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Diabetic retinopathy at diagnosis of type 2 diabetes in the UK: a database analysis (pdf)

Objective To validate a mathematical algorithm that calculates risk of diabetic retinopathy progression in a diabetic population with UK staging (R0–3; M1) of diabetic retinopathy. Of the current three million cases of diabetes in the UK, 80% of these patients will develop diabetic retinopathy (DR), which is the most common cause of blindness in people of working age in the UK. We were overwhelmed by the number of applications for this year’s YDEF Retinopathy course and would like to thank everyone who applied. Results: Angiopoietin 1 concentrations were low in patients with macular hole (median 17 pg/ml) while in NPDR with CSMO they were 2002 pg/ml (range 289–5820 pg/ml) and in PDR 186 pg/ml (range 26–2292 pg/ml). It causes changes in the blood vessels in the eyes and affects the circulatory system of the retina. Of 752 DR patients studied, 53.9% were male; mean age (+/-SD) was 64.2+/-12.8 years. Teleophthalmology is therefore currently perfectly placed to face this urgent and immediate challenge of provision of optimal and expert care to remote and multiple patients over widespread geographical areas.

There were 58 patients with type I diabetes and 100 with type II, with a mean duration of diabetes of 23 and 16.5 years, respectively. Some ophthalmologists who contribute to a diabetic retinopathy treatment service also contribute to the local screening service as a clinical lead and / or arbitration grader, in which case they are expected to participate in the quality assurance mechanisms stipulated by the national screening programmes. Dr Hogg and her colleagues believe that these vessels are likely to be most vulnerable early on, and therefore may be better at providing an earlier indication of retinopathy than the large vessels that are currently used for assessment. Thirdly, making sure that this change is properly communicated to people with diabetes so they understand the changes and the importance of attending eye screening – whether it is once a year or once every two years. This will enable the researchers to study the regional impact of diabetic retinopathy on a range of different cell types and learn more about the development of this condition. The book is timely in its ability to capture very recent therapeutic advances that are significantly changing how eye care professional practice. No significant relationships were observed for obesity and diastolic blood pressure.

Try sunglasses, consult your optometrist and ophthalmologist, but if extremely severe you may have to give up driving. Age, male sex, hyperglycaemia and hypertension were identified as risk factors of early retinopathy in type 2 diabetes. – Abbreviations ATC Anatomical Therapeutic Chemical Classification System ICD International Classification of Diseases Diabetic retinopathy is one of the leading causes of visual loss [1]. Therefore patients with type 2 diabetes should have an eye examination shortly after the diagnosis of diabetes [2]. There have been many epidemiological studies assessing the prevalence of retinopathy, although few have looked at patients with newly diagnosed type 2 diabetes [3]. Recently, Looker et al examined the prevalence of, and risk factors for, diabetic retinopathy in people with newly diagnosed type 2 diabetes mellitus, using Scottish national data [4]. In their study, a high prevalence (19.3%) of early retinopathy was reported [4].

The aim of the present study was to estimate the prevalence of and risk factors for diabetic retinopathy in newly diagnosed type 2 diabetes in general practices in the UK using a large nationwide database. Laser therapy has been demonstrated to allow patients to maintain their vision longer than those left untreated. Briefly, Disease Analyzer UK assembles longitudinal data on diagnoses, prescriptions and laboratory values reported from 674 office-based physicians (97 general practices). The panel of general practitioners in Disease Analyzer UK is broadly representative of the UK population, although there is under-representation of smaller practices and of practices in Scotland and Northern Ireland, and there is a slight over-representation of younger doctors [5]. Ethnic variations in the prevalence of diabetic retinopathy in people with diabetes attending screening in the United Kingdom (DRIVE UK). Then all patients with type 2 diabetes were identified on the basis of International Classification of Diseases (ICD-10) codes (E11) (www.who.int/classifications/icd/en/). Finally, patients with diabetes duration 40 years were selected.

For each study subject, age, sex, diabetes duration, BMI, HbA1c, and systolic and diastolic blood pressure were assessed. In addition, antihypertensive drug prescriptions were assessed on the basis of Anatomical Therapeutic Chemical Classification System (ATC) codes (http://www.whocc.no/atc_ddd_index/; C03, diuretics; C07, -blockers; C08, calcium antagonists; C09, ACE inhibitors). Presence of retinopathy was defined on the basis of the ICD code (E11.3) or on the original diagnosis text of the physicians. The time period between first diabetes diagnosis and first retinopathy diagnosis was calculated for each patient. Descriptive analyses were obtained for all variables, and mean SD for normally distributed variables and median (interquartile range) for continuous variables not normally distributed were calculated. Univariate and multivariate logistic regression was used to examine associations of potential risk factors with prevalent diabetic retinopathy. The level of statistical significance was 5%.

All analyses were carried out using SAS, version 9.2 (SAS Institute, Cary, NC, USA). There were 12,524 patients with newly diagnosed type 2 diabetes mellitus in the general practices. The only difference is that optical reflectivity is measured. Take Dario with you and you’ll appreciate the colors of the sunset knowing that you are monitoring your blood sugar and insulin levels with the most accurate device on the market. This result of the present database study is in line with a current investigation based on national data in Scotland, where 91% of all people newly diagnosed with diabetes have been screened for diabetic retinopathy [4]. The prevalence of retinopathy in newly diagnosed type 2 diabetes is higher than in people with screen-detected diabetes. For example, in the Australian Diabetes, Obesity and Lifestyle Study, retinopathy was present in 6.2% of those with previously undiagnosed diabetes based on an oral glucose tolerance test [3].

Thus, because in the first year after clinical diagnosis about 20% already show evidence of diabetic retinopathy, undetected diabetes is likely to have been present for several years. Recent results of the Prevalence of Diabetic Eye Disease Study (Tayside, Scotland) indicate that the onset of detectable retinopathy occurs 5.8 years (95% CI 4.6, 7.0) before type 2 diabetes diagnosis [6]. The evaluation of risk factors for retinopathy in newly diagnosed diabetes is relevant for prevention of visual impairment [1, 4]. Population-based studies and clinical trials have demonstrated that poor glycaemic and blood pressure control are key risk factors for the development of retinopathy [3, 4, 7]. Also male sex has been reported as a risk factor in some studies [4, 8]. The present study confirms these associations. HbA1c, systolic blood pressure, antihypertensive drug prescriptions and male sex were all independently related to the odds of having diabetic retinopathy in multivariate analyses.

In contrast with the study by Looker et al, we found a significant relationship with age [4]. Furthermore, we could not replicate the finding of the Scottish study that lower BMI was associated with retinopathy [4]. In the present study, obesity was not related to retinopathy. This lack of an association is most likely due to the fact that most of the patients with type 2 diabetes were obese. Overall, the evidence supporting a relationship between anthropometry risk factors and retinopathy in type 2 diabetes is inconclusive [7]. Both a higher risk of retinopathy in obese people as well as a protective role for higher BMI has been reported [7, 9]. It should be noted that retrospective primary care database analyses such as the present study are limited by the validity and completeness of data.

Assessment of morbidity relied on ICD codes by primary care physicians only. In particular, no information was available on how the retinopathy was diagnosed (e.g. fundus photographs, fundus examinations). Furthermore, valid data on socioeconomic status and lifestyle-related risk factors (smoking, alcohol, physical activity) were lacking. Finally, although guidelines request screening for retinopathy in newly diagnosed diabetes, the present prevalence estimate is only based on those subjects who had been referred for an eye investigation. In conclusion, the prevalence of any diabetic retinopathy in patients with type 2 diabetes newly diagnosed in general practices in the UK was 19%. This estimate is lower than those reported in the past (e.g.

the United Kingdom Prospective Diabetes Study), but is higher than those from population-based screening [3, 10]. Age, male sex, high systolic blood pressure and hyperglycaemia (HbA1c) were identified as risk factors for early retinopathy in type 2 diabetes. Funding IMS Health. Duality of interests The authors declare that there is no duality of interest associated with this manuscript. Contribution statement Both authors made substantial contributions to the conception and design, analysis and interpretation of data as well as to the drafting and revising the manuscript. In detail, KK undertook the primary data analysis, and WR drafted the article. Both authors approved the final version of the manuscript.

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