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Screening for Diabetic Retinopathy with Extended Intervals, Safe and Without Compromising Adherence: A Retrospective Cohort Study
Department of Ophthalmology, Karlstad Hospital, Region Värmland, Karlstad, Sweden. (Diabetes Endocrinology and Metabolism Research Center)
Örebro University, School of Medical Sciences. (Diabetes Endocrinology and Metabolism Research Center)ORCID iD: 0000-0003-1025-1682
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Ophthalmology, Karlstad Hospital, Region Värmland, Karlstad, Sweden. (Diabetes Endocrinology and Metabolism Research Center)ORCID iD: 0000-0003-4273-0741
2021 (English)In: Diabetes Therapy, ISSN 1869-6953, E-ISSN 1869-6961, Vol. 12, no 1, p. 223-234Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Screening for diabetic retinopathy (DR) prevents blindness through the early detection of sight-threatening retinal microvascular lesions that respond to timely local treatment. However, the provision of easy and regular access to DR screening programs is currently being challenged by the increasing prevalence of diabetes. One proposed solution is to extend the screening interval for patients at low risk for progression of retinopathy. To date, most providers of screening programs have hesitated to implement a strategy of extended intervals due to the lack of data on whether adherence and safety are compromised when retinal examinations occur less frequently. In the study reported here, we investigated adherence to the screening program and progression of retinopathy in patients with type 2 diabetes participating in a DR screening program with extended intervals.

METHODS: This was a retrospective study that included 1000 patients with type 2 diabetes mellitus who attended a screening program for DR. The patients were consecutively placed into a low-risk patient cohort with no retinopathy or into an intermediate-risk patient cohort with mild retinopathy (each cohort n = 500). Screening intervals were 36 months for the low-risk cohort and 18 months for the intermediate-risk cohort.

RESULTS: The 1000 subjects enrolled in the study had a median age of 68 (interquartile range 12) years and 60.4% were men. At the follow-up screening visit, data on 102 subjects were not included in the analysis of adherence rate due to death, severe systemic illness, other concurrent eye disease or migration. Among the 898 remaining subjects, adherence to the screening program was 93.7% (413/443) in the 36-month group and 98.3% (449/455) in the 18-month group (p < 0.0001). Non-adherence decreased with increasing age (odds ratio 0.92, 95% confidence interval 0.888-0.954, p = 0.0005). At follow-up, 65 subjects showed progression of retinopathy; none had worse than moderate retinopathy. Risk factors for DR and treatment for hyperglycemia, hypertension and hyperlipidemia were compared among subjects in the low-risk cohort: non-adherent subjects did not differ from their adherent counterparts without progression of DR, but the former had a shorter duration of diabetes and higher diastolic blood pressure than adherent subjects with progression of DR (4.5 vs. 7.5 years, p = 0.007; and 80 vs. 75 mmHg, p = 0.02, respectively).

CONCLUSION: The results suggest that screening DR at extended intervals can be achieved with high adherence rates without compromising patient safety. However, younger subjects and those at higher risk of progression may require extra attention.

Place, publisher, year, edition, pages
Springer, 2021. Vol. 12, no 1, p. 223-234
Keywords [en]
Adherence, Attendance, Diabetes mellitus, Diabetic retinopathy, Screening
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:oru:diva-87336DOI: 10.1007/s13300-020-00957-0ISI: 000587973900003PubMedID: 33165837Scopus ID: 2-s2.0-85095715980OAI: oai:DiVA.org:oru-87336DiVA, id: diva2:1500072
Note

Funding Agencies:

Kamprad Family Foundation for Entrepreneurship, Research Charity  

Centre for Clinical Research, Region Värmland, Sweden 

Available from: 2020-11-11 Created: 2020-11-11 Last updated: 2024-03-05Bibliographically approved

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Sharif, AliJendle, JohanHellgren, Karl-Johan

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