OBJECTIVETo examine the global prevalence and major risk factors for diabetic retinopathy (DR) and vision-threatening diabetic retinopathy (VTDR) among people with diabetes.RESEARCH DESIGN AND METHODSA pooled analysis using individual participant data from population-based studies around the world was performed. A systematic literature review was conducted to identify all population-based studies in general populations or individuals with diabetes who had ascertained DR from retinal photographs. Studies provided data for DR end points, including any DR, proliferative DR, diabetic macular edema, and VTDR, and also major systemic risk factors. Pooled prevalence estimates were directly age-standardized to the 2010 World Diabetes Population aged 20–79 years.RESULTSA total of 35 studies (1980–2008) provided data from 22,896 individuals with diabetes. The overall prevalence was 34.6% (95% CI 34.5–34.8) for any DR, 6.96% (6.87–7.04) for proliferative DR, 6.81% (6.74–6.89) for diabetic macular edema, and 10.2% (10.1–10.3) for VTDR. All DR prevalence end points increased with diabetes duration, hemoglobin A1c, and blood pressure levels and were higher in people with type 1 compared with type 2 diabetes.CONCLUSIONSThere are approximately 93 million people with DR, 17 million with proliferative DR, 21 million with diabetic macular edema, and 28 million with VTDR worldwide. Longer diabetes duration and poorer glycemic and blood pressure control are strongly associated with DR. These data highlight the substantial worldwide public health burden of DR and the importance of modifiable risk factors in its occurrence. This study is limited by data pooled from studies at different time points, with different methodologies and population characteristics.

OBJECTIVE -To study time course changes in knowledge, problem solving ability, and quality of life in patients with type 2 diabetes managed by group compared with individual care and education.RESEARCH DESIGN AND METHODS -We conducted a 5-year randomized controlled clinical trial of continuing systemic education delivered by group versus individual diabetes care in a hospital-based secondary care diabetes unit. There were 120 patients with non-insulin-treated type 2 diabetes enrolled and randomly allocated to group or individual care. Eight did not start and 28 did not complete the study. The main outcome measures were knowledge of diabetes, problem solving ability, quality of life, HbA 1c , BMI, and HDL cholesterol.RESULTS -Knowledge of diabetes and problem solving ability improved from year 1 with group care and worsened among control subjects (P Ͻ 0.001 for both). Quality of life improved from year 2 with group care but worsened with individual care (P Ͻ 0.001). HbA 1c level progressively increased over 5 years among control subjects (ϩ1.7%, 95% CI 1.1-2.2) but not group care patients (ϩ0.1%, Ϫ0.5 to 0.4), in whom BMI decreased (Ϫ1.4, Ϫ2.0 to Ϫ0.7) and HDL cholesterol increased (ϩ0.14 mmol/l, 0.07-0.22).CONCLUSIONS -Adults with type 2 diabetes can acquire specific knowledge and conscious behaviors if exposed to educational procedures and settings tailored to their needs. Traditional one-to-one care, although delivered according to optimized criteria, is associated with progressive deterioration of knowledge, problem solving ability, and quality of life. Better cognitive and psychosocial results are associated with more favorable clinical outcomes.

OBJECTIVE -To evaluate whether group visits, delivered as routine diabetes care and structured according to a systemic education approach, are more effective than individual consultations in improving metabolic control in non-insulin-treated type 2 diabetes.RESEARCH DESIGN AND METHODS -In a randomized controlled clinical trial of 112 patients, 56 patients were allocated to groups of 9 or 10 individuals who participated in group consultations, and 56 patients (considered control subjects) underwent individual visits plus support education. All visits were scheduled every 3 months. RESULTS -After 2 years, HbA 1c levels were lower in patients seen in groups than in control subjects (P Ͻ 0.002). Levels of HDL cholesterol had increased in patients seen in groups but had not increased in control subjects (P ϭ 0.045). BMI (P ϭ 0.06) and fasting triglyceride level (P ϭ 0.053) were lower. Patients participating in group visits had improved knowledge of diabetes (P Ͻ 0.001) and quality of life (P Ͻ 0.001) and experienced more appropriate health behaviors (P Ͻ 0.001). Physicians spent less time seeing 9 -10 patients as a group rather than individually, but patients had longer interaction with health care providers.

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