Korean J Fam Pract. 2018; 8(5): 793-798  https://doi.org/10.21215/kjfp.2018.8.5.793
Does the Severity of Type 2 Diabetes Affect Yearly Diabetic Retinal Examination?: A Cross Sectional Analysis of the Korea National Health and Nutrition Examination Survey 2013-2015
Soo Kyung Yang, Eun Ji Lee, You Hyun Song, Jung Eun Kim, In Young Choi, Duk-Chul Lee*
Department of Family Medicine, Severance Hospital, Seoul, Korea
Duk-Chul Lee
Tel: +82-2-2228-2331, Fax: +82-2-362-2473
E-mail: faith@yuhs.ac
ORCID: http://orcid.org/0000-0001-9166-1813
Received: July 21, 2017; Revised: October 12, 2017; Accepted: October 13, 2017; Published online: October 20, 2018.
© The Korean Academy of Family Medicine. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: The purpose of this study was to analyze how the severity of type 2 diabetes impacts the prevalence of diabetic retinal examinations, to explore the prevention of microvascular complications and to clarify the factors associated with yearly eye examinations in diabetes patients.
Methods: This was a cross-sectional study. We chose 11 factors related to type 2 diabetes patients, including hemoglobin A1c (HbA1c), age, education level, income level, and comorbidity with hypertension. We used the chi-square test and logistic regression to analyze these factors according to whether or not patients had undergone fundus examination.
Results: After adjustment for covariates, we found no significant relationship between severity of type 2 diabetes and yearly diabetic retinal examinations. However, patients with severely uncontrolled type 2 diabetes (HbA1c≥10%) tended to undergo more diabetic retinal examinations than other groups. Additionally, individuals with lower levels of education were found to be significantly less likely to have a fundus examination, while patients with hypertension tend to more likely to undergo yearly diabetic retinal examinations.
Conclusion: Patients with uncontrolled type 2 diabetes do not undergo more yearly diabetic retinal examinations than patients with controlled type 2 diabetes (HbA1c<7%). Physicians should educate patients with severely uncontrolled type 2 diabetes on the importance of yearly retinal screening. Physicians and policy makers should also strongly recommend yearly eye examinations for diabetic patients who smoke, have lower levels of education, or have comorbidity with hypertension.
Keywords: Diabetic Retinopathy; Type 2 Diabetes Mellitus; Glycosylated Hemoglobin A1c; Prevention and Control
  1. Deshpande AD, Harris-Hayes M, Schootman M. Epidemiology of diabetes and diabetes-related complications. Phys Ther 2008; 88: 1254-64.
    Pubmed KoreaMed CrossRef
  2. Schäfer I, Pawels M, Küver C, Pohontsch NJ, Scherer M, van den Bussche H, et al. Strategies for improving participation in diabetes education. A qualitative study. PLoS One 2014; 9: e95035.
    Pubmed KoreaMed CrossRef
  3. Organisation for Economic Co-operation and Development. Health at a glance 2013: OECD indicators. Paris: Organisation for Economic Co-operation and Development (OECD) Publishing; 2013.
  4. Task Force Team for Basic Statistical Study of Korean Diabetes Mellitus of Korean Diabetes Association, Park IeB, Kim J, Kim DJ, Chung CH, Oh JY, et al. Diabetes epidemics in Korea: reappraise nationwide survey of diabetes “diabetes in Korea 2007”. Diabetes Metab J 2013; 37: 233-9.
    Pubmed KoreaMed CrossRef
  5. Hwang J, Johnson JA. Relationship between duration of type 2 diabetes and self-reported participation in diabetes education in Korea. Asia Pac J Public Health 2015; 27: NP311-21.
    Pubmed CrossRef
  6. Kim SG, Choi DS. The present state of diabetes mellitus in Korea. J Korean Med Assoc 2008; 51: 791-8.
  7. Cheung N, Mitchell P, Wong TY. Diabetic retinopathy. Lancet 2010; 376:124-36.
  8. Yau JW, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T; MetaAnalysis for Eye Disease (META-EYE) Study Group, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care 2012; 35:556-64.
    Pubmed KoreaMed CrossRef
  9. Yang JY, Kim NK, Lee YJ, et al. Prevalence and factors associated with dia betic retinopathy in a Korean adult population: the 2008-2009 Korea National Health and Nutrition Examination Survey. Diabetes Res Clin Pract 2013; 102: 218-24.
    Pubmed CrossRef
  10. Gye HJ, Song SJ. New modalities for the diagnosis and treatment of diabetic retinopathy. Korean J Med 2015; 89: 271-6.
  11. American Diabetes Association. 10. Microvascular complications and foot care. Diabetes Care 2017; 40(Supplement 1): S88-98.
    Pubmed CrossRef
  12. Rhee BD. Epidemiological characteristics of diabetes mellitus among Korean population. J Korean Diabetes Assoc 2003; 27: 173-8.
  13. Lee K. Distribution characteristics of the medical services in Korea. J Korean Geogr Soc 2005; 40: 242-511.
  14. Kanski JJ. Clinical ophthalmology. Paris: Elsevier; 2005. p. 455.
  15. Choi JH, Na BJ, Chun SA. Factors related to fundus examination in diabetes mellitus patients. Korean J Health Policy Adm 2010; 20: 125-36.
  16. Shin KH, Chi MJ. Fundus examination rate in diabetics and the public health factors associated with fundus examination rate. J Korean Ophthalmol Soc 2009; 50: 1319-25.
  17. Shin BK, Kim KS. Evaluation for the fundus findings of diabetes mellitus patients who visited to the ophthalmic department for the first time. J Korean Ophthalmol Soc 2002; 43: 2158-65.
  18. Kim YJ, Kim JG, Lee JY, Lee KS, Joe SG, Park JY, et al. Development and progression of diabetic retinopathy and associated risk factors in Korean patients with type 2 diabetes: the experience of a tertiary center. J Korean Med Sci 2014; 29: 1699-705.
    Pubmed KoreaMed CrossRef
  19. Rim TH, Byun IH, Kim HS, Lee SY, Yoon JS. Factors associated with diabetic retinopathy and nephropathy screening in Korea: the third and fourth Korea National Health and Nutrition Examination Survey (KNHANES III and IV). J Korean Med Sci 2013; 28: 814-20.
    Pubmed KoreaMed CrossRef

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