[A study on the mediation effect of insulin use on diabetic retinopathy in a community population].

Objective: To explore the risk factors for diabetic retinopathy (DR) in patients with diabetes and the mediating effect of insulin use on the relationship between glycated hemoglobin (HbA1c) and DR. Methods: Cross-sectional study. Random cluster sampling was conducted using a random number table method. A total of 84 sampling points (including 2 pilot points) were selected from the registered population of patients with type 2 diabetes aged 50 years and above at the Disease Prevention and Control Center in Funing County, Jiangsu Province. Questionnaires and biochemical tests were performed to obtain information on the general characteristics of the participants, medical history, insulin use, and glycated hemoglobin (HbA1c) levels. Ocular examinations, including anterior segment and fundus examinations, were conducted. The participants were divided into two groups, DR (diabetic retinopathy) and non-DR, based on the presence or absence of retinal hemorrhages, hard exudates, cotton wool spots, neovascularization, preretinal or vitreous hemorrhage. Univariate and multivariate logistic regression analyses were performed to identify the influencing factors for DR. The Karlson-Holm-Breen analysis method was used for mediation effect analysis. Results: A total of 2 067 diabetic patients were enrolled, of whom 1 965 completed the survey and 1 802 were included in the statistical analysis, resulting in a response rate of 87.2%. Among them, 660 patients were diagnosed with DR, with a detection rate of 36.63%. The results of multivariate analysis showed that diabetes duration (OR=1.166, 95%CI: 1.138-1.196), family history of diabetes (OR=1.325, 95%CI: 1.001-1.755), insulin therapy (OR=1.995, 95%CI: 1.434-2.777), HbA1c level (OR=1.513, 95%CI: 1.189-1.925), and alcohol consumption (OR=0.712, 95%CI: 0.514-0.985) were independent risk factors for DR. The mediating effect of insulin use accounted for 13.67% of the total effect of HbA1c on DR (P<0.001). Conclusions: The risk factors for DR in patients with diabetes include a history of insulin therapy, longer duration of diabetes, family history of diabetes, alcohol consumption, and high HbA1c levels. Insulin use increases the impact of HbA1c on DR and has a partial mediating effect on DR.目的： 探讨糖尿病患者患糖尿病视网膜病变（DR）的危险因素及胰岛素的使用在糖化血红蛋白（HbA1c）与DR关系中的中介效应。 方法： 横断面研究。采取随机数字表法进行随机整群抽样，抽取江苏省阜宁县疾病预防控制中心登记的50岁及以上的2型糖尿病患者群共计84个抽样点（其中2个为预试验点），进行问卷调查和生化检查，了解受检者的一般情况、全身疾病史、胰岛素使用情况以及糖化血红蛋白浓度等，眼部检查包括眼前节和眼底检查。根据眼底是否有出血点、硬性渗出、棉絮斑、新生血管、视网膜前或玻璃体积血等采用成组病例对照研究设计将受检者分为有DR和无DR两组，通过单因素和多因素Logistic回归分析，筛选出DR的影响因素，采用比值比（OR）及其95%置信区间（CI）描述关联强度。利用Karlson-Holm-Breen分析方法进行中介效应分析。 结果： 共检录了2 067例糖尿病患者，实际接受调查1 965例，最终纳入统计分析1 802例，应答率为87.2%，其中DR患者660例，检出率为36.63%。多因素分析结果显示，糖尿病病程（OR=1.166，95%CI：1.138~1.196）、糖尿病家族史（OR=1.325，95%CI：1.001~1.755）、使用胰岛素治疗（OR=1.995，95%CI：1.434~2.777）、HbA1c 水平（OR=1.513，95%CI：1.189~1.925）和饮酒（OR=0.712，95%CI：0.514~0.985）是DR的独立影响因素。使用胰岛素的中介作用占HbA1c水平对DR总效应的13.67%（P<0.001）。 结论： 糖尿病患者发生DR的危险因素是胰岛素治疗史、糖尿病病程长、糖尿病家族史、饮酒和HbA1c水平高，其中使用胰岛素会使得HbA1c水平对DR的影响增加，对DR具有部分中介效应。.