Article Text

Download PDFPDF

Risk factors of diabetic retinopathy and sight-threatening diabetic retinopathy: a cross-sectional study of 13 473 patients with type 2 diabetes mellitus in mainland China
  1. Yan Liu1,
  2. Jiarui Yang1,
  3. Liyuan Tao2,
  4. Huibin Lv1,
  5. Xiaodan Jiang1,
  6. Mingzhou Zhang1,
  7. Xuemin Li1
  1. 1 Department of Ophthalmology, Peking University Third Hospital, Beijing, China
  2. 2 Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
  1. Correspondence to Dr Xuemin Li; lxmlxm66{at}


Objective To explore the risk factors of diabetic retinopathy (DR) and sight-threatening diabetic retinopathy (STDR) among Chinese patients with diabetes.

Design, setting and participants A cross-sectional investigation was performed in eight screening clinics in six provinces across mainland China. Information about the risk factors was recorded in screening clinics. Some risk factors (sex, age, diagnosis age, diabetes duration, systolic blood pressure (SBP), diastolic blood pressure, fasting blood glucose (FBG) and glycosylated haemoglobin (HbA1c)) were recorded in all eight clinics, while others were collected only in a subset of the clinics. The relationships between the risk factors and DR and between the risk factors and STDR were explored for the eight factors mentioned above and for all factors studied.

Main outcomes and measures Risk factors of DR and STDR were assessed, and a nomogram of the results was produced.

Results Younger age, longer diabetes duration, higher SBP, higher FBG and higher HbA1c were found to be independent risk factors for both DR and STDR in the eight-factor analyses. In the all-factor analysis, younger age, longer diabetes duration, higher SBP, oral medicine use and insulin use were independent risk factors for both DR and STDR; higher postprandial blood glucose (PBG), HbA1c, triglyceride andlow-density lipoprotein were independent risk factors for DR only, and higher FBG was a risk factor for STDR only.

Conclusions In this cross-sectional investigation, several risk factors were found for DR and STDR. Notably, FBG, PBG and HbA1c were all risk factors for DR or STDR, suggesting that stricter blood glucose control in clinical practice is required.

  • diabetic retinopathy
  • risk factors
  • glucose
  • WHR
  • BMI

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors YL and JY designed the whole study, completed the data collection and wrote the manuscript. JY and LT performed the data analysis, and LT contributed to the epidemic portion of the manuscript. HL and XJ contributed to the study design and contributed to the writing of the manuscript. MZ assisted with the study design, data collection and contributed to the editing of the manuscript. XL oversaw the study, gave advice on the study design and revised the manuscript. XL was the guarantor of this study and had full access to all the data in this study. XL also takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding This study was also supported by the Beijing Municipal Science & Technology Commission. Grant Number: Z141107002514042.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Peking University Third Hospital Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

  • Collaborators Chinese Foundation for Lifeline Express and Lifeline Express Hong Kong Foundation.