INS and obesity due to melanocortin 4 receptor deficiency: The prevalence of DR was 19.7%; 9.1% had NPDR, 10.6% had PDR, and 5.7% had macular edema. The most significant associated risk factors were the patient's age and duration of diabetes. Other significant risk factors were male gender, neuropathy, nephropathy, insulin use, poor glycemic control, and hypertension, while smoking, hyperlipidemia, and obesity significantly decreased the risk for DR.