Rates of Progression in Diabetic Retinopathy During Different Time Periods

Abstract

OBJECTIVEThis meta-analysis reviews rates of progression of diabetic retinopathy to proliferative diabetic retinopathy (PDR) and/or severe visual loss (SVL) and temporal trends.RESEARCH DESIGN AND METHODSThis systematic literature review and meta-analysis of prospective studies assesses progression of retinopathy among diabetic patients without treatment for retinopathy at baseline. Studies published between 1975 to February 2008 were identified. Outcomes of interest were rates of progression to PDR and/or SVL. Pooled baseline characteristics and outcome measures were summarized using weighted averages of counts and means. Baseline characteristics and outcomes were compared between two periods: 1975–1985 and 1986–2008.RESULTSA total of 28 studies comprising 27,120 diabetic patients (mean age 49.8 years) were included. After 4 years, pooled incidence rates for PDR and SVL were 11.0 and 7.2%, respectively. Rates were lower among participants in 1986–2008 than in 1975–1985. After 10 years, similar patterns were observed. Participants in 1986–2008 studies had lower proportions of PDR and non-PDR at all time points than participants in 1975–1985 studies.CONCLUSIONSSince 1985, diabetic patients have lower rates of progression to PDR and SVL. These findings may reflect an increased awareness of retinopathy risk factors; earlier identification and initiation of care for patients with retinopathy; and improved medical management of glucose, blood pressure, and serum lipids. Differences in baseline characteristics, particularly in the prevalence and severity of retinopathy, could also have contributed to these temporal differences.

Trends in blindness due to diabetic retinopathy among adults aged 18–69 years over a decade in Ireland

“…This is in accordance with previous research describing national trends in the incidence of lower leg amputations between 2005 and 2009 among the population with diabetes [34]. Findings from the present study are in contrast to international research where a decrease in the incidence of blindness [6,10,20,22,23,[35][36][37] and other diabetes related complications [38] have been documented. It has been suggest that while the rates of some diabetes complications have decreased, the absolute number of cases will continue to rise because of the rising prevalence of diabetes [38].…”

ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD – Summary

“…Although its incidence has declined following the implementation of intensive treatment regimens, vision-threatening proliferative retinopathy affects 50% of subjects with type 1 diabetes mellitus (T1DM), and 29% with T2DM develop vision-threatening macular oedema. [75][76][77] Rapidly progressive retinopathy indicates increased cardiovascular risk and the combination of retinopathy and nephropathy predicts excess morbidity and mortality; in T2DM advanced retinopathy more than doubles this risk. 78 Intensified glucose lowering, targeting an HbA 1c of 6.0-7.0%, (42-53 mmol/mol), 79 has consistently been associated with decreased frequency and severity of microvascular complications.…”

Incidence and progression of diabetic retinopathy in Japanese adults with type 2 diabetes: 8 year follow-up study of the Japan Diabetes Complications Study (JDCS)

“…Although improved management of risk factors and advances in treatment modalities for diabetic retinopathy have contributed to reducing the risk of blindness from this pathology [2][3][4], type 2 diabetes per se has been continuously increasing in Asian populations [5,6]. The report from the International Diabetes Federation estimated that people with diabetes in the Asian Pacific region will increase from 137 million in 2010 to 214 million by 2030 [7].…”