Time to diabetic retinopathy and its prognostic factors among adults with type 2 diabetes mellitus in Johor, Malaysia from 2015 to 2019: a retrospective cohort study using surveillance data.
5 affiliations
- 1Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Selangor, 47000, Malaysia.
- 2Faculty of Computer and Mathematical Sciences, Universiti Teknologi MARA, Shah Alam, Selangor, 40450, Malaysia.
- 3Department of Ophthalmology, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Selangor, 47000, Malaysia.
- 4Public Health Division, Johor State Health Department, Jalan Persiaran Permai, Johor Bahru, Johor, 81200, Malaysia.
- 5Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, Selangor, 47000, Malaysia. [email protected].
Abstract
Background
Diabetic retinopathy is a major microvascular complication of type 2 diabetes mellitus and remains a leading cause of preventable visual impairment worldwide. Understanding the time to onset of diabetic retinopathy and its prognostic factors is essential to optimise screening strategies and guide early intervention. This study aimed to determine the time to development of diabetic retinopathy and identify its associated prognostic factors among adults with type 2 diabetes mellitus in Johor, Malaysia.Methods
We conducted a retrospective cohort study using secondary data from the National Diabetes Registry in Johor, Malaysia. Adults aged ≥ 18 years with type 2 diabetes mellitus who had no documented diabetic retinopathy DR at cohort entry were included. Cohort entry was defined as the first eligible National Diabetes Registry registration/assessment date between 1 January 2015 and 31 December 2019. Participants were followed until first documented diabetic retinopathy, death, loss to follow-up, transfer out, or 31 December 2019, whichever occurred first. Baseline sociodemographic, clinical, treatment-related and complication variables were evaluated. Kaplan-Meier methods, Log-rank test, and Cox regression analyses were used to evaluate time to first documented diabetic retinopathy and its prognostic factors.Results
Of 50,457 registry records initially identified, 1,056 duplicate records were removed. After excluding 1,448 records with incomplete eligibility, outcome or key baseline information, 47,953 participants were included in the original analytic dataset. Of these, 6,402 (13.3%) had a diabetic retinopathy diagnosis recorded in the registry and 41,551 (86.7%) were censored. Following verification of temporal eligibility and exclusion of 6,401 prevalent diabetic retinopathy records recorded before or at cohort entry, 41,552 participants contributed 64,551.7 person-years of follow-up, during which one incident diabetic retinopathy event occurred. Median follow-up estimated using the reverse Kaplan-Meier method was 6.1 months (IQR 5.3-29.0; range 3.2-113.4 months). duration of diabetes greater than 10 years (AHR = 1.96, 95% CI: 1.79-2.14), hypertension (AHR = 1.20, 95% CI: 1.10-1.31), dyslipidaemia (AHR = 1.25, 95% CI: 1.16-1.34), high waist circumference (AHR = 1.08, 95% CI: 1.02-1.14), positive urine protein (AHR = 1.09, 95% CI: 1.04-1.15), poor glycaemic control (AHR = 1.11, 95% CI: 1.03-1.20), and complications such as nephropathy (AHR = 1.78, 95% CI: 1.69-1.88) and diabetic foot ulcer (AHR = 1.92, 95% CI: 1.67-2.20) were independently associated with an increased risk of diabetic retinopathy.Conclusions
Diabetic retinopathy develops within a relatively short duration following type 2 diabetes mellitus diagnosis and is influenced by a combination of metabolic, clinical, and complication-related factors. Early risk stratification and integrated management of modifiable risk factors are essential to delay the onset of diabetic retinopathy. These findings provide important real-world evidence to support targeted screening and public health strategies in Malaysia.
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BibTeX
@article{teruna2026time,
title = {{Time to diabetic retinopathy and its prognostic factors among adults with type 2 diabetes mellitus in Johor, Malaysia from 2015 to 2019: a retrospective cohort study using surveillance data.}},
author = {Muhammad Muaz Shahriman Teruna and Tajul Rosli Razak and Siti Munira Yasin and Abdullah Ashraf Rafique Ali and Norzaher Ismail and Muhammad Muzzammil Mohamad Salleh and Mohamad Zuhair Mohamed Yusoff and Muhammad Hariz Ammar Khebir and Nur Adila Che Rameli and Muhammad Irfan Mohd Sallehhudin and Muhamad Syazni Mohamad Asraff and Mohamad Rodi Isa},
journal = {BMC ophthalmology},
year = {2026},
month = aug,
doi = {10.1186/s12886-026-05180-2},
url = {https://europepmc.org/article/MED/42958475},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Time to diabetic retinopathy and its prognostic factors among adults with type 2 diabetes mellitus in Johor, Malaysia from 2015 to 2019: a retrospective cohort study using surveillance data.
AU - Muhammad Muaz Shahriman Teruna
AU - Tajul Rosli Razak
AU - Siti Munira Yasin
AU - Abdullah Ashraf Rafique Ali
AU - Norzaher Ismail
AU - Muhammad Muzzammil Mohamad Salleh
AU - Mohamad Zuhair Mohamed Yusoff
AU - Muhammad Hariz Ammar Khebir
AU - Nur Adila Che Rameli
AU - Muhammad Irfan Mohd Sallehhudin
AU - Muhamad Syazni Mohamad Asraff
AU - Mohamad Rodi Isa
PY - 2026
DA - 2026/08/01
JO - BMC ophthalmology
DO - 10.1186/s12886-026-05180-2
UR - https://europepmc.org/article/MED/42958475
AB - Background Diabetic retinopathy is a major microvascular complication of type 2 diabetes mellitus and remains a leading cause of preventable visual impairment worldwide. Understanding the time to onset of diabetic retinopathy and its prognostic factors is essential to optimise screening strategies and guide early intervention. This study aimed to determine the time to development of diabetic retinopathy and identify its associated prognostic factors among adults with type 2 diabetes mellitus in Johor, Malaysia.Methods We conducted a retrospective cohort study using secondary data from the National Diabetes Registry in Johor, Malaysia. Adults aged ≥ 18 years with type 2 diabetes mellitus who had no documented diabetic retinopathy DR at cohort entry were included. Cohort entry was defined as the first eligible National Diabetes Registry registration/assessment date between 1 January 2015 and 31 December 2019. Participants were followed until first documented diabetic retinopathy, death, loss to follow-up, transfer out, or 31 December 2019, whichever occurred first. Baseline sociodemographic, clinical, treatment-related and complication variables were evaluated. Kaplan-Meier methods, Log-rank test, and Cox regression analyses were used to evaluate time to first documented diabetic retinopathy and its prognostic factors.Results Of 50,457 registry records initially identified, 1,056 duplicate records were removed. After excluding 1,448 records with incomplete eligibility, outcome or key baseline information, 47,953 participants were included in the original analytic dataset. Of these, 6,402 (13.3%) had a diabetic retinopathy diagnosis recorded in the registry and 41,551 (86.7%) were censored. Following verification of temporal eligibility and exclusion of 6,401 prevalent diabetic retinopathy records recorded before or at cohort entry, 41,552 participants contributed 64,551.7 person-years of follow-up, during which one incident diabetic retinopathy event occurred. Median follow-up estimated using the reverse Kaplan-Meier method was 6.1 months (IQR 5.3-29.0; range 3.2-113.4 months). duration of diabetes greater than 10 years (AHR = 1.96, 95% CI: 1.79-2.14), hypertension (AHR = 1.20, 95% CI: 1.10-1.31), dyslipidaemia (AHR = 1.25, 95% CI: 1.16-1.34), high waist circumference (AHR = 1.08, 95% CI: 1.02-1.14), positive urine protein (AHR = 1.09, 95% CI: 1.04-1.15), poor glycaemic control (AHR = 1.11, 95% CI: 1.03-1.20), and complications such as nephropathy (AHR = 1.78, 95% CI: 1.69-1.88) and diabetic foot ulcer (AHR = 1.92, 95% CI: 1.67-2.20) were independently associated with an increased risk of diabetic retinopathy.Conclusions Diabetic retinopathy develops within a relatively short duration following type 2 diabetes mellitus diagnosis and is influenced by a combination of metabolic, clinical, and complication-related factors. Early risk stratification and integrated management of modifiable risk factors are essential to delay the onset of diabetic retinopathy. These findings provide important real-world evidence to support targeted screening and public health strategies in Malaysia.
SN - 1471-2415
ER -