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Early detection of type 2 diabetes mellitus and screening for retinopathy are associated with reduced prevalence and severity of retinopathy
Department of Ophthalmology, The National University Hospital, Reykjavik, Iceland; University of Iceland, Reykjavik, Iceland; Department of Ophthalmology, Örebro University Hospital, Örebro, Sweden.
Family Medicine and Preventive Medicine Section, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
Department of Ophthalmology, Örebro University Hospital, Örebro, Sweden.
Family Medicine and Preventive Medicine Section, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
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2016 (English)In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 94, no 3, 232-239 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: To explore whether the prevalence and severity of retinopathy differ in diabetes cohorts diagnosed through screening as compared with conventional health care.

Methods: A total of 257 diabetes patients, 151 detected through screening and 106 through conventional clinical care, were included. Retinopathy was evaluated by fundus photography. The modified Airlie House adaptation of the Early Treatment Retinopathy Study protocol was used to grade the photographs. Averages of clinically collected fasting blood glucose (FBG), blood pressure and body mass index values were compiled from diabetes diagnosis until the eye examination. Blood chemistry, smoking habits and peripheral neuropathy were assessed at the time of the eye examination.

Results: Among the screening-detected patients, 22% had retinopathy as compared to 51% among those clinically detected (p < 0.0001). In a multivariate analysis, patients with retinopathy were more likely to have increased average FBG (OR 1.42, 95% CI 1.19-1.70 per mmol/l) and peripheral neuropathy (OR 2.75, 95% CI 1.40-5.43), but less likely to have screening-detected diabetes (OR 0.31, 95% CI 0.17-0.57). Similar results were found using increasing severity grade of retinopathy as outcome. The cumulative retinopathy prevalence for the screening-detected diabetes cohort as compared with the clinically diagnosed cohort was significantly lower from 10 years' follow-up and onwards (p = 0.0002).

Conclusions: Among patients with screening-detected diabetes, the prevalence of retinopathy and increasing severity of retinopathy were significantly lower than among those who had their diabetes diagnosed through conventional care, even when other risk factors for retinopathy such as duration, hyperglycaemia and blood pressure were considered. Early detection of diabetes reduces prediagnostic time spent with hyperglycaemia. In combination with early and regular screening for retinopathy, more effective prevention against retinopathy can be provided.

Place, publisher, year, edition, pages
Hoboken, USA: Wiley-Blackwell Publishing Inc., 2016. Vol. 94, no 3, 232-239 p.
Keyword [en]
Diabetes duration, longitudinal data, opportunistic case finding, peripheral neuropathy, retinopathy, screening, type 2 diabetes mellitus
National Category
Endocrinology and Diabetes Ophthalmology
Identifiers
URN: urn:nbn:se:oru:diva-50097DOI: 10.1111/aos.12954ISI: 000374693000014PubMedID: 26855250OAI: oai:DiVA.org:oru-50097DiVA: diva2:925744
Note

Funding Agencies:

Örebro County Council

Helga Jonsdottir and Sigurlidi Kristjansson Memorial Fund, Reykjavik, Iceland

Science Fund of The National University Hospital, Reykjavik, Iceland

Available from: 2016-05-03 Created: 2016-05-03 Last updated: 2017-10-17Bibliographically approved

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