Cristina T.

Bolos BMLS 2E
A Journal Critique on Tehran Lipids and Glucose Study
The journal article provided is entitled “Incidence and risk factors of severe nonproliferative/
proliferative diabetic retinopathy: More than a decade follow up in the Tehran Lipids and
Glucose Study”. The paper was written by, Mahsa Sardarinia, Samaneh Asgari, Reyhane Hizomi
Arani, Fatemeh Eskandari, Fereidoun Azizi, Davood Khalili and Farzad Hadaegh with the doi
number of 10.1111/jdi.13647. First published on 17th of August 2021. This research study
pursued a decade follow up observation in Tehran’s lipid and glucose study, exposing its risk
factors and the possible incidence rate caused by severe non proliferative and proliferative
diabetic retinopathy.
Before we are going to delve into the discussion, let’s dissect important words from the title
itself for the reader’s better understanding. First, Tehran is a city located at Tehran province
known as the capital city of Iran. In lined with this, the participants of this research study are
mainly Iranians. As cited in the article from Scanlon et al. “race is a significant factor in the
development of DR in different populations.” Thus, we can say that this study has its own
limitations, and it cannot be used to be a standard guide but only a fundamental basis for further
related studies. When race plays a significant factor in this kind of studies, it is guaranteed that
some expectations and limitations will not be meet and presented if this study will take place on
another race.
Moreover, when we say nonproliferative diabetic retinopathy (NPDR), the more prevalent
variety, is marked by the absence of new blood vessel growth (proliferating). The walls of the
blood vessels in your retina deteriorate when you have NPDR. Small protrusions from the
smaller arteries' walls can occasionally leak fluid and blood into the retina. Meanwhile, the
advanced stage of proliferative retinopathy is marked by the development of abnormally new
blood vessels on the retina's surface. These blood vessels have the potential to burst and leak into
the vitreous, the clear, watery gel that fills the eye, which can seriously impair vision. Treatment
for diabetic retinopathy at this stage is frequently urgent. To make this brief, the key word is that
non-proliferative diabetic retinopathy is no new growth of blood vessels in the retina and
proliferative diabetic retinopathy is when blood vessel growth is seen in the retina’s surface.
It is clearly stated in the journal article provided, quoting from American Diabetes Association
and the American Academy of Ophthalmology “recommend that patients with type 2 diabetes
mellitus should undergo further ophthalmic assessments at least once a year.” To further
elaborate, it is necessary to have an on-time check-ups for a timely diagnosis. To prevent further
complications and quick management of the illness. Unfortunately, we cannot deny the fact that
this also relies on the patient’s socioeconomic status. Some cannot afford to have at least once a
year check up due to financial reasons leading to deterioration of overall health and some does
not have enough capabilities to acquire healthcare insurances; it does also vary in the healthcare
system of one’s country.
In the clinical and laboratory measurements portion of the article, “height and weight as body
measurement were executed and participants was wearing light clothes and shoes were asked to
remove” This statement may be not causing any big thoughts to others, but personally this is a
good way of showcasing measurements. In some instance, clothes and removal of shoes is not
that significant when weighing one’s weight but scientifically speaking, this can create a false
increase in weight that could lead to erroneous and contradicting result of the original body
weight since there is no constant weight between clothes and shoes.
The journal was able to compare the progression of diabetic retinopathy from a non-smoker and
a smoker, “smokers are reported to have higher amounts of carboxyhemoglobin than non-
smokers, which results in a reduction in the blood's ability to carry oxygen, with retinal hypoxia
causing the development of DR. Additionally, nicotine may cause vasoconstriction, which may
make DR worse.” Aside from diet, lifestyle takes a big shift in overall health. This means that the
risk factors of diabetic retinopathy tend to have a drastic impact on patients who smoked rather
than those who are not. Which is supported by this study, it was mentioned that “Approximately
1% of Iranians with type 2 diabetes mellitus experienced severe NPDR/PDR each year. Severe-
NPDR/PDR related to normal body weight, current smoking, prehypertension, recently
diagnosed hypertension, and poor treatment of diabetes.”
To sum up, "Incidence and risk factors of severe nonproliferative/proliferative diabetic
retinopathy: More than a decade follow up in the Tehran Lipids and Glucose Study," is the title
of the journal article that is being made available. Mahsa Sardarinia, Samaneh Asgari, Reyhane
Hizomi Arani, Fatemeh Eskandari, Davood Khalili, and Farzad Hadaegh all contributed to the
writing of the paper. Patients with type 2 diabetes should receive further ophthalmic evaluations
at least once a year, according to recommendations from the American Diabetes Association and
the American Academy of Ophthalmology. In addition to eating, lifestyle has a significant
impact on general health. Patients who smoke tend to be much more affected by the risk factors
for diabetic retinopathy than those who do not. The risk factors of the participants in Tehran in
developing diabetic retinopathy was more likely from smoking, unable to monitor
prehypertension and control of diabetes. Race was also a factor in conducting this study.
Therefore, I conclude that, this study is magnificently well made. The writers of this journal
article merit praise and a standing ovation for their brilliant insights, in my opinion as I read it.
Given that the study's participants came from 13 different Tehran districts, this is a laudable
action. No research endeavor is a failure when it involves creative minds and motivated
individuals who are prepared to contribute. However, it requires a greater size of population to
be accepted as a reliable foundation for subsequent studies on the subject. Despite the study's
flaws, it must nonetheless be acknowledged because it will be used in some way to guide future
research of a similar nature.
This study may be brain-whacking to critique but surely as the reader, it has done its job to
impart knowledge about diabetic retinopathy and its risk factors.