Emergence, Isolation and Coexistence of nephropathy and retinopathy among diabetic mellitus type 2 patients: A cross-sectional Study from a tertiary hospital-based population of Eritrea.

Background: DM2 is a growing chronic metabolic disorder affecting the aging populations in LMICs.The current prevalence of diabetic microvascular complications and their associated factors is relatively unknown in Eritrea. We aimed to determine the magnitude of retinopathy and nephropathy in patients who followed up in the study site as well as identify associated demographic and clinical factors . Methodology: Hospital based cross-sectional study was conducted among 302 type 2 diabetic patients attending in Halibet Referral Hospital, Diabetes Follow-up Clinic in Asmara. The presence of microvascular complications was defined as having one of DR or DN upon physician diagnosis. Socio-demographic and clinical information of patients were collected using questionnaires and patients’ clinical records. Relationships between DN and DR and the diagnostic efficacy of DR for DN were explored. Results: Diabetic microvascular complications were documented in 84.1% participants. Diabetic nephropathy showed the highest prevalence (43.3%), followed by coexisting nephropathy and retinopathy (30.1%). Our study demonstrated a clear relationship of age, diabetes duration, systolic blood pressure and Framingham risk score with microvascular complications of diabetes. Furthermore, the diagnostic accuracy of retinopathy in detecting nephropathy has been explored in this study, where retinopathy showed lower sensitivity (40%) and specificity (60%) with accuracy rate of 46%. Patients with diabetic nephropathy and retinopathy had a higher median systolic blood pressure [130 (IQR: 120-146)], as determined by the Kruskal-Wallis test (p-value = 0.06). More notably, participants with coexisting complications had a significantly higher median Framingham risk score of 21.9 (IQR: 14.7-33.2); P-value=0.001. Conclusion: Early recognition and timely intervention of microvascular complications remains central in designing effective preventive strategies in diabetes. The findings underscore the urgent need for targeted interventions focusing on lifestyle modifications, early detection, and effective management of diabetes and its associated complications. The association of diabetic retinopathy with diabetic nephropathy as a viable indicator early screening and timely identification of kidney diseases for diabetic patients in resource limited settings.