[ Diabetes Type 2 ]

Epidemiology of diabetic retinopathy: Expected vs reported prevalence of cases in the French population

Contributors MBS, CS and KH participated equally in all aspects of the literature review, manuscript design, writing, final review and approval of the manuscript for submission, and preparation of the response to reviewer comments and manuscript revisions for resubmission. A prospective study was carried out from August 2010 to August 2014 in the community of Fengyutan (China). of Ophthalmology, U. Nineteen studies were included. In Victoria, only 55% of the population with diabetes currently access eye care services at the recommended intervals. Annual screening is recommended, with mydriatic stereoscopic fundus photography being the most sensitive detection method. Population estimates for Ireland were obtained from the Central Statistics Office.

1998;352:837–53. Report covers the disease overview including etiology, path physiology, symptoms, diagnosis, disease management, and current treatment options. CONCLUSIONS: A better control of diabetes mellitus may lead us to observe an increase in visual acuity, and a better control of diabetic retinopathy. To ease the burden of work, some have recommended training allied eye care professionals to perform retinal photography, grading, and assessment through telemedicine after linking regional referral hospital with a major Tertiary Ophthalmic Care Hospital. Diabetic retinopathy was clinically graded using Klein’s classification (Modified Early Treatment Diabetic Retinopathy Study scales) [9]. Click here to see the Library]. In the most recently diagnosed patients — those referred between 1979 and 1984 — decreases in the incidences of DR and MO were demonstrated, suggesting that modern strategies to control glucose levels and to lower blood pressure have contributed to reducing the incidence of these diabetes complications.

In summary, data from various longitudinal studies suggest that the annual incidence of DR is approximately 2–6%. This means that the incidence rates are only about five to 10 times lower than the prevalence rates, suggesting a high turnover of patients with retinopathy. This is probably related to their shorter life expectancy due to advanced age and longstanding diabetes. Click here to see the Library], the sample was mainly hospital-based, and limited to a small number of patients with type 2 diabetes who regularly attended hospital for endocrinology consultation. In this study, DR was explored using a reference method for diagnosis (direct ophthalmoscopy, slit-lamp examination, fluorescein angiography). The prevalences of any DR, PDR and MO were 33, 3.3 and 5.6%, respectively. Advanced retinopathy (PDR, MO) increased with increased duration of diabetes, and was strongly linked to the other diabetes complications studied — namely, peripheral neuropathy and nephropathy.

The American Heart Association considers diabetes as 1 of the 6 major controllable risk factors for cardiovascular disease. Click here to see the Library], DR was found more frequently in patients with type 1 rather than type 2 diabetes, and whether treated or not with insulin (31.1, 12.9 and 8.6%, respectively). Click here to see the Library]. The patients’ mean duration of diabetes was 8.9 years, and more than a third had complications related to diabetes. A yearly eye exam in diabetics is highly recommended as such preventive measures are cost-effective [ 8, 10 ]. Click here to see the Library]. Data were analyzed from 3648 subjects reimbursed for an oral antidiabetic drug and/or insulin during the fourth trimester of 2001, and from their 1718 physicians.

According to the patients’ questionnaires, 14.5% had already received previous laser treatment and 42.6% had undergone fundus examination during 2001. According to the physicians’ questionnaires, 9.9% of patients had DR, 4.5% had already received laser treatment and 65.3% had previously undergone ophthalmological examination. In contrast, reimbursement files showed that only 43% of patients had consulted an ophthalmologist during the past year. Good glycemic and hypertension control should be recommended to prevent the occurrence of these complications of diabetes. In addition, measures were also possibly underevaluated, as a smaller proportion of patients than had been declared had undergone fundus examination during the past year. Click here to see the Library]. Of 199 diabetic patients, 140 patients (70.35%) had DR.

These data suggest that the severity of DR is related to longer duration of diabetes and to the frequency of other comorbidities — particularly nephropathy and coronary heart disease. PDR accounted for 20.8% of reported DR in French patients, which may reflect the fact that patients were more likely to be diagnosed with DR only at later stages of diabetic disease or when DR is at a more advanced stage. The insulin users were younger and had lower diastolic blood pressure and lower total cholesterol as compared with the two other groups combined. Yet, taking all the selected studies together, the frequency of “known” or “recorded” DR in French diabetic patients was around 10% — well below the 28.7% average estimated prevalence of DR from epidemiological studies. This suggests that DR is either underdiagnosed in patients with diabetes or that the prevalence of DR is much lower in France than in other Western countries perhaps because of, for instance, different strategies in the screening and treatment of diabetes. Click here to see the Library]. Of these patients, 8.6% were found to have DR.

Patients screened had satisfactory control of their diabetes (mean HbA1c =7.2%), but 6.8% had never consulted an ophthalmologist and 55% had not had an eye examination within the past two years. Not surprisingly, prevalence rates were lower than in DODIA, probably due to selection bias. As patients voluntarily participate in such screening campaigns, those who attend are usually highly motivated and treatment-compliant. This also means that, in such individuals, the rate of diabetes complications is likely to be less marked. Click here to see the Library]. Over a 28-month period, 13,777 diabetic patients of unknown retinal status were screened for DR using non-mydriatic cameras. Photographs were taken by technicians (16 screening sites located in hospitals, healthcare centres and prisons), while the images were graded by trained ophthalmologists at a reading centre.

DR was detected in 23.4% of patients. Of the patients diagnosed with DR, 0.5% had PDR and 3.4% had MO. In addition, 5.6% of patients (n =777) had undiagnosed severe DR requiring urgent referral to an ophthalmologist for laser treatment. Click here to see the Library]. More important, the results of recent screening programmes (Table 4) indicate that 10–20% of French diabetic patients of previously unknown retinal status have retinopathy. Click here to see the Library], the evidence suggests that patients do not fully comply with screening and that the prevalence of DR in non-compliant patients could be as high as 10–20%. Alternative methods of DR screening using nonmydriatic fundus photography have been validated, and show the same sensitivity and specificity in DR diagnosis as does ophthalmoscopy.

In addition, DR screening programmes using ambulatory screening and/or a telemedicine network have been successfully conducted on a local community basis and have proved to facilitate access to regular, annual evaluations of patients with diabetes. Indeed, implementing DR screening programmes that cover the entire French territory are, without doubt, a key target for improving DR diagnosis and shortening treatment delays in patients with referable retinopathy. Dr Delcourt has been a consultant for Chauvin–Bausch & Lomb, Alcon, Novartis, Pfizer and Lilly, and received funds from Théa Laboratories. Dr Massin has been a consultant for Lilly, Takeda, Novartis, Pfizer and Solvay. Dr Rosilio is an employee of Eli Lilly and Company.

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