Diabetic retinopathy at diagnosis of type 2 diabetes in Scotland

Looker, Helen C.; Nyangoma, Stephen; Cromie, David; Olson, John A.; Leese, Graham; Black, M.; Doig, J.; Lee, N.; Lindsay, Robert; McKnight, John; Morris, Andrew D.; Philip, Sam; Sattar, Naveed; Wild, Sarah H.; Colhoun, Helen M.

doi:10.1007/s00125-012-2596-z

Cited by 94 publications

(79 citation statements)

References 25 publications

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“…Around 79% of individuals invited for diabetic eye screening in England took up the offer of screening in 2010/2011 [4]. Patients who do not attend for screening have poorer HbA 1c and blood pressure control [7] and have been diagnosed with diabetes for longer [7,8], all of which are risk factors for developing retinopathy [8][9][10][11][12][13][14][15]. These observations suggest that patients who do not attend for eye screening might be at increased risk of diabetic eye disease.…”

Section: Introductionmentioning

confidence: 99%

Non-attendance at diabetic eye screening and risk of sight-threatening diabetic retinopathy: a population-based cohort study

Forster

Forbes

Dodhia³

et al. 2013

Diabetologia

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Aims/hypothesis This study evaluated whether repeated nonattendance for diabetic eye screening is associated with the risk of sight-threatening diabetic retinopathy (STDR). Methods This was a cohort study of 6,556 residents with diabetes who were invited for screening between 2008 and 2011 in a population-based eye screening programme in inner London and who attended for their first-ever screen in 2008. The proportion of participants with STDR was evaluated in relation to the number of years in which screening was missed.Results The proportion of participants who did not attend screening decreased between 2009 and 2011 (annual reduction 1.6% [95% CI 0.9%, 2.3%]). The adjusted relative odds of STDR for 210 participants who did not attend two consecutive years of screening were 3.76 (95% CI 2.14, 6.61; p<0.001), compared with participants who were screened annually. In 605 participants with mild non-proliferative retinopathy at the first screen, the adjusted relative odds of developing proliferative or moderate to severe nonproliferative retinopathy were 5.72 (95% CI 7.43, 22.83; p=0.013) for 53 participants who missed two screens. Conclusions/interpretation Patients who do not attend diabetic eye screening are at increased risk of developing STDR. Tracing of non-attenders with evidence of established retinopathy should be an important fail-safe procedure.

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Section: Introductionmentioning

confidence: 99%

Non-attendance at diabetic eye screening and risk of sight-threatening diabetic retinopathy: a population-based cohort study

Forster

Forbes

Dodhia³

et al. 2013

Diabetologia

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“…In a disease cohort of diabetic individuals in which systolic blood pressure and Hb A1c concentrations were higher in those with than those without diabetic retinopathy, Spijkerman et al [26] did not find an association between HbA 1c levels and diabetic retinopathy in participants with screening-detected diabetes, but higher rates of arterial hypertension and dyslipidaemia were observed. In a study of the prevalence of and risk factors for diabetic retinopathy in people with newly diagnosed type 2 diabetes mellitus using Scottish national data, diabetic retinopathy was associated with male sex, systolic blood pressure, time to screening and obesity [27]. In terms of dyslipidaemia, intraretinal modified LDLs have been implicated in diabetic retinopathy, and it has been shown that extravascular modified LDLs may promote retinal pigment epithelium injury through oxidative stress, endoplasmic reticulum autophagy and apoptosis, whereas modified HDLcholesterol had protective effects [28,29].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of diabetic retinopathy in screening-detected diabetes mellitus: results from the Gutenberg Health Study (GHS)

Ponto

Koenig²,

Pető

et al. 2016

Diabetologia

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Aims/hypothesis Individuals with type 2 diabetes mellitus may experience an asymptomatic period of hyperglycaemia, and complications may already be present at the time of diagnosis. We aimed to determine the prevalence of diabetic retinopathy in patients with newly diagnosed (screeningdetected) type 2 diabetes. Methods The Gutenberg Health Study is a population-based study with 15,010 participants aged between 35 and 74 years. We determined the weighted prevalence of diabetic retinopathy by assessing fundus photographs. Screeningdetected type 2 diabetes was defined as an HbA 1c concentration of 6.5% (47.5 mmol/mol) or more, no medical diagnosis of diabetes and no intake of insulin or oral glucoselowering agents. Results Of 14,948 participants, 1377 (9.2%) had diabetes mellitus. Of these, 347 (25.2%) had newly diagnosed type 2 diabetes detected by the screening. Overall, the weighted prevalence of screening-detected type 2 diabetes was 2.1%. Fundus photos were evaluable for 285 (82.1%) participants with newly diagnosed diabetes. The weighted prevalence of diabetic retinopathy in screening-detected type 2 diabetes was 13.0%; 12% of participants had a mild non-proliferative diabetic retinopathy and 0.6% had a moderate nonproliferative diabetic retinopathy. Diabetic retinopathy was proliferative in 0.3%. No cases of severe non-proliferative diabetic retinopathy or diabetic maculopathy were found. Thirty (14.9%) of 202 and six (7.2%) of 83 individuals with and without concomitant arterial hypertension, respectively, had diabetic retinopathy (OR 2.54, 95% CI 1.06, 7.14). Visual acuity did not differ between individuals with and without diabetic retinopathy . Conclusions/interpretation In this large European study, the prevalence of diabetic retinopathy in screening-detected type 2 diabetes was 13%. Only a very small proportion of participants with detected diabetic retinopathy needed treatment.

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“…Given that the level of CV risk increases with the duration of T2D [61,62], early and effective modification of CVD risk, whilst mitigating the risk of developing/worsening T2D, would seem sensible. Indeed, the benefits of earlier T2D screening are demonstrated by a recent analysis of data from 51,526 people with newly diagnosed T2D in Scotland, in which the majority of patients were screened for T2D within an acceptable period and the prevalence of retinopathy at first screening was significantly lower than that observed in previous studies [63].…”

Section: T2d Risk Stratificationmentioning

confidence: 93%

The use of statins in people at risk of developing diabetes mellitus: Evidence and guidance for clinical practice

Sattar¹,

Ginsberg

Ray

et al. 2014

Atherosclerosis Supplements

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Reducing low-density lipoprotein cholesterol (LDL-C) levels using statins is associated with significant reductions in cardiovascular (CV) events in a wide range of patient populations. Although statins are generally considered to be safe, recent studies suggest they are associated with an increased risk of developing Type 2 diabetes (T2D). This led the US Food and Drug Administration (FDA) to change their labelling requirements for statins to include a warning about the possibility of increased blood sugar and HbA1c levels and the European Medicines Agency (EMA) to issue guidance on a small increased risk of T2D with the statin class. This review examines the evidence leading to these claims and provides practical guidance for primary care physicians on the use of statins in people with or at risk of developing T2D. Overall, evidence suggests that the benefits of statins for the reduction of CV risk far outweigh the risk of developing T2D, especially in individuals with higher CV risk. To reduce the risk of developing T2D, physicians should assess all patients for T2D risk prior to starting statin therapy, educate patients about their risks, and encourage risk-reduction through lifestyle changes. Whether some statins are more diabetogenic than others requires further study. Statin-treated patients at high risk of developing T2D should regularly be monitored for changes in blood glucose or HbA1c levels, and the risk of conversion from pre-diabetes to T2D should be reduced by intensifying lifestyle changes. Should a patient develop T2D during statin treatment, physicians should continue with statin therapy and manage T2D in accordance with relevant national guidelines.

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Diabetic retinopathy at diagnosis of type 2 diabetes in Scotland

Cited by 94 publications

References 25 publications

Non-attendance at diabetic eye screening and risk of sight-threatening diabetic retinopathy: a population-based cohort study

Non-attendance at diabetic eye screening and risk of sight-threatening diabetic retinopathy: a population-based cohort study

Prevalence of diabetic retinopathy in screening-detected diabetes mellitus: results from the Gutenberg Health Study (GHS)

The use of statins in people at risk of developing diabetes mellitus: Evidence and guidance for clinical practice

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