Escala internacional de severidad de la retinopatía y del edema macular diabético

Gálvez, MI López

doi:10.4321/s0365-66912004000400001

Cited by 5 publications

(5 citation statements)

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“…This scale has the following categories: no retinopathy, nonproliferative DR (mild, moderate and severe), proliferative DR and Diabetic Macular Edema (retinal thickening and hard exudates in the posterior pole). This DR severity scale is based on the results of the ETDRS [15] and, therefore, relies on scientific evidence, pretending not to displace the original classification, but only to provide a basis for simple operation and adequate clinical practice [16]. In the absence of photographic records, it was difficult to determine the number of microaneurysms per quadrant, so we decided to simplify the category of nonproliferative DR in two gradations mild and moderate/severe.…”

Section: Methodsmentioning

confidence: 99%

Four-Year Incidence of Diabetic Retinopathy in a Spanish Cohort: The MADIABETES Study

et al. 2013

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ObjectiveTo evaluate the incidence of diabetic retinopathy in patients with Type 2 Diabetes Mellitus, to identify the risk factors associated with the incidence of retinopathy and to develop a risk table to predict four-year retinopathy risk stratification for clinical use, from a four-year cohort study.DesignThe MADIABETES Study is a prospective cohort study of 3,443 outpatients with Type 2 Diabetes Mellitus, sampled from 56 primary health care centers (131 general practitioners) in Madrid (Spain).ResultsThe cumulative incidence of retinopathy at four-year follow-up was 8.07% (95% CI = 7.04–9.22) and the incidence density was 2.03 (95% CI = 1.75–2.33) cases per 1000 patient-months or 2.43 (95% CI = 2.10–2.80) cases per 100 patient-years. The highest adjusted hazard ratios of associated risk factors for incidence of diabetic retinopathy were LDL-C >190 mg/dl (HR = 7.91; 95% CI = 3.39–18.47), duration of diabetes longer than 22 years (HR = 2.00; 95% CI = 1.18–3.39), HbA1c>8% (HR = 1.90; 95% CI = 1.30–2.77), and aspirin use (HR = 1.65; 95% CI = 1.22–2.24). Microalbuminuria (HR = 1.17; 95% CI = 0.75–1.82) and being female (HR = 1.12; 95% CI = 0.84–1.49) showed a non-significant increase of diabetic retinopathy. The greatest risk is observed in females who had diabetes for more than 22 years, with microalbuminuria, HbA1c>8%, hypertension, LDL-Cholesterol >190 mg/dl and aspirin use.ConclusionsAfter a four-year follow-up, the cumulative incidence of retinopathy was relatively low in comparison with other studies. Higher baseline HbA1c, aspirin use, higher LDL-Cholesterol levels, and longer duration of diabetes were the only statistically significant risk factors found for diabetic retinopathy incidence. This is the first study to demonstrate an association between aspirin use and diabetic retinopathy risk in a well-defined cohort of patients with Type 2 Diabetes Mellitus at low risk of cardiovascular events. However, further studies with patients at high cardiovascular and metabolic risk are needed to clarify this issue.

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Section: Methodsmentioning

confidence: 99%

Four-Year Incidence of Diabetic Retinopathy in a Spanish Cohort: The MADIABETES Study

et al. 2013

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“…La clasificación ETDRS aunque esta considerada el «Gold standard», sin embargo no se utiliza en la clínica porque presenta muchos niveles y estadios, requiere fotógrafos experimentados y un equipo sofisticado de almacenamiento y archivo y no ha probado ser fácil ni práctica (10,11). La clasificación simplificada se apoya en la evidencia científica de la clasificación ETDRS y en sus niveles.…”

Section: Discussionunclassified

“…La clasificación simplificada se apoya en la evidencia científica de la clasificación ETDRS y en sus niveles. Esta clasificación solo pretende un manejo más sencillo en la práctica clínica (10,11). Ha sido asumida por la Academia Americana de Oftalmología como medio de unificar la terminología en los manuscritos y comparar resultados entre distintos estudios (11,12); sin embargo, todavía no existen evidencias sobre su utilidad y aceptación.…”

Section: Discussionunclassified

Estudio Granada sobre retinopatía diabética: Cribado de 8.244 pacientes diabéticos. I

García-Serrano

Serrano-Laborda

López-Pozas

et al. 2007

Arch Soc Esp Oftalmol

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RESUMENObjetivo: Evaluar el programa de cribado regular de la retinopatía diabética en la población asistida del Hospital Universitario San Cecilio de Granada. Material y métodos: Se realizó durante un seguimiento de 2 años, un estudio de cohortes prospectivo y multicentrico. El estudio comprende las exploraciones de la retina de 8.244 diabeticos en 14 centros de salud. Se realizaron 11.924 exámenes de retina en midriasis utilizando un oftalmoscopio indirecto. La clasificación de las lesiones fue la recomendada por la Escala Internacional Simplificada de Retinopatia Diabética y Edema Macular. La periocidad de las exploraciones fueron las recomendadas por el ETDRS. Resultados: La prevalencia de diabetes en el area de salud fue del 2,77%. La asistencia media al programa fue del 84,1%, solamente en un 0,3% de los pacientes el fondo de ojo fue inexplorable. El 91,3% de la poblacion diabética conocida acudió al menos a un examen de fondo de ojo, remitiéndo-se para tratamiento hospitalario el 3,4% de los pacientes. ARTÍCULO ORIGINAL ABSTRACTObjectives: To evaluate the results of regular screening for diabetic retinopathy in the geographic area assigned to the San Cecilio University Hospital of Granada. Material and methods: A multicenter prospective cohort study was carried out over a 2-year followup period. Retinal examinations were performed in 8244 diabetics in 14 health centres. 11,924 retinal examinations using an indirect ophthalmoscope, following pupil dilatation, were carried out. The classification of the lesions was as recommended by the simplified international scale of diabetic retinopathy and macular edema. The intervals between fundus examinations followed those recommented by the etdrs. Results: The crude prevalence of diabetes in the health area concerned was 2.77%. The average screening compliance of the program was 84.1%, and in only 0.3% of the patients was the fundus ophthalmoscopy ungradable. 91.3% of the known diabetic population attended for at least one fundus examination, with only 3.4%

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“…In addition, sociodemographic and clinical data, as well as laboratory tests and pharmacologic medication for T1D, were collected from electronic health records, including sex, age, diabetes mellitus duration, type of diabetes, body mass index (BMI), smoking behavior, use of continuous subcutaneous insulin infusion (CSII), baseline HbA1c, last available HbA1c, FGM usage time, age at disease onset, insulin dose, nephropathy, and retinopathy. Both complications were classified following international standard [ 17 – 19 ]. We also considered a “non–fatal cardiovascular event” as a composite variable combining ischemic heart disease and non-fatal ischemic stroke.…”

Section: Methodsmentioning

confidence: 99%

Impact of socioeconomic status on chronic control and complications of type 1 diabetes mellitus in users of glucose flash systems: a follow-up study

Sebastian-Valles,

Martínez-Alfonso,

Arranz Martin

et al. 2024

BMC Med

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Background This study investigates the association between socioeconomic status (SES) and glycemic control in individuals with type 1 diabetes (T1D) using flash glucose monitoring (FGM) devices within a public health system where these technologies are freely available and utilized according to recommended guidelines. Methods A follow-up study of 1060 adults (mean age 47.4 ± 15.0 years, 49.0% women) with T1D, receiving care at three Spanish university hospitals that regularly employ the FGM system. SES was assessed using the Spanish Deprivation Index and the average annual net income per person. Glycemic data were collected over a 14-day follow-up period, including baseline glycated hemoglobin (HbA1c) levels prior to sensor placement, the last available HbA1c levels, and FGM-derived glucose metrics. Individuals with sensor usage time < 70% were excluded. Chronic micro and macrovascular complications related to diabetes were documented. Regression models, adjusted for clinical variables, were employed to determine the impact of SES on optimal sensor control (defined as time in range (TIR) ≥ 70% with time below range < 4%) and disease complications. Results The average follow-up was of 2 years. The mean TIR and the percentage of individuals with optimal control were higher in individuals in the highest SES quartile (64.9% ± 17.8% and 27.9%, respectively) compared to those in the lowest SES quartile (57.8 ± 17.4% and 12.1%) (p < 0.001). Regression models showed a higher risk of suboptimal control (OR 2.27, p < 0.001) and ischemic heart disease and/or stroke (OR 3.59, p = 0.005) in the lowest SES quartile. No association was observed between SES and the risk of diabetic nephropathy and retinopathy. FGM system improved HbA1c levels across all SES quartiles. Although individuals in the highest SES quartile still achieved a significantly lower value at the end of the follow-up 55 mmol/mol (7.2%) compared to those in the lowest SES quartile 60 mmol/mol (7.6%) (p < 0.001), the significant disparities in this parameter between the various SES groups were significantly reduced after FGM technology use. Conclusions Socioeconomic status plays a significant role in glycemic control and complications in individuals with T1D, extending beyond access to technology and its proper utilization. The free utilization of FGM technology helps alleviate the impact of social inequalities on glycemic control.

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Escala internacional de severidad de la retinopatía y del edema macular diabético

Cited by 5 publications

References 0 publications

Four-Year Incidence of Diabetic Retinopathy in a Spanish Cohort: The MADIABETES Study

Four-Year Incidence of Diabetic Retinopathy in a Spanish Cohort: The MADIABETES Study

Estudio Granada sobre retinopatía diabética: Cribado de 8.244 pacientes diabéticos. I

Impact of socioeconomic status on chronic control and complications of type 1 diabetes mellitus in users of glucose flash systems: a follow-up study

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