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

Abstract

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.

Diabetic retinopathy: hyperglycaemia, oxidative stress and beyond

“…Diabetic retinopathy ranks fifth among common causes for blindness or severe vision impairment and a recent meta-analysis revealed that the age-standardised prevalence of diabetic retinopathyrelated blindness will increase due to increasing populations and average age together with a reduction in death rates [2]. Lending support to the magnitude of the problem are reports that even when a person first presents at screening services, advanced diabetic retinopathy is present at levels that are no longer amenable to medical interventions [3,4]. Recent population-based studies from Europe revealed that screening-detected diabetic retinopathy appeared in more than…”

“…13% of individuals with newly diagnosed type 2 diabetes [4]. Although lower than the rate reported from the UK Prospective Diabetes Study (UKPDS) [5], diabetes is still underdiagnosed and individuals may present when retinopathy is beyond the 'point of no return' at which progression can be halted by glucose-lowering therapy (see Fig.…”

Diabetic retinopathy is not present in newly diagnosed diabetic patients

“…To the Editor: Ponto and colleagues would have us believe that 12.6% of type 2 diabetic patients newly diagnosed through a screening programme of the general population had retinopathy at the time of diagnosis [1]. This is not the case.…”

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Efficacy and safety of triamcinolone acetonide posterior subtenon injection in patients with diabetic maculopathy

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