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Risk of Retinopathy in Type 1 and Type 2 Diabetic Patients

DR prevalence of DR higher in T1s; T2s have the major burden….

One of the microvascular complications of type 1 and type 2 diabetes is diabetic retinopathy (DR), which can cause blindness and low vision in this patient population along with other age-related eyes condition. Many screening programs have been introduced and implemented worldwide to better detect, diagnose, and treat DR. The goal of this study was to determine the prevalence of DR using a large community based screening programme in order to accurately estimate the future burden of this specific and debilitating complication of diabetes.

A total of 220 locations throughout Wales were included in the community-based mobile screening service called National Diabetic Retinopathy Screening Service for Wales (DRSSW). Screening inclusion criteria included diabetic patients with age ≥ 12 years without any eye-related diseases. Exclusion criteria included patients <12 years old, those who were already under the care of hospital eye services (HES) for DR-related reasons, and those with medical reasons. For type 1 diabetes, age at diagnosis was divided into subgroups ≤12 yrs, 13–23 yrs and ≥24 yrs. Diabetes duration was also divided into subgroups <10 yrs, 10–19 yrs and ≥20 years. For type 2 diabetes, the subgroups for age at diagnosis were ≤55 yrs, 56–66 yrs and ≥67 yrs, and for diabetes duration were <5 years, 5–9 years and ≥10 years, respectively. Several tests such as t-tests and chi-squared tests with p value of <0.05 were used for statistical analyses. Logistic regression analyses were also performed to assess the association of variables to DR status.

From January 2015 to November 2009, a total of 91,393 patients including 5,003 type 1 diabetic patients and 86,390 type 2 diabetic patients were screened by DRSSW. The prevalence of any DR were 56.3% in type 1 diabetic and 30.9% in type 2 diabetic. For sight-threatening DR (STDR), the prevalence were 11.2% in type 1 diabetic and 2.9% in type 2 diabetic. For non-sight-threatening DR (NSTDR), prevalence were 45.1% in type 1 diabetic and 28.1% in type 2 diabetic. The study also showed that type 1 diabetic patients with STDR were more likely to be male, younger at the time of diagnosis, with a longer duration of diabetes, and older at first screening compared to those without DR. Type 2 diabetic patients with STDR were also more likely to be male, younger at the screening event, with a longer duration of diabetes, and more likely to receive insulin therapy compared to those without DR. Thus, the study showed an association between duration of diabetes and insulin therapy and STDR as well as NSTDR in type 1 and 2 diabetic patients.

In conclusion, the prevalence of DR was higher in people with type 1 diabetes; however, type 2 diabetic patients have the major burden. Early detection will ensure that patients will be assessed and treated early; thus, patient outcomes will be improved.

Practice Pearls:

  • The prevalence of DR was higher in people with type 1 diabetes; however, type 2 diabetic patients have the major burden.
  • Increasing duration of diabetes was the most significant risk factor for any DR in patients with type 1 and 2 diabetes.
  • Higher risk for DR was associated with the use of insulin.

Thomas, Rebecca L et al. “Prevalence of Diabetic Retinopathy Within a National Diabetic Retinopathy Screening Service.”The British Journal of Ophthalmology. 2015;99(1):64-68.