild nonproliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR, and proliferative diabetic retinopathy (PDR) [18]. The data analysis was performed utilising IBM Corp.'s Statistical Package for Social Sciences (SPSS) version 25 software. This analysis aimed to investigate the relationship between the HbA1c levels of individuals with diabetes, which function as an indicator of diabetes management, and several other factors under scrutiny. Additionally, the presence and severity of diabetic retinopathy (DR) were also considered. The chi-square test and logistic regression analysis were employed. A p-value below the threshold of 0.05 was considered to have statistical significance. Descriptive statistics, including measures such as the mean, standard deviation (SD), and the independent one-sample ttest, were utilised to evaluate the statistical significance of the observed differences among the means of the factors being examined.

The present study consisted of 130 individuals diagnosed with diabetes who sought medical attention at ophthalmology. Among the entire sample, 111 individuals were identified as having type 2 diabetes mellitus (DM), while 19 persons were diagnosed with type 1 DM. In the study, a significant proportion of the participants (n=76; 58.5%) were classified as female, with an average age of 49.8 ± 16.2 years. In contrast, 54 patients (41.5%) were classified as male, with an average age of 54.1 ± 12.4 years. No statistically significant difference was found in the mean age (51.5 ± 14.8 years) when examined regarding gender (p = 0.094). The mean duration of DM was 11.5 ± 8.8 years. There was a statistically significant disparity (p = 0.001) observed in the length of diabetic retinopathy (DR) between people with and without DR, with corresponding durations of 15.9 ± 8.3 years and 10 ± 8.5 years. As illustrated in Figure 1, the mean HbA1c level among the participants was 8.8 ± 1.7. 17 individuals, including 13.1% of the overall sample, exhibited a result below 7%. In contrast, it was observed that a value equal to or over 7% was present in 113 individuals, accounting for 87% of the whole sample. No statistically significant difference was seen in the average HbA1c levels between males and females. The prevalence of diabetic retinopathy (DR) among the participants was determined to be 35 people, constituting 26.9% of the overall sample. The link between diabetic retinopathy (DR) and the factors under inquiry was examined using the chi-square test, as indicated by the results presented in Table 1. The findings suggest a statistically significant association between the occurrence of diabetic retinopathy (DR) and the length of time a person has had diabetes mellitus (DM) (p = 0.001), as well as between the presence of DR and levels of glycated haemoglobin (HbA1c) (p = 0.036). However, the study did not find any statistically significant link between diabetic retinopathy (DR) and characteristics such as age, level of education, employment status, financial position, follow-up status, and body mass index (BMI). According to the DR severity grading system, it was discovered that within the patient population, a total of 95 individuals (representing 73.1% of the sample) displayed no discernible manifestations of diabetic retinopathy (DR). Furthermore, a total of 11 individuals (8.5%) were identified as having mild non-proliferative diabetic retinopathy (NPDR), while an additional 11 patients (8.5%) were categorised as having moderate NPDR. Moreover, 11 patients, accounting for 8.5% of the sample, were diagnosed with severe nonproliferative diabetic retinopathy (NPDR). In contrast, just two patients, representing 1.5% of the sample, exhibited proliferative diabetic retinopathy (PDR). A significant association was identified between the severity of diabetic retinopathy (DR) and the length of diabetes mellitus (DM) (p = 0.021), as well as between the severity of DR and the presence of a family history of DM (p = 0.036). Nevertheless, the analysis did not reveal any statistically significant correlation between levels of HbA1c and the severity of diabetic retinopathy (p = 0.293). The results of the logistic regression analysis performed in Table 2 suggest that the duration of diabetes mellitus (DM) is a statistically significant risk factor for diabetic retinopathy (DR), as evidenced by a p-value of 0.001. The statistical analysis demonstrated that the significance of HbA1c was equivalent, as evidenced by a p-value of 0.040. In contrast, our analysis did not identify any significant association between diabetic retinopathy (DR) and the diverse characteristics investigated, such as gender, family history of diabetes mellitus (DM), smoking habits, hypertension, coronary artery disease (CAD), renal dysfunction, cholesterol levels, triglyceride levels, and serum creatinine levels. Table 1: Demographic and Clinical characteristics of patients Parameters Diabetes Retinopathy Total p- value Yes (N;%) No (N;%) Age 0.266 15 to 29 years 1 (6.7%) 14 (93.3%) 15 30 to 49 years 7 (25.9%) 20 (74.1%) 27 50 to 59 years 13 (28.3%) 33 (71.7%) 46 ≥ 60 years 14 (33.3%) 28 (66.7%) 42 Gender 0.567 Male 13 (24.1%) 41 (75.9% 54 Female 22 (28.9%) 54 (71.1%) 76 Body Mass index Normal 9 (21.4%) 3 33 (78.6%) 42 0.313 Overweight 6 (21.4%) 22 (78.6%) 28 Obese 20 (33.3%) 40 (66.7%) 60 Diabetes mellitus duration 0.001 1 to 5 years 6 (13%) 40 (87%) 46 6 to 10 years 4 (14.8%) 23 (85.2%) 27 ≥ 11 year 25 (43.9%) 32 (56.1%) 57 Hemoglobin A1C 0.036 < 7% 1 (5.9%) 16 (94.1%) 17 ≥ 7% 34 (30.1) 79 (69.9%) 13 Follow up status 0.278 Irregular 37 9 (24.3%) 28 (75.7%) Regular 87 26 (29.9%) 61 (70.1%) Table 2: Logistic regression Analysis of Diabetes retinopathy Parameters Diabetes Retinopathy Total Odd ratio (95% C.I) p- value Yes (N;%) No (N;%) Prior history of coronary artery disease 1.6 (0.567 to 4.46) 0.876 Yes 8 (38.1%) 13 (61.9%) 21 No 27 (24.8%) 82 (75.2%) 109 Hypertension History 1.68 (0.74 to 3.57) 0.48 Yes 21 (31.8%) 45 (68.2%) 66 No 14 (21.9%) 50 (78.1%) 64 Previous history of Renal Impairment 1.43 (0.33 to 5.98) 0.37 Yes 3 (33.3%) 6 (66.7%) 9 No 32 (26.4%) 89 (73.6%) 121 Family history of Diabetes Mellitus 0.88 (0.38 to 1.98) 0.765 Yes 24 (27.9%) 62 (72.1%) 86 No 11 (25%) 33 (75%) 44 Smoking status 0.49 (0.123 to 2.57) 0.43 Non smoker 33 (28%) 85 (72%) 118 smoker 2 (16.7%) 10 (83.3%) 12 Serum creatinine levels 1.33 (0.27 to 4.87) 0.234 High 3 (30%) 7 (70%) 120 Normal 32 (26.7%) 88 (73.7%) 10 Total Cholesterol 0.58 (0.123 to 2.798) 0.456 High 2 (18.2%) 9 (81.8%) 11 Normal 33 (27.7%) 86 (72.3%) 119 Triglycerides 0.82 (0.356 to 1.986) 0.231 High 9 (24.3%) 28 (75.7% 37 Normal 26 (28%) 67 (72%) 93

The current investigation documented a prevalence incidence of 26.9% for diabetic retinopathy (DR) in patients diagnosed with diabetes mellitus (DM). Worldwide research observed the prevalence of diabetic retinopathy (DR) varies between 15% and 45%.[19,20] According to the DR severity grading system, our study findings indicate that most patients, specifically 73.1%, did not display any discernible indications of diabetic retinopathy (DR). Furthermore, it was shown that 8.5% of the patients presented with mild non-proliferative diabetic retinopathy (NPDR), whilst an additional 8.5% manifested strong NPDR. Furthermore, it was observed that 8.5% of the patients exhibited severe non-proliferative diabetic retinopathy (NPDR), whereas a small proportion of 1.5% displayed proliferative diabetic retinopathy (PDR). Hajar et al. [21] conducted a study wherein they found that a significant proportion of individuals diagnosed with diabetes, precisely 68.1%, did not display any discernible indications of retinopathy. Furthermore, it was observed that 18% of the participants demonstrated mild non-proliferative diabetic retinopathy (NPDR), whereas 5.3% presented with moderate NPDR. In addition, it was found that 3.5% of the patients exhibited severe non-proliferative diabetic retinopathy (NPDR), whereas a minority of 1.1% displayed proliferative diabetic retinopathy (PDR). The current study unveiled a statistically significant association between the advancement of diabetic retinopathy (DR) and glycated haemoglobin (HbA1c) levels (p = 0.040). However, the research yielded no statistically significant association between levels of HbA1c and the severity of diabetic retinopathy (p = 0.293). The probability of diabetic individuals getting diabetic retinopathy (DR) is significantly elevated by a factor of 6.9 when their HbA1c levels reach or exceed 7% compared to those with HbA1c levels below 7%. The study participants exhibited an average HbA1c level of 8.9 ± 1.7. Notably, there was no statistically significant difference observed in the mean HbA1c levels between male and female people. In contrast, the study conducted by El-Bab et al. [22] revealed that male participants had significantly higher average levels of HbA1c compared to their female counterparts. Multiple studies have provided evidence of a significant association between HbA1c and DR [23,19], with an additional study further establishing a large relationship between HbA1c levels and the severity of DR [24]. A cross-sectional study was conducted in Abha, Saudi Arabia, to investigate the correlation between HbA1c levels and diabetic retinopathy (DR). The study's findings indicated a significant correlation between levels of HbA1c and the occurrence of diabetic retinopathy, as observed in the univariable analysis. Nevertheless, the statistical analysis using multiple logistic regression demonstrated that this connection was insignificant [25]. In addition, a study conducted using cross-sectional analysis demonstrated a significant correlation between the probability of developing diabetic retinopathy (DR) and patients who have an HbA1c level of 7% or higher, exhibiting a 17.5-fold higher risk compared to persons who maintain well-regulated glycemic control [23]. The observed discrepancy was found to possess statistical significance. Based on a separate investigation, it was determined that those exhibiting a glycated haemoglobin (HbA1c) concentration of 7% or over had a 1.9-fold increased probability of developing diabetic retinopathy (DR) in comparison to those with an HbA1c level below 7% [20]. The prevalence of elevated HbA1c levels among diabetic individuals suggests a significant imperative to improve diabetes management in basic healthcare settings. The reduction of the prevalence and mitigation of the progression of diabetic retinopathy can be accomplished by using a variety of crucial strategies. Furthermore, it is crucial to augment patient awareness regarding the detrimental consequences linked to insufficient care for diabetic mellitus (DM). The present study comprised 130 participants, 76 identifying as female and 54 as male. The mean age of the female participants was 49.8 ± 16.2 years, whereas the mean age of the male participants was 54.1 ± 12.4 years. Regarding the comparison of gender, there were no statistically significant differences seen in the mean age (p = 0.094). Nevertheless, the findings of our investigation indicate that female patients exhibited a 1.285-fold increased probability of encountering diabetic retinopathy (DR) compared to their male counterparts. Upon analysis of the association between gender and HbA1c levels, it was noted that within the subset of patients exhibiting HbA1c levels below 7%, a majority of 59% were classified as female. In contrast, the remaining 41% were classified as male. Consequently, this yielded a female-to-male ratio of 10:7. In contrast, an examination revealed that within the cohort of persons with an HbA1c level of 7 or higher, 58% were classified as female, whereas 42% were classified as male, yielding a female-to-male ratio of 66:47. Concerning the severity of diabetic retinopathy (DR) and its correlation with gender, the ratios of females to males were 1.3, 1.8, 1.8, 1.8, and 1 in DR stages 1, 2, 3, 4, and 5, respectively. However, the study indicated no statistically significant difference between DR and gender (p = 0.537). The findings of this study are consistent with prior investigations conducted by Valizadeh et al. (2019) and Badawi et al. which similarly reported a lack of statistically significant association between the incidence of diabetic retinopathy (DR) and gender. Concerning diabetic retinopathy (DR) and the duration of diabetes mellitus (DM), the mean duration of DM observed in our study was 11.5 ± 8.8 years. A statistically significant disparity (p = 0.001) was seen in the length of diabetic retinopathy (DR) between people with and without DR, with mean durations of 15.9 ± 8.3 years and 10 ± 8.5 years, respectively. The findings of our research indicate that persons who have been diagnosed with diabetes mellitus (DM) for 11 years or more have a much higher risk, approximately 5.2 times larger, of acquiring diabetic retinopathy (DR). On the other hand, it was shown that persons who had been diagnosed with diabetes mellitus (DM) for a duration of six to 10 years exhibited a 1.2-fold higher probability of developing diabetic retinopathy (DR) in comparison to those with a DM duration of one to five years. Furthermore, our investigation unveiled a significant association between the duration of diabetes mellitus (DM) and the probability of developing diabetic retinopathy (DR) (p = 0.001), as well as the severity of DR (p = 0.021). The study conducted by Badawi et al. (23) established a favourable association between the duration of diabetes mellitus (DM) and the probability of developing diabetic retinopathy (DR). The research conducted by Valizadeh et al. (2019) did not yield a statistically significant association between an extended duration of diabetes mellitus (DM) and the occurrence of diabetic retinopathy (DR). However, the researchers noted an increased probability of diabetic retinopathy (DR) development in persons with a prolonged duration of diabetes mellitus (DM). The prevalence of diabetic retinopathy (DR) among patients diagnosed with type 1 diabetes and a duration of five years or less has demonstrated a rise from 6.1% to 62% in those who have experienced the ailment for ten years or more. Likewise, the incidence of diabetic retinopathy (DR) has seen a notable rise from 10% to 50% over a corresponding period in individuals diagnosed with type 2 diabetes [6]. The study revealed an increased probability of developing diabetic retinopathy (DR) when considering the moderating effects of HbA1c levels and duration of diabetes mellitus (DM). The development of diabetic retinopathy (DR) has been determined to be mostly influenced by the levels of HbA1c and the duration of diabetes mellitus (DM). A substantial proportion, precisely 12.9%, of the observed variance in DR was attributed to these parameters. Furthermore, the association between HbA1c levels and the duration of diabetes mellitus (DM) accounted for an additional statistically significant 2.2% of the variance. This study documented a prevalence rate of 33.3% for patients diagnosed with obesity and diabetic retinopathy (DR). The subjects with an abnormal body mass index (BMI) had a 1.6-fold increased susceptibility to developing DR compared to those with a BMI within the usual range. Nevertheless, it is crucial to acknowledge that this heightened risk did not achieve statistical significance. Furthermore, it was noted that 21.4% of the people categorised as overweight displayed indications of diabetic retinopathy (DR), suggesting a 0.9-fold increased probability of acquiring DR compared to individuals with a normal body mass index (BMI). Moreover, the findings were considered to be statistically insignificant. The results of this study align with a prior examination conducted in Medina, Saudi Arabia, which demonstrated that individuals who were obese had a 1.5 times higher probability of developing diabetic retinopathy (DR) compared to the control group consisting of individuals with a normal body mass index (BMI) [23]. Similarly, it was ascertained that this discovery lacked statistical significance. To bolster the comprehensiveness of our research, we integrated a range of biochemical parameters to examine the relationship between specific variables and the presence or absence of diabetic retinopathy (DR), as well as the severity of DR. Our statistical analysis indicated that there was no statistically significant correlation between dietary restriction (DR) and heightened levels of cholesterol and triglycerides (p = 0.726 and 0.673, respectively). The statistical analysis using the chi-square test revealed no significant association between cholesterol levels and the severity of diabetic retinopathy (p = 0.621). Similarly, a lack of substantial correlation was observed between triglyceride levels and the severity of diabetic retinopathy (p = 0.509). In the study conducted by Cetin et al. [26], it was demonstrated that there existed no statistically significant association between the levels of total cholesterol and triglycerides and the incidence or severity of diabetic retinopathy (DR). On the other hand, a study conducted on persons diagnosed with type 2 diabetes unveiled a significant association between the levels of total cholesterol and triglycerides and diabetic retinopathy [27]. A study conducted in Qassem, Saudi Arabia, disclosed a statistically significant association between dyslipidemia and proliferative diabetic retinopathy (PDR). Therefore, it may be inferred that the management of blood glucose levels and the use of lipid-lowering drugs in persons diagnosed with type 2 diabetes may have the ability to delay or prevent the occurrence of visual impairment associated with diabetic retinopathy [28]. Retinopathy and nephropathy are acknowledged as chronic complications of diabetes mellitus (DM), hence requiring the incorporation of creatinine as a variable in our study. However, the statistical analysis indicated no significant association between the variable under investigation and the presence of DR, as evidenced by a p-value of 0.819. This finding suggests that persons with a higher creatinine level had a 1.2 times greater likelihood of developing DR than those with a normal creatinine level. The results of this investigation show a similarity to those of a study conducted in Iran. Furthermore, the research findings indicated a statistically significant association between creatinine levels and the extent of diabetic retinopathy (p = 0.1) [29]. The study involved a sample size of 130 participants, consisting of 76 females (58.5%) with an average age of 49.8 ± 16.2 years and 54 males (41.5%) with an average age of 54.1 ± 12.4 years. The researchers employed a rigorous selection process to guarantee that the male and female participants were matched in age. The statistical analysis findings revealed no statistically significant disparities between the two groups concerning age (p = 0.094). Furthermore, the study revealed no statistically significant association between age and the severity of diabetic retinopathy (p = 0.076). Moreover, a lack of statistically significant correlation was seen between age and the overall prevalence of diabetic retinopathy (p = 0.255). Nevertheless, it was shown that there existed a positive association between age and the incidence of individuals diagnosed with diabetic retinopathy (DR). The predominant factor contributing to this finding was mostly ascribed to the duration of diabetes mellitus rather than only to advanced age. The sample size of the first group, which comprised persons aged 15-29 years, was somewhat smaller in comparison to the sample sizes of the remaining categories. The observed disparity in the sample size may explain the occurrence of a solitary instance of diabetic retinopathy detected within this cohort. The individual being examined exhibited an extended period of unregulated type 1 diabetes mellitus lasting for 15 years, which may potentially operate as a supplementary element in the progression of diabetic retinopathy. This finding aligns with other studies that noted a distinction, albeit it did not achieve statistical significance [19,30]. Nevertheless, prior studies have established a significant association between diabetic retinopathy (DR) and increasing age [22,23,25]. There was no statistically significant link found between educational attainment and the prevalence of diabetic retinopathy (DR). One plausible explanation for this phenomenon is the divergence between the conceptualisations of education and awareness. Hence, it cannot be assumed that every person with a formal education has sufficient knowledge regarding the issues related to diabetes and the effects of diabetes mellitus on ocular well-being. No statistically significant relationship was found between job status, financial situation, and follow-up status as potential risk factors and the occurrence of DR. The results were consistent with a previous study [19] but differed from other studies [6,23]. The findings of our study indicate that non-smokers had a significantly reduced chance, approximately 0.5 times lower, of developing diabetic retinopathy (DR) compared to persons who smoked. Nevertheless, our analysis did not reveal a statistically significant association between the progression of diabetic retinopathy (DR) and smoking. The research involved a cohort of 130 participants, comprising 12 individuals (9.2%) who self-identified as smokers and 118 persons (90.8%) who self-identified as non-smokers. A research investigation in Abha, Saudi Arabia, yielded findings indicating that smoking does not substantially influence the subsequent progression of diabetic retinopathy (DR) [25]. Nevertheless, these findings were inconsistent with other studies that demonstrated a significant correlation between smoking and diabetic retinopathy (DR), suggesting that smoking heightened the likelihood of developing DR [22,23,31]. Prior research has demonstrated a significant correlation between hypertension and the development of diabetic retinopathy (DR), as well as its significant role in the progression of DR. Therefore, the surveillance and control of hypertension can effectively slow the progression of DR [23,20]. In the context of this study, it was ascertained that a total of 66 individuals, constituting 50.8% of the whole sample, had been formally diagnosed with hypertension. Within this specific subgroup, a total of 21 persons were identified as having both hypertension and diabetic retinopathy (DR), accounting for 31.8% of the patients diagnosed with hypertension. Furthermore, our research findings indicate that individuals diagnosed with hypertension exhibited a 1.667-fold higher probability of acquiring diabetic retinopathy (DR). Nevertheless, this particular discovery in isolation does not offer sufficient evidence to categorise hypertension as a substantial risk factor for diabetic retinopathy (DR). Additional studies have produced similar results [25, 23]. Given the disparate outcomes, we argue that further investigation is warranted on hypertension, hence mandating the establishment of precise criteria for assessing blood pressure regulation and its influence on diabetic retinopathy. The current study yielded results indicating that there was no statistically significant correlation between coronary artery disease (CAD) and the occurrence of diabetic retinopathy (DR). A cohort of 21 individuals, including 16.2% of the study population, disclosed a medical background encompassing coronary artery disease (CAD). Nevertheless, this ratio is considered inadequate for conducting a meaningful comparison or establishing the statistical significance of coronary artery disease (CAD) as a risk factor. The research conducted in Medina did not produce any considerable evidence to support the hypothesis that there is a significant association between coronary artery disease (CAD) and the prevalence of diabetic retinopathy (DR) [22]. There was no statistically significant link seen between renal impairment and the presence of diabetic retinopathy (DR). In the current study, a sample size of 130 participants was assessed, revealing that nine persons (6.9%) exhibited renal impairment. Out of the patients in this cohort with renal impairment, three individuals (33.3%) were concurrently diagnosed with diabetic retinopathy (DR). Prior studies have established a significant association between estimated glomerular filtration rate (eGFR) and diabetic retinopathy (DR). The acceleration of diabetic retinopathy progression has been reported to occur specifically due to a decrease in the estimated glomerular filtration rate (eGFR) [20, 32]. Subsequent investigations have provided further evidence that microalbuminuria is a reliable indicator for detecting the early development of diabetic retinopathy in persons diagnosed with type 2 diabetes [33,34]. Therefore, it is recommended to use estimated glomerular filtration rate (eGFR) and microalbuminuria as markers for evaluating renal impairment alongside the prevalence and severity of diabetic retinopathy (DR) in future research initiatives. During the ocular examinations conducted as part of our study, researchers identified and documented additional issues. A cohort of fifty individuals, constituting 38.5% of the sample, exhibited the presence of cataracts. The percentage above was projected as a result of the release of a review report regarding the occurrence of cataracts in patients diagnosed with diabetes. Existing documentation establishes cataracts as an early ocular manifestation of diabetes. Persons with diabetes had a notably increased susceptibility, ranging from three to fivefold, to developing cataracts compared to persons without diabetes [35]. Additionally, our study findings indicate that 10 individuals, including 8% of the overall sample, demonstrated the presence of glaucoma and displayed an increase in optic disc cupping. Furthermore, six individuals, comprising 4.6% of the study's sample, exhibited clinically significant macular oedema. Furthermore, it is noteworthy that three people, constituting 2.3% of the sample, displayed maculopathy, whereas two participants, comprising 1.5% of the sample, manifested papilledema. In addition, the research investigation documented a prevalence rate of 0.8% for certain visual disorders, namely vitreous haemorrhage, interstitial corneal opacity, non-arteritic anterior ischemic optic neuropathy, retinal detachment, retinitis pigmentosa, and shallow anterior chamber

The prevalence of diabetic retinopathy (DR) among the individuals included in our study was around 26.9%. A notable correlation was observed between the levels of HbA1c and the length of diabetes mellitus (DM) concerning the occurrence of diabetic retinopathy (DR) among individuals diagnosed with diabetes. According to a study, those diagnosed with diabetes mellitus (DM) for 11 years or more are five times more likely to develop diabetic retinopathy (DR) than those with diabetes for five years or less. This increased risk remains consistent regardless of the individual's level of diabetes control. The ophthalmologist-led screening is crucial for those diagnosed with diabetes mellitus (DM), even if their glycated haemoglobin (HbA1c) levels are well-controlled. The prompt detection of diabetic retinopathy (DR) is of utmost importance to impede the advancement of the condition and the subsequent emergence of severe manifestations, resulting in the loss of eyesight.

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