Changes observed in diabetic retinopathy: eight-year follow-up of a Spanish population

Romero-Aroca, Pedro; Riva-Fernández, Sofia de la; Valls, Aïda; Sagarra-Alamo, Ramon; Moreno, Antonio; Soler, Núria

doi:10.1136/bjophthalmol-2015-307689

Cited by 45 publications

(51 citation statements)

References 24 publications

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“…This affects the sensitivity of the macular photoreceptor cells, leading to changes in vision and vision loss [4]. DME is the leading cause of visual impairment and blindness in people with diabetes [5], and its incidence in Spain has increased in recent years [6], similar to the incidence of diabetes. Currently, pharmacological management of DME consists of administering corticosteroids or antiangiogenic drugs by intravitreal injection [3].…”

Section: Methodsmentioning

confidence: 99%

A Multiple Stakeholder Multicriteria Decision Analysis in Diabetic Macular Edema Management: The MULTIDEX-EMD Study

Andrés-Nogales

Trillo

Ruiz-Moreno

et al. 2020

PharmacoEconomics Open

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Background The clinical and economic management of retinal diseases has become more complex following the introduction of new intravitreal treatments. Multicriteria decision analysis (MCDA) offers the potential to overcome the challenges associated with traditional decision-making tools. Objectives A MCDA to determine the most relevant criteria to decision-making in the management of diabetic macular edema (DME) based on the perspectives of multiple stakeholders in Spain was developed. This MCDA was termed the MULTIDEX-EMD study. Methods Nineteen stakeholders (7 physicians, 4 pharmacists, 5 health authorities and health management experts, 1 psychologist, and 2 patient representatives) participated in this three-phase project. In phase A, an advisory board defined all of the criteria that could influence DME treatment decision-making. These criteria were then screened using a discrete choice experiment (DCE) (phase B). Next, a multinomial logit model was fitted by applying the backward elimination algorithm (relevant criteria: p value < 0.05). Finally, the results were discussed in a deliberative process (phase C). Results Thirty-one criteria were initially defined (phase A) and grouped into 5 categories: efficacy/effectiveness, safety, organizational and economic impact, patient-reported outcomes, and other therapeutic features. The DCE results (phase B) showed that 10 criteria were relevant to the decision-making process for a 50-to 65-year-old DME patient: mean change in best corrected visual acuity (p value < 0.001), percentage of patients with an improvement of ≥ 15 letters (p value < 0.001), effect duration per administration (p value = 0.008), retinal detachment (p value < 0.001), endophthalmitis (p value = 0.012), myocardial infarction (p value < 0.001), intravitreal hemorrhage (p value = 0.021), annual treatment cost per patient (p value = 0.001), health-related quality of life (HRQoL) (p value = 0.004), and disability level (p value = 0.021). Conclusions From a multi-stakeholder perspective, the selection of an appropriate treatment for DME patients should guarantee patient safety and maximize the visual acuity improvement and treatment effect duration. It should also contribute to system sustainability by being affordable, it should have a positive impact on HRQoL, and it should prevent disability.

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Section: Methodsmentioning

confidence: 99%

A Multiple Stakeholder Multicriteria Decision Analysis in Diabetic Macular Edema Management: The MULTIDEX-EMD Study

Andrés-Nogales

Trillo

Ruiz-Moreno

et al. 2020

PharmacoEconomics Open

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“…As a molecular mechanism for the pathogenesis and development of diabetic retinopathy, hyperglycemia-induced intracellular metabolic disorder including the excessive activity of vascular endothelial growth factor (VEGF) in the retina, oxidative stress such as reactive oxygen species (ROS) produced both intracellularly and extracellularly, accumulation of advanced glycation end-products, and increased cytokines among others are included. Generally, the major cause of visual impairment in patients with diabetic retinopathy is diabetic macular edema (DME) [4]. VEGF is already known to play an important role in the development of DME, and anti-VEGF therapy, which blocks the action of VEGF, is widely used for the treatment of DME [5,6].…”

Section: Introductionmentioning

confidence: 99%

Effects of an Aquaporin 4 Inhibitor, TGN-020, on Murine Diabetic Retina

Oosuka

Oku

Horie

et al. 2020

IJMS

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Purpose: To investigate the effect of a selective aquaporin 4 (AQP4) inhibitor, 2-(nicotinamide)-1,3,4-thiadiazole (TGN-020), on the expression of vascular endothelial growth factor (VEGF) and reactive oxygen species (ROS) production, as well as on the retinal edema in diabetic retina. Methods: Intravitreal injections of bevacizumab, TGN-020, or phosphate-buffered saline (PBS) were performed on streptozotocin-induced diabetic rats. Retinal sections were immunostained for anti-glial fibrillary acidic protein (GFAP), anti-AQP4, and anti-VEGF. Protein levels of VEGF from collected retinas were determined by Western blot analysis. In addition, retinal vascular leakage of Evans Blue was observed in the flat-mounted retina from the diabetic rats in the presence or absence of TGN-020. Volumetric changes of rat retinal Müller cells (TR-MUL5; transgenic rat Müller cells) and intracellular levels of ROS were determined using flow cytometry analysis of ethidium fluorescence in the presence or absence of TGN-020 or bevacizumab under physiological and high glucose conditions. Results: In the diabetic retina, the immunoreactivity and protein levels of VEGF were suppressed by TGN-020. AQP4 immunoreactivity was higher than in the control retinas and the expressions of AQP4 were co-localized with GFAP. Similarly to VEGF, AQP4 and GFAP were also suppressed by TGN-020. In the Evans Blue assay, TGN-020 decreased leakage in the diabetic retinas. In the cultured Müller cells, the increase in cell volumes and intracellular ROS production under high glucose condition were suppressed by exposure to TGN-020 as much as by exposure to bevacizumab. Conclusion: TGN-020 may have an inhibitory effect on diabetic retinal edema.

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“…Our univariate analyses showed that patient age and duration of diabetes were significantly related to DR. The United Kingdom Prospective Diabetes Study likewise demonstrated that DR progression was associated with older age, whereas other studies found no such association on univariate analyses . Additionally, certain studies have shown that the duration of diabetes is positively associated with DR, while other studies found no such relationship .…”

Section: Discussionmentioning

confidence: 98%

“…In this community-based study, the incidence of DR was 10.6%, which was comparable with that of a cohort in Wales 29 but higher than that of two other European studies in which the annual incidence of DR were reported as 8.37% and 8.13%, respectively. 30,31 These findings indicated that diabetic patients in different regions have different incidence rates of DR and that Chinese populations have a higher risk of developing DR than their European counterparts, 32 which in turn may be attributable to insufficient control of glucose and lipid levels.…”

Section: Incidence Progression and Regression Of Drmentioning

confidence: 99%

“…The United Kingdom Prospective Diabetes Study likewise demonstrated that DR progression was associated with older age, 42 whereas other studies found no such association on univariate analyses. 30,39 Additionally, certain studies have shown that the duration of diabetes is positively associated with DR, 34,38 while other studies found no such relationship. 12,35 Nevertheless, neither of these two factors showed any independent associations with DR in our own multivariate analyses.…”

Section: Risk Factorsmentioning

confidence: 99%

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Retinopathy among Chinese subjects with type 2 diabetes mellitus in Shanghai: A community‐based follow‐up study

Qin

Jing

Jia

et al. 2019

Health Planning & Management

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Summary Objective To determine the incidence, progression, and regression rates of diabetic retinopathy (DR), as well as their associated factors, in Chinese type 2 diabetic patients. Methods Diabetic patients who participated in a previous survey were recruited for a 1‐year follow‐up study. Nonmydriatic fundus photographs were acquired to assess the severity of DR as per the International Clinical Diabetic Retinopathy Disease Severity Scale (2002). Factors that potentially influence DR outcomes, including its incidence, progression, and regression, were identified via statistical analyses. Results We initially recruited 2453 subjects, among whom 2331 were followed and included in the final analysis. The incidences of new and progressed (ie, ≥2 scale steps) DR were 10.6% and 6.1%, respectively. Moreover, 7.3% of patients with established DR at baseline experienced complete regression. Multivariate logistic regression analysis revealed that high glycosylated haemoglobin (HbA1c) (odds ratio [OR] = 1.50, P = .021) and hyperlipidaemia (OR = 1.46, P = .025) were independent predictors of DR development, high HbA1c (OR = 4.16, P = .027) and macroalbuminuria (OR = 5.60, P = .010) predicted DR progression, and low HbA1c (OR = 0.20, P = .001) and low triglyceride levels (OR = 0.34, P = .026) were associated with DR regression. Conclusions Albumin and HbA1c levels should be closely monitored as signs of progressive retinal damage in diabetic subjects. Optimized control of glucose and triglyceride levels is vital for reducing the incidence of DR or promoting its regression in afflicted patients.

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Changes observed in diabetic retinopathy: eight-year follow-up of a Spanish population

Cited by 45 publications

References 24 publications

A Multiple Stakeholder Multicriteria Decision Analysis in Diabetic Macular Edema Management: The MULTIDEX-EMD Study

A Multiple Stakeholder Multicriteria Decision Analysis in Diabetic Macular Edema Management: The MULTIDEX-EMD Study

Effects of an Aquaporin 4 Inhibitor, TGN-020, on Murine Diabetic Retina

Retinopathy among Chinese subjects with type 2 diabetes mellitus in Shanghai: A community‐based follow‐up study

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