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Four-Year Screening Interval and Vision-Threatening Retinopathy in Type 2 Diabetes Patients With Good Glycemic
Tetsuro Tsujimoto1, Hiroshi Kajio2
1Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan; Department of Diabetes and Endocrinology, Toranomon Hospital Kajigaya, Kanagawa, Japan.
Objective:
To assess whether vision-threatening retinopathy developed after 4 years in patients with type 2 diabetes with good glycemic control during follow-up.
Patients And Methods:
Using data from the Action to Control Cardiovascular Risk in Diabetes and Action to Control Cardiovascular Risk in Diabetes Follow-on studies (conducted from January 1, 2001, to October 14, 2014), we investigated the incidence of vision-threatening retinopathy after 4 years in patients with type 2 diabetes with good or poor glycemic control. Patients with proliferative diabetic retinopathy at baseline were excluded. Vision-threatening retinopathy was defined as severe nonproliferative diabetic retinopathy, proliferative diabetic retinopathy, laser photocoagulation, or vitrectomy. Good and poor glycemic control was defined as mean glycated hemoglobin level less than 7% and 7% or greater during follow-up, respectively.
Results:
This study included 2285 patients. Among patients with no retinopathy at baseline, the 4-year incidence of vision-threatening retinopathy was 0% (0 of 386) and 0.8% (6 of 721) in those with good and poor glycemic control, respectively (P=.54). Similarly, severe retinopathy was not observed at 8 years in patients who did not have retinopathy at 4 years. Among patients with mild to moderate nonproliferative diabetic retinopathy at baseline, the 4-year incidence of vision-threatening retinopathy was significantly higher in those with poor glycemic control than in those with good glycemic control (9.7% [77 of 790] vs 4.4% [13 of 297]; P=.004). Additionally, the remission rate of diabetic retinopathy was low in patients with a long duration of diabetes. Four-year incidences of vision-threatening retinopathy were higher in patients with retinopathy at baseline who had poorer glycemic control and longer durations of diabetes.
Conclusion:
It may be safe to extend screening intervals for diabetic retinopathy to 4 years or longer in patients with type 2 diabetes with no retinopathy.
Insights
Good glycemic control in type 2 diabetes patients may allow for extended diabetic retinopathy screening intervals. Even with good control, retinopathy can develop, but at a lower rate than with poor control.
Area of Science:
- Ophthalmology
- Endocrinology
- Clinical Research
Background:
- Diabetic retinopathy is a leading cause of vision loss in type 2 diabetes.
- Glycemic control is crucial in managing diabetic complications.
- Current screening guidelines recommend regular eye examinations.
Purpose of the Study:
- To evaluate the incidence of vision-threatening retinopathy after 4 years in type 2 diabetes patients.
- To compare outcomes between patients with good vs. poor glycemic control.
- To inform diabetic retinopathy screening interval recommendations.
Main Methods:
- Analysis of data from the Action to Control Cardiovascular Risk in Diabetes studies (2001-2014).
- Inclusion of 2285 patients with type 2 diabetes, excluding those with proliferative retinopathy at baseline.
- Definition of vision-threatening retinopathy and categorization of glycemic control (HbA1c <7% vs. ≥7%).
Main Results:
- Among patients without baseline retinopathy, 4-year incidence of vision-threatening retinopathy was 0% with good control vs. 0.8% with poor control.
- Patients with mild/moderate retinopathy at baseline showed significantly higher incidence (9.7% vs. 4.4%) with poor glycemic control.
- Higher incidences were observed in patients with retinopathy at baseline, poorer glycemic control, and longer diabetes duration.
Conclusions:
- Extending diabetic retinopathy screening to 4 years or longer may be safe for type 2 diabetes patients with no retinopathy.
- Maintaining good glycemic control is essential for preventing retinopathy progression.
- Diabetic retinopathy remission rates are low, particularly in long-standing diabetes.
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