Comparative Evaluation of Glycaemic and Non-Glycaemic Factors as Determinants of Retinopathy Status in an Adult Population: A Case-Control Study.

Background and Aims: Hyperglycemia is a known risk factor for retinopathy. With diabetes cases expected to increase from 366 million in 2011 to 552 million by 2030, the global burden of retinopathy may rise. Given this observation, more attention is focused on glycaemic determinants of retinopathy to the neglect of non-glycaemic factors, particularly in Ghana. However, genetic and environmental variations may highlight the importance of non-glycaemic factors as determinants of retinopathy. Methods: This case-control study was conducted between January and August 2024 at the Emmanuel Eye Medical Center in Accra, Ghana. The study involved 160 participants aged between 34 and 81 years. Of the 160 participants, 80 (50%) were diagnosed with retinopathy. Fasting venous blood samples were collected and analyzed for glycaemic factors, including fasting blood glucose (FBG), glycated hemoglobin (HbA1c), and non-glycaemic factors, including fasting lipids and complete blood count indices. Results: Results showed that the FBG (8.4 ± 2.6 vs. 6.3 ± 1.6, p < 0.001) and HbA1c (6.3 ± 1.6 vs. 6.3 ± 1.4, p < 0.001) levels were higher in the retinopathy. After adjusting for age and BMI, persons with hyperglycemia had about four-fold greater odds of developing retinopathy [AOR = 4.378 (95% CI: 2.212-8.666)]. In comparison, persons with poor glycaemic control had about two-fold greater odds of developing retinopathy [AOR = 2.499 (1.298-4.813)]. Only FBG and HbA1c reached statistical significance in operator characteristics curve analysis, with the area under the curve, sensitivity, and specificity at 0.75, 87.5, 56.3 and 0.79, 76.3, and 78.8, respectively. A significant sex difference between sex and retinopathy was only observed in the red blood cell count. Conclusion: Glycaemic factors are more strongly associated with retinopathy than non-glycaemic factors. Early screening should prioritize glycaemic factors while considering non-glycaemic factors due to genetic and environmental variations in retinopathy development.