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Early detection of type 2 diabetes mellitus and screening for retinopathy are associated with reduced prevalence and severity of retinopathy
Author(s) -
Olafsdottir Eydis,
Andersson Dan K. G.,
Dedorsson Inger,
Svärdsudd Kurt,
Jansson Stefan P. O.,
Stefánsson Einar
Publication year - 2016
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/aos.12954
Subject(s) - medicine , retinopathy , diabetes mellitus , fundus photography , diabetic retinopathy , cohort , body mass index , cohort study , type 2 diabetes , ophthalmology , fluorescein angiography , endocrinology , visual acuity
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.