Abstract / Summary
Background: Diabetic macular edema (DME) is the most common cause of vision loss in people with diabetes. Although the global prevalence of DME is increasing and several studies have been conducted worldwide, research on the burden and risk factors of diabetic macular edema in Ethiopia remains limited. This research aimed to investigate the magnitude, patterns, and determinants of DME among people with diabetes at Debre Markos Referral Hospital.
Method: A hospital-based prospective cross-sectional study was conducted among 426 type 1 and type 2 people with diabetes from April 1 to May 30, 2025. Participants were selected via systematic random sampling using the patient registry as a sampling frame. Data were collected using three approaches: medical record review, participant interviews, and direct clinical assessment. Blood pressure, body weight, height, blood glucose, and serum lipid profiles were measured directly for all participants. Fundus evaluation was performed using slit-lamp biomicroscopy and optical coherence tomography, and diabetic macular edema was defined according to the Early Treatment Diabetic Retinopathy Study criteria. Data were entered into EpiData 3.1 and exported to SPSS version 25. Descriptive statistics and logistic regression analyses were conducted. Variables with a p < 0.25 in the bivariate analysis were included in the multivariable model, with statistical significance set at p < 0.05.
Results: Diabetic macular edema was identified in 112 of 426 participants (26.29%; 95% CI 22.29-30.71%), of whom 28/112 (25.00%) had clinically significant diabetic macular edema. Among the 112 participants with diabetic macular edema, diffuse DME was the most common morphological pattern (49/112, 43.75%), followed by cystoid (27/112, 24.10%), tractional (21/112, 18.75%), combined (11/112, 9.82%), and serous (4/112, 3.57%). Diabetic retinopathy was present in 148/426 (34.74%) participants. Among participants with NPDR, 68/106 (64.15%) had DME, whereas 36/42 (85.71%) of those with PDR had DME. Visual acuity impairment was observed in 99/112 (88.39%) participants with DME and in 178/426 (41.78%) of the total study population. Multivariable logistic regression showed that age 41-65 years (AOR=3.02, 95% CI 1.53-5.98), age > 65 years (AOR=5.73, 95% CI 2.04-16.12), poor glycemic control (AOR=3.15, 95% CI: 1.81-5.45), elevated total cholesterol (AOR = 1.97, 95% CI 1.07-3.62), hypertension (AOR = 3.10, 95% CI 1.7-5.44), BMI ≥25 kg/m2 (AOR = 2.39, 95% CI 1.35-4.22), and diabetes duration >10 years (AOR = 4.10, 95% CI 2.41-6.98) were independently associated with DME.
Conclusion and recommendation: Diabetic macular edema is a significant complication among people with diabetes. Age, glycaemic control level, hypertension, BMI, total cholesterol, and diabetic duration were associated with DME. Therefore, we recommend strengthening routine DME screening and integrated diabetes and eye-care services in Ethiopia, with emphasis on early detection and management of DME and optimal management of blood glucose, blood pressure, lipid levels, and body weight among people with diabetes.