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Scanlon PH. Improving the screening of risk factors in diabetic retinopathy. Expert Rev Endocrinol Metab 2022; 17:235-243. [PMID: 35730170 DOI: 10.1080/17446651.2022.2078305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/12/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION In 2002, Diabetic Retinopathy was reported as the leading cause of blindness in the working age group. The introduction of systematic screening programs in the UK has reduced visual loss and blindness due to diabetic retinopathy, but it does still occur with catastrophic consequences for the individual. AREAS COVERED The author conducted an ongoing search for articles relating to diabetic retinopathy since 2000 utilizing Zetoc Alert with keywords and contents page lists from relevant journals. This review covers the risk factors for loss of vision due to diabetic retinopathy and discusses ways in which the awareness of these risk factors can be used to further reduce visual loss. Some risk factors such as glycemic and B/P control are well known from landmark trials. This review has included these factors but concentrated more on the evidence behind those risk factors that are not so clearly defined or so well known. EXPERT OPINION The major risk factors are well known, but one continues to find that people with diabetes lose vision in situations in which a better awareness of the risks by both the individual with diabetes and the health workers involved may have prevented the visual loss.
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Affiliation(s)
- Peter H Scanlon
- Consultant Ophthalmologist, Department of Ophthalmologist, Gloucestershire Hospitals NHS Foundation Trust Cheltenham, UK
- National Clinical Lead, NHS Diabetic Eye Screening Programme (Ophthalmology), Public Health Commissioning and Operations, England
- Associate Professor, Nuffield Department of Clinical Neuroscience, University of Oxford, UK
- Visiting Professor, School of Health and Social Care, University of Gloucestershire, UK
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Burn H, Hamm L, Black J, Burnett A, Harwood M, Burton MJ, Evans JR, Ramke J. Eye care delivery models to improve access to eye care for Indigenous peoples in high-income countries: a scoping review. BMJ Glob Health 2021; 6:bmjgh-2020-004484. [PMID: 33762252 PMCID: PMC7993359 DOI: 10.1136/bmjgh-2020-004484] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/28/2020] [Accepted: 01/20/2021] [Indexed: 12/27/2022] Open
Abstract
Purpose Globally, there are ~370 million Indigenous peoples. Indigenous peoples typically experience worse health compared with non-Indigenous people, including higher rates of avoidable vision impairment. Much of this gap in eye health can be attributed to barriers that impede access to eye care services. We conducted a scoping review to identify and summarise service delivery models designed to improve access to eye care for Indigenous peoples in high-income countries. Methods Searches were conducted on MEDLINE, Embase and Global Health in January 2019 and updated in July 2020. All study designs were eligible if they described a model of eye care service delivery aimed at populations with over 50% Indigenous peoples. Two reviewers independently screened titles, abstracts and full-text articles and completed data charting. We extracted data on publication details, study context, service delivery interventions, outcomes and evaluations, engagement with Indigenous peoples and access dimensions targeted. We summarised findings descriptively following thematic analysis. Results We screened 2604 abstracts and 67 studies fulfilled our eligibility criteria. Studies were focused on Indigenous peoples in Australia (n=45), USA (n=11), Canada (n=7), New Zealand (n=2), Taiwan (n=1) and Greenland (n=1). The main disease focus was diabetic retinopathy (n=30, 45%), followed by ‘all eye care’ (n=16, 24%). Most studies focused on targeted interventions to increase availability of services. Fewer than one-third of studies reported involving Indigenous communities when designing the service. 41 studies reflected on whether the model improved access, but none undertook rigorous evaluation or quantitative assessment. Conclusions The geographical and clinical scope of service delivery models to improve access to eye care for Indigenous peoples in high-income countries is narrow, with most studies focused on Australia and services for diabetic retinopathy. More and better engagement with Indigenous communities is required to design and implement accessible eye care services.
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Affiliation(s)
- Helen Burn
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Lisa Hamm
- School of Optometry and Vision Science, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Joanna Black
- School of Optometry and Vision Science, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Anthea Burnett
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Matire Harwood
- General Practice and Primary Healthcare, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK.,Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK.,School of Optometry and Vision Science, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
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Freundlich SEN, Connell CJW, McGhee CNJ, Cunningham WJ, Bedggood A, Poole P. Enhancing Māori and Pasifika graduate interest in ophthalmology surgical training in New Zealand/Aotearoa: Barriers and opportunities. Clin Exp Ophthalmol 2020; 48:739-748. [DOI: 10.1111/ceo.13766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/16/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Simone E. N. Freundlich
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health SciencesThe University of Auckland Auckland New Zealand
- Department of OphthalmologyAuckland District Health Board Auckland New Zealand
| | - Charlotte J. W. Connell
- School of Medicine, Faculty of Medical and Health SciencesThe University of Auckland Auckland New Zealand
| | - Charles N. J. McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health SciencesThe University of Auckland Auckland New Zealand
- Department of OphthalmologyAuckland District Health Board Auckland New Zealand
| | | | - Antony Bedggood
- Department of Ophthalmology, Division of Health SciencesThe University of Otago Dunedin New Zealand
| | - Phillippa Poole
- School of Medicine, Faculty of Medical and Health SciencesThe University of Auckland Auckland New Zealand
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Xie L, Yang S, Squirrell D, Vaghefi E. Towards implementation of AI in New Zealand national diabetic screening program: Cloud-based, robust, and bespoke. PLoS One 2020; 15:e0225015. [PMID: 32275656 PMCID: PMC7147747 DOI: 10.1371/journal.pone.0225015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/18/2020] [Indexed: 11/18/2022] Open
Abstract
Convolutional Neural Networks (CNNs) have become a prominent method of AI implementation in medical classification tasks. Grading Diabetic Retinopathy (DR) has been at the forefront of the development of AI for ophthalmology. However, major obstacles remain in the generalization of these CNNs onto real-world DR screening programs. We believe these difficulties are due to use of 1) small training datasets (<5,000 images), 2) private and 'curated' repositories, 3) locally implemented CNN implementation methods, while 4) relying on measured Area Under the Curve (AUC) as the sole measure of CNN performance. To address these issues, the public EyePACS Kaggle Diabetic Retinopathy dataset was uploaded onto Microsoft Azure™ cloud platform. Two CNNs were trained; 1 a "Quality Assurance", and 2. a "Classifier". The Diabetic Retinopathy classifier CNN (DRCNN) performance was then tested both on 'un-curated' as well as the 'curated' test set created by the "Quality Assessment" CNN model. Finally, the sensitivity of the DRCNNs was boosted using two post-training techniques. Our DRCNN proved to be robust, as its performance was similar on 'curated' and 'un-curated' test sets. The implementation of 'cascading thresholds' and 'max margin' techniques led to significant improvements in the DRCNN's sensitivity, while also enhancing the specificity of other grades.
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Affiliation(s)
- Li Xie
- School of Optometry and Vision Sciences, The University of Auckland, Auckland, New Zealand
| | - Song Yang
- School of Optometry and Vision Sciences, The University of Auckland, Auckland, New Zealand
- School of Computer Sciences, The University of Auckland, Auckland, New Zealand
| | - David Squirrell
- Department of Ophthalmology, The University of Auckland, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - Ehsan Vaghefi
- School of Optometry and Vision Sciences, The University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
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Ramke J, Jordan V, Vincent AL, Harwood M, Murphy R, Ameratunga S. Diabetic eye disease and screening attendance by ethnicity in New Zealand: A systematic review. Clin Exp Ophthalmol 2019; 47:937-947. [PMID: 31034719 DOI: 10.1111/ceo.13528] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/27/2019] [Accepted: 04/14/2019] [Indexed: 11/29/2022]
Abstract
To examine differences in incidence, prevalence and screening for diabetic retinopathy in New Zealand, we searched MEDLINE, EMBASE and CINAHL up to 6 December 2018 for observational studies reporting diabetic eye disease or attendance at retinal screening, disaggregated by ethnicity. Two authors separately screened and selected studies, and extracted data. None of the 11 included studies reported data on visual impairment from diabetic retinopathy. All nine studies reporting diabetic eye disease by ethnicity found Pacific people and Māori had higher rates of sight-threatening disease and lower rates of screening attendance compared to Europeans. Data for Asian people were infrequently reported, but when they were, they also fared worse than Europeans. This review highlights that equity-focused strategies are needed to address ethnic disparities in eye health among New Zealanders with diabetes. The review also identifies how research methods can be strengthened to enable future calculation of robust disease prevalence estimates.
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Affiliation(s)
- Jacqueline Ramke
- Section of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Vanessa Jordan
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Andrea L Vincent
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Matire Harwood
- Te Kupenga Hauora Māori, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rinki Murphy
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Shanthi Ameratunga
- Section of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
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Simmons D, Kumar S, Crook N, Rush E. Diabetes among Māori women with self-reported past gestational diabetes mellitus in a New Zealand Māori community. Aust N Z J Obstet Gynaecol 2017; 57:599-603. [DOI: 10.1111/ajo.12639] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 04/10/2017] [Indexed: 01/28/2023]
Affiliation(s)
- David Simmons
- School of Medicine; Western Sydney University; Sydney New South Wales Australia
| | - Shejil Kumar
- St George Public Hospital; Sydney New South Wales Australia
| | - Nic Crook
- Lakes District Health Board; Rotorua New Zealand
| | - Elaine Rush
- Auckland University of Technology; Auckland New Zealand
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Murphy R, Jiang Y, Booth M, Babor R, MacCormick A, Hammodat H, Beban G, Barnes RM, Vincent AL. Progression of diabetic retinopathy after bariatric surgery. Diabet Med 2015; 32:1212-20. [PMID: 25689226 DOI: 10.1111/dme.12727] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2015] [Indexed: 12/14/2022]
Abstract
AIM To assess the impact of bariatric surgery on the progression of diabetic retinopathy in patients with Type 2 diabetes. METHOD We conducted a retrospective, observational study of patients with Type 2 diabetes who underwent bariatric surgery between 1 January 2001 and 31 December 2012 and had hospital-based retinal screening records. Data were collected from four surgical centres. Those who had pre-operative retinal screening and at least one post-operative retinal screen were eligible for analysis. A generalized linear mixed model was used to explore significant clinical predictors on the post-operative grade severity over time, controlling for important baseline characteristics. RESULTS Three hundred and eighteen patients were eligible for analysis. Of these, 68.6% had no diabetic retinopathy pre-operatively compared with 18.9%, 8.5% and 4% with a diabetic retinopathy grade of minimal, mild or moderate and higher, respectively. First post-operative retinal screening results showed that after surgery 73% had no change in their diabetic retinopathy grade, 11% regressed and 16% progressed. The probability of having a diabetic retinopathy grade of moderate or higher over time post surgery was significantly associated with the magnitude of HbA1c reduction from pre-surgery HbA1c levels, a shorter post-operative retinal screening duration, more severe pre-operative retinal screening grade, male gender and non-Maori/Pacific ethnicity. CONCLUSIONS A higher pre-operative diabetic retinopathy grade, and a large decrease in HbA1c post surgery warrant closer monitoring of diabetic retinopathy after bariatric surgery. Further prospective, randomized studies are required to investigate the gender and ethnic differences found.
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Affiliation(s)
- R Murphy
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Y Jiang
- Department of Statistics, University of Auckland, Auckland, New Zealand
| | - M Booth
- Department of Surgery, North Shore Hospital, Auckland, New Zealand
| | - R Babor
- Department of Surgery, Middlemore Hospital, Auckland, New Zealand
| | - A MacCormick
- Department of Surgery, Middlemore Hospital, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - H Hammodat
- Department of Surgery, North Shore Hospital, Auckland, New Zealand
| | - G Beban
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | - R M Barnes
- Eye Department, Auckland District Health Board, Auckland, New Zealand
| | - A L Vincent
- Eye Department, Auckland District Health Board, Auckland, New Zealand
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
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Nouya AY, Nansseu JRN, Moor VJA, Pieme CA, Noubiap JJN, Tchoula CM, Mokette BM, Takam RDM, Tankeu F, Ngogang JY, Kengne AP. Determinants of fructosamine levels in a multi-ethnic Sub-Saharan African population. Diabetes Res Clin Pract 2015; 107:123-9. [PMID: 25458342 DOI: 10.1016/j.diabres.2014.09.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 08/29/2014] [Accepted: 09/15/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE Fructosamine provides an estimate of diabetes control over a shorter period than HbA1c, and has been proposed as a suitable parameter to monitor glycemic control in low-income countries. The aim of this study was to investigate determinants of fructosamine levels in an urban non-diabetic population of Cameroon. METHODS This was a cross-sectional study including 437 healthy adults with no known history of diabetes mellitus, aged 40 years and above, recruited from the ten administrative regions, representing major ethnic groups in the country. Plasma glucose and fructosamine were measured after an overnight fasting. Univariable and multivariable analyses were used to investigate the factors associated with fructosamine measurements. RESULTS Fructosamine levels ranged from 68.2 to 940.8 μmol/l with a mean (standard deviation) of 294.4 (131.3) μmol/l. These levels varied significantly across regions and were higher in men than in women (p=0.001) and in those with screen-detected diabetes than in those with normoglycemia (p<0.0001). There was a negative correlation between fructosamine and body mass index (r=-0.15, p=0.009), and a positive correlation with fasting plasma glucose (FPG) (r=0.37, p<0.0001) and total bilirubinemia (r=0.21, p<0.0001). In multivariable model, sex, BMI, FPG, total bilirubine and screen-detected diabetes were no longer associated with fructosamine levels. CONCLUSION Fructosamine was not independently associated with age, sex, ethnicity, and the glycemic status. Further studies need to be carried out to better elucidate all the factors determining the measurement of fructosamine in order to accurately interpret its values in diabetic populations.
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Affiliation(s)
| | - Jobert Richie N Nansseu
- Sickle Cell Unit, Mother and Child Centre, Chantal Biya Foundation, Yaounde, Cameroon; Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
| | - Vicky Joceline Ama Moor
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon; Laboratory of Biochemistry, Yaounde University Teaching Hospital, Yaounde, Cameroon.
| | - Constant Anatole Pieme
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
| | | | | | - Bruno M Mokette
- Faculty of Sciences, University of Yaounde I, Yaounde, Cameroon
| | | | - Francine Tankeu
- Faculty of Sciences, University of Yaounde I, Yaounde, Cameroon.
| | - Jeanne Yonkeu Ngogang
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon; Laboratory of Biochemistry, Yaounde University Teaching Hospital, Yaounde, Cameroon.
| | - Andre Pascal Kengne
- Faculty of Sciences, University of Yaounde I, Yaounde, Cameroon; South African Medical Research Council and University of Cape Town, Cape Town, South Africa.
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Zatic T, Bendelic E, Paduca A, Rabiu M, Corduneanu A, Garaba A, Novac V, Curca C, Sorbala I, Chiaburu A, Verega F, Andronic V, Guzun I, Căpăţină O, Zamă-Mardari I. Rapid assessment of avoidable blindness and diabetic retinopathy in Republic of Moldova. Br J Ophthalmol 2014; 99:832-6. [PMID: 25550353 DOI: 10.1136/bjophthalmol-2014-305824] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 11/19/2014] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To evaluate the prevalence and causes of blindness and visual impairment, the prevalence of diabetes mellitus and diabetic retinopathy among people aged ≥50 years in the Republic of Moldova using Rapid Assessment of Avoidable Blindness plus Diabetic Retinopathy ('RAAB+DR') techniques. MATERIALS AND METHODS 111 communities of people aged ≥50 years were randomly selected. In addition to standard RAAB procedures in all people with diabetes (previous history of the disease or with a random blood glucose level >11.1 mm/L (200 mg/dL)), a dilated fundus examination was performed to assess the presence and the degree of diabetic retinopathy using the Scottish DR grading system. RESULTS 3877 (98%) people out of the 3885 eligible people were examined. The prevalence of blindness was 1.4% (95% CI 1.0% to 1.8%). The major causes of blindness and severe visual impairment were untreated cataract (58.2%), glaucoma (10.9%), and other posterior segment causes (10.9%). The estimated prevalence of diabetes was 11.4%. Among all people with diabetes, 55.9% had some form of retinopathy, and sight threatening diabetic retinopathy affected 14.6%. CONCLUSIONS The RAAB+DR survey in the Republic of Moldova established that untreated cataract is the major cause of avoidable blindness in rural areas. This needs to be tackled by expanding the geographical coverage of cataract surgical services.
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Affiliation(s)
- Tatiana Zatic
- Ministry of Health of the Republic of Moldova, Head of Directorate Primary Care,Chisinău, Republic of Moldova
| | - Eugen Bendelic
- State University of Medicine and Pharmacy "Nicolae Testemiteanu", Faculty of Medicine, Department of Ophthalmology of Republic of Moldova
| | - Ala Paduca
- State University of Medicine and Pharmacy "Nicolae Testemiteanu", Faculty of Medicine, Department of Ophthalmology of Republic of Moldova
| | - Mansour Rabiu
- International Agency of Prevention of Blindness Eastern Mediterranean region, Riyadh, Saudi Arabia
| | - Angela Corduneanu
- State University of Medicine and Pharmacy "Nicolae Testemiteanu", Faculty of Medicine, Department of Ophthalmology of Republic of Moldova
| | - Angela Garaba
- State University of Medicine and Pharmacy "Nicolae Testemiteanu", Faculty of Medicine, Department of Ophthalmology of Republic of Moldova
| | - Victoria Novac
- State University of Medicine and Pharmacy "Nicolae Testemiteanu", Faculty of Medicine, Department of Ophthalmology of Republic of Moldova
| | - Cristina Curca
- State University of Medicine and Pharmacy "Nicolae Testemiteanu", Faculty of Medicine, Department of Ophthalmology of Republic of Moldova
| | - Inga Sorbala
- State University of Medicine and Pharmacy "Nicolae Testemiteanu", Faculty of Medicine, Department of Ophthalmology of Republic of Moldova
| | - Andrei Chiaburu
- State University of Medicine and Pharmacy "Nicolae Testemiteanu", Faculty of Medicine, Department of Ophthalmology of Republic of Moldova
| | - Florentina Verega
- State University of Medicine and Pharmacy "Nicolae Testemiteanu", Faculty of Medicine, Department of Ophthalmology of Republic of Moldova
| | - Victoria Andronic
- State University of Medicine and Pharmacy "Nicolae Testemiteanu", Faculty of Medicine, Department of Ophthalmology of Republic of Moldova
| | - Irina Guzun
- State University of Medicine and Pharmacy "Nicolae Testemiteanu", Faculty of Medicine, Department of Ophthalmology of Republic of Moldova
| | - Olga Căpăţină
- State University of Medicine and Pharmacy "Nicolae Testemiteanu", Faculty of Medicine, Department of Ophthalmology of Republic of Moldova
| | - Iulea Zamă-Mardari
- State University of Medicine and Pharmacy "Nicolae Testemiteanu", Faculty of Medicine, Department of Ophthalmology of Republic of Moldova
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Scanlon PH, Aldington SJ, Stratton IM. Epidemiological issues in diabetic retinopathy. Middle East Afr J Ophthalmol 2013; 20:293-300. [PMID: 24339678 PMCID: PMC3841946 DOI: 10.4103/0974-9233.120007] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
There is currently an epidemic of diabetes in the world, principally type 2 diabetes that is linked to changing lifestyle, obesity, and increasing age of the population. Latest estimates from the International Diabetes Federation (IDF) forecasts a rise from 366 million people worldwide to 552 million by 2030. Type 1 diabetes is more common in the Northern hemisphere with the highest rates in Finland and there is evidence of a rise in some central European countries, particularly in the younger children under 5 years of age. Modifiable risk factors for progression of diabetic retinopathy (DR) are blood glucose, blood pressure, serum lipids, and smoking. Nonmodifiable risk factors are duration, age, genetic predisposition, and ethnicity. Other risk factors are pregnancy, microaneurysm count in an eye, microaneurysm formation rate, and the presence of any DR in the second eye. DR, macular edema (ME), and proliferative DR (PDR) develop with increased duration of diabetes and the rates are dependent on the above risk factors. In one study of type 1 diabetes, the median individual risk for the development of early retinal changes was 9.1 years of diabetes duration. Another study reported the 25 year incidence of proliferative retinopathy among population-based cohort of type 1 patients with diabetes was 42.9%. In recent years, people with diabetes have lower rates of progression than historically to PDR and severe visual loss, which may reflect better control of glucose, blood pressure, and serum lipids, and earlier diagnosis.
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Affiliation(s)
- Peter H Scanlon
- Gloucestershire Diabetic Retinopathy Research Group, Cheltenham General Hospital, Cheltenham, Gloucestershire, South West, UK
- English National Health Service Diabetic Eye Screening Programme, Victoria Warehouse, The Docks, Gloucester, Gloucestershire, South West, UK
| | - Stephen J Aldington
- Gloucestershire Diabetic Retinopathy Research Group, Cheltenham General Hospital, Cheltenham, Gloucestershire, South West, UK
| | - Irene M Stratton
- Gloucestershire Diabetic Retinopathy Research Group, Cheltenham General Hospital, Cheltenham, Gloucestershire, South West, UK
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Abstract
This literature review is aimed at the evaluation of the potential for cataract prevention in Europe. It was performed using PubMed with Mesh and free-text terms. Studies included were (i) performed on a population of Caucasian origin at an age range of 40-95 years, (ii) cataract was clinically verified, (iii) drug record of prescriptions, their indication, a record of every diagnosis, dosage and quantity of prescribed medicine were available, (iv) sample size >300 and (v) published between 1990 and 2009. The results of 29 articles were reviewed. Former [3.75 (2.26-6.21)] or current smoking [2.34 (1.07-5.15)], diabetes of duration >10 years [2.72 (1.72-4.28)], asthma or chronic bronchitis [2.04 (1.04-3.81)], and cardiovascular disease [1.96 (1.22-3.14)] increased the risk of cataract. Cataract was more common in patients taking chlorpromazine during ≥90 days with a dosage ≥300 mg [8.8 (3.1-25.1)] and corticosteroids >5 years [3.25 (1.39-7.58)] in a daily dose >1600 mg [1.69 (1.17-2.43)]. Intake of a multivitamin/mineral formulation [2.00 (1.35-2.98)] or corticosteroids [2.12 (1.93-2.33)] also increased the risk of cataract. Corticosteroids applied orally [3.25 (1.39-7.58)], parenteral [1.56 (1.34-1.82)] or inhalational [1.58 (1.46-1.71)] lead to cataract more frequently than those applied topically: nasal [1.33 (1.21-1.45)], ear [1.31 (1.19-1.45)] or skin [1.43 (1.36-1.50)]. Outpatient cataract surgery was negatively associated with total cataract surgery costs, and chlorpromazine, corticosteroids and multivitamin/mineral formation increase the risk of posterior subcapsular cataract dependent on dose, treatment application and duration. This review presented a comprehensive overview of specific and general cataract risk factors and an update on most recent experimental studies and randomized control trials directed at cataract prevention.
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Affiliation(s)
- Elena Prokofyeva
- Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tuebingen, Tuebingen, Germany.
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Ruta LM, Magliano DJ, Lemesurier R, Taylor HR, Zimmet PZ, Shaw JE. Prevalence of diabetic retinopathy in Type 2 diabetes in developing and developed countries. Diabet Med 2013; 30:387-98. [PMID: 23331210 DOI: 10.1111/dme.12119] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND As the global prevalence of diabetes increases, so will the numbers of people with diabetic retinopathy. Our review aimed to provide a comprehensive picture of available studies of diabetic retinopathy and how prevalence varies around the developed and developing world. METHODS A detailed literature search using PubMed was undertaken. The following search term was used: 'diabetic retinopathy AND prevalence'. The titles and abstracts of all publications identified by the search were reviewed and 492 studies were retrieved. Inclusion and exclusion criteria were applied. RESULTS A total of 72 articles from 33 countries were included. There were only 26 population-based studies using fundus photography (12 in developing countries), of which only 16 (eight in developing countries) were published since 2000. Prevalence estimates varied from as low as 10% to as high as 61% in persons with known diabetes and from 1.5 to 31% in newly diagnosed diabetes. Across all the studies, the median (interquartile range) prevalence of any diabetic retinopathy in known diabetes was 27.9% (22-37%) and 10.5% (6-16%) in newly diagnosed diabetes. Prevalence of diabetic retinopathy was higher in developing countries. CONCLUSION Significant gaps exist in that reliable population-based data from developing nations and indigenous populations in particular are lacking. Major differences in study characteristics and methodologies make comparisons very difficult. More research is required and study methodologies must be better standardized. This will provide important information for prevention and treatment strategies.
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Affiliation(s)
- L M Ruta
- Baker IDI Heart and Diabetes Institute, The University of Melbourne, Melbourne, Vic., Australia
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Sukala WR, Page RA, Rowlands DS, Lys I, Krebs JD, Leikis MJ, Cheema BS. Exercise intervention in New Zealand Polynesian peoples with type 2 diabetes: Cultural considerations and clinical trial recommendations. Australas Med J 2012; 5:429-35. [PMID: 23024717 PMCID: PMC3442187 DOI: 10.4066/amj.2012.1311] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The Maori and Pacific Islands peoples of New Zealand suffer a greater burden of type 2 diabetes mellitus (T2DM) and associated comorbidities than their European counterparts. Empirical evidence supports the clinical application of aerobic and resistance training for effective diabetes management and potential remission, but few studies have investigated the effectiveness of these interventions in specific ethnic cohorts. We recently conducted the first trial to investigate the effect of prescribed exercise training in Polynesian people with T2DM. This article presents the cultural considerations undertaken to successfully implement the study. The research procedures were accepted and approved by cultural liaisons and potential participants. The approved methodology involved a trial evaluating and comparing the effects of two, 16-week exercise regimens (i.e. aerobic training and resistance training) on glycosylated haemoglobin (HbA1c), related diabetes markers (i.e. insulin resistance, blood lipids, relevant cytokines and anthropometric and hemodynamic indices) and health-related quality of life. Future exercise-related research or implementation strategies in this cohort should focus on cultural awareness and techniques to enhance participation and compliance. Our approach to cultural consultation could be considered by researchers undertaking trials in this and other ethnic populations suffering an extreme burden of T2DM, including indigenous Australians and Americans.
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Affiliation(s)
- William R. Sukala
- Institute of Food, Nutrition & Human Health, Massey University, Wellington, New Zealand
- School of Health and Human Sciences, Southern Cross University, Lismore, Australia
| | - Rachel A. Page
- Institute of Food, Nutrition & Human Health, Massey University, Wellington, New Zealand
| | - David S. Rowlands
- School of Sport and Exercise, Massey University, Wellington, New Zealand
| | - Isabelle Lys
- Faculty of Engineering, Health, Science and the Environment, Charles Darwin University, Australia
| | - Jeremy D. Krebs
- Faculty of Medicine, University of Otago, Wellington, New Zealand
| | - Murray J. Leikis
- Wellington Hospital, Capital and Coast District Health Board, Wellington, New Zealand
| | - Birinder S. Cheema
- School of Science and Health, University of Western Sydney, Campbelltown, Australia
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15
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Prokofyeva E, Zrenner E. Epidemiology of major eye diseases leading to blindness in Europe: a literature review. Ophthalmic Res 2011; 47:171-88. [PMID: 22123077 DOI: 10.1159/000329603] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 05/18/2011] [Indexed: 12/11/2022]
Abstract
The objective of this work was to study the epidemiology of major eye diseases leading to blindness in Europe through a systematic literature review. The literature search was performed using the Medline database (PubMed), with MeSH and free text search terms. Inclusion criteria for the studies were: (a) performed on a healthy population of Caucasian origin aged between 50 and 75 years; (b) diagnosed by ophthalmological examination in accordance with the International Classification of Diseases 10; (c) contained a detailed description of the sampling and diagnostic procedures and data resources; (d) sample size>500, and (e) published between 1990 and 2008. The results of 57 studies on the prevalence and incidence of age-related macular degeneration, diabetic retinopathy and glaucoma are reported, providing an up-to-date and comprehensive overview of these diseases in Europe from an epidemiological perspective.
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Affiliation(s)
- Elena Prokofyeva
- Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tübingen, Tübingen, Germany.
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16
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McCarthy A, Shaban R, Stone C. Fa’afaletui: A Framework for the Promotion of Renal Health in an Australian Samoan Community. J Transcult Nurs 2010; 22:55-62. [DOI: 10.1177/1043659610387154] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: Samoan communities in Australia exhibit a disproportionate rate of kidney disease compared with other Australians. This article describes a research project that used a culturally sensitive framework, Fa’afaletui, to help reduce the barriers of language and culture and increase our understanding of the factors contributing to kidney disease, in one Samoan community in Australia. Design: Semistructured group interviews were undertaken with Samoan community families and groups. The interviews were analyzed according to key concepts embedded in the Fa’afaletui framework. Findings: Four factors associated with health risks in this Samoan community emerged: diet and exercise, issues related to the collective (incorporating the village, church, and family), tapu or cultural protocols, and the importance of language. Conclusions: The findings suggest that future kidney health promotion initiatives within this Samoan community will be more effective if they are sensitive to Samoan cultural norms, language, and context.
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Affiliation(s)
- Alexandra McCarthy
- Queensland University of Technology, Kelvin Grove, Queensland, Australia,
| | - Ramon Shaban
- Griffith University, Meadowbrook, Queensland, Australia
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17
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West SD, Groves DC, Lipinski HJ, Nicoll DJ, Mason RH, Scanlon PH, Stradling JR. The prevalence of retinopathy in men with Type 2 diabetes and obstructive sleep apnoea. Diabet Med 2010; 27:423-30. [PMID: 20536514 DOI: 10.1111/j.1464-5491.2010.02962.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To clarify the relationship between obstructive sleep apnoea (OSA) and diabetic retinopathy. RESEARCH DESIGN AND METHODS A cohort of 240 men from primary and secondary care previously participated in a study on the prevalence of OSA in Type 2 diabetes and provided anthropometric information, details of their diabetes, had glycated haemoglobin (HbA1c) measured and overnight oximetry performed. They were re-contacted for permission to review their routine screening clinical retinal photographs, which were then scored by a trained grader, providing detailed retinopathy, maculopathy and photocoagulation scores. RESULTS One hundred and eighteen men both consented and had retinal photographs available to review. Of these, 24% had OSA, with mean+/-sd 4% oxygen saturation (SaO2) dips/h of 20.9+/-16.6 vs. 2.8+/-2.1 in the non-OSA group. As expected, the OSA group had a significantly higher mean body mass index of 31.9+/-5.2 vs. 28.5+/-5.1 kg/m2 and neck size 44.5+/-3.6 vs. 41.9+/-2.5 cm, but the two groups did not differ significantly in age, diabetes duration, diabetes treatment, HbA1c, smoking history or proportion with known hypertension. Retinopathy and maculopathy scores were significantly worse in the OSA group (P<0.0001). Multiple regression analysis showed only OSA (R2=0.19, P<0.0001) and HbA1c (R2=0.04, P=0.03) to be significant independent predictors of retinopathy. OSA was the only independent significant predictor of the total microaneurysm score (R2=0.21, P=0.004), a detailed retinopathy subclassification. OSA was the only independent significant predictor of maculopathy (R2=0.3, P<0.001). CONCLUSION In men with Type 2 diabetes, there is a strong association between retinopathy and OSA, independent of conventional retinopathy risk factors.
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Affiliation(s)
- S D West
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK.
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18
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Why do patients still require surgery for the late complications of Proliferative Diabetic Retinopathy? Eye (Lond) 2010; 24:435-40. [DOI: 10.1038/eye.2009.320] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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19
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Raymond NT, Varadhan L, Reynold DR, Bush K, Sankaranarayanan S, Bellary S, Barnett AH, Kumar S, O'Hare JP. Higher prevalence of retinopathy in diabetic patients of South Asian ethnicity compared with white Europeans in the community: a cross-sectional study. Diabetes Care 2009; 32:410-5. [PMID: 19074992 PMCID: PMC2646018 DOI: 10.2337/dc08-1422] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to compare prevalence and risk factors for diabetic retinopathy among U.K. residents of South Asian or white European ethnicity. RESEARCH DESIGN AND METHODS This was a community-based cross-sectional study involving 10 general practices; 1,035 patients with type 2 diabetes were studied: 421 of South Asian and 614 of white European ethnicity. Diabetic retinopathy, sight-threatening retinopathy, maculopathy, and previous laser photocoagulation therapy were assessed after grading of retinal photographs. Data were collected on risk factors including age, duration, and treatment of diabetes, blood pressures, serum total cholesterol, and A1C. RESULTS Patients of South Asian ethnicity had significantly higher systolic (144 vs. 137 mmHg, P < 0.0001) and diastolic (84 vs. 74 mmHg, P < 0.0001) blood pressure, A1C (7.9 vs. 7.5%, P < 0.0001), and total cholesterol (4.5 vs. 4.2 mmol/l, P < 0.0001). Diabetic retinopathy was detected in 414 (40%) patients (189 South Asian [45%] versus 225 white European [37%]; P = 0.0078). Sight-threatening retinopathy was detected in 142 (14%) patients (68 South Asian [16%] versus 74 white European [12%]; P = 0.0597). After adjustment for confounders, there were significantly elevated risks of any retinopathy and maculopathy for South Asian versus white European patients. CONCLUSIONS Patients of South Asian ethnicity had a significantly higher prevalence of diabetic retinopathy and maculopathy, with significantly elevated systolic and diastolic blood pressure, A1C, and total cholesterol; lower attained age; and younger age at diagnosis. Earlier onset of disease and higher levels of modifiable risk factors make early detection of diabetes, annual referral for retinal screening, and intensive risk factor control key elements in addressing this health inequality.
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Affiliation(s)
- Neil T Raymond
- Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
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20
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Retinopatía diabética y ceguera en España. Epidemiología y prevención. ACTA ACUST UNITED AC 2008; 55:459-75. [DOI: 10.1016/s1575-0922(08)75843-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Accepted: 07/30/2008] [Indexed: 01/12/2023]
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Naqshbandi M, Harris SB, Esler JG, Antwi-Nsiah F. Global complication rates of type 2 diabetes in Indigenous peoples: A comprehensive review. Diabetes Res Clin Pract 2008; 82:1-17. [PMID: 18768236 DOI: 10.1016/j.diabres.2008.07.017] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 07/14/2008] [Accepted: 07/16/2008] [Indexed: 12/18/2022]
Abstract
INTRODUCTION AND OBJECTIVE The world's Indigenous peoples are experiencing an unprecedented epidemic of type 2 diabetes [T2DM] but little has been published describing the complications burden. The objective of this paper was to conduct a systematic review of T2DM complications in Indigenous populations worldwide. METHODS A literature review was conducted using PubMed and EMBASE to examine available complications data. Country, Indigenous population, authors, publication year, total sample size, Indigenous sample size, age, methodology, and prevalence of nephropathy, end-stage renal disease, retinopathy, neuropathy, lower extremity amputations, cardiovascular disease, hospitalizations and mortality due to diabetes were recorded. RESULTS One-hundred and eleven studies were selected. Results revealed a disproportionate burden of disease complications among all Indigenous peoples regardless of their geographic location. Complication rates were seen to vary widely across Indigenous groups. DISCUSSION Gaps were found in the published literature on complications among Indigenous populations, especially those living in underdeveloped countries. These gaps may be in part due to the challenges caused by varying operational practices, research methodologies, and definitions of the term Indigenous, making documentation of rates among these peoples problematic. Comprehensive surveillance applying standardized definitions and methodologies is needed to design targeted prevention and disease management strategies for Indigenous peoples with T2DM.
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Affiliation(s)
- Mariam Naqshbandi
- Centre for Studies in Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, Suite 245-100 Collip Circle, London, Ontario, Canada N6G 4X8
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Lim S, Chellumuthi C, Crook N, Rush E, Simmons D. Low prevalence of retinopathy, but high prevalence of nephropathy among Maori with newly diagnosed diabetes-Te Wai o Rona: Diabetes Prevention Strategy. Diabetes Res Clin Pract 2008; 80:271-4. [PMID: 18242758 DOI: 10.1016/j.diabres.2007.12.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Accepted: 12/19/2007] [Indexed: 10/22/2022]
Abstract
AIMS/HYPOTHESIS To describe the prevalence of retinopathy and microalbuminuria at diagnosis of diabetes in a predominantly Maori study population. METHODS Biomedical assessment including photographic retinal examination was undertaken among 157 (68.9% of eligible) members of Maori families (3.3% non-Maori) diagnosed with diabetes during a community screening programme (n=5240) as part of a diabetes prevention strategy. RESULTS Mean HbA1c of those with newly diagnosed diabetes was 7.8+/-1.5% with 34.4% having an HbA1c >/=8.0%. Retinopathy was present in 3 (1.7%) subjects, cataracts in 3.2%, microalbuminuria in 29.6% and albuminuria in 7.7%. After adjusting for covariates, only smoking was a risk factor for microalbuminuria/proteinuria (current and former smokers: increased 3.81(1.32-11.0) and 3.67(1.30-10.4) fold, respectively). CONCLUSIONS The prevalence of retinopathy at diagnosis was lower than in previous studies, yet that of microalbuminuria/proteinuria remained high. The retinopathy data suggest that case detection for diabetes in the community may be improving, but that other strategies among those at risk of diabetes, including those promoting smoking cessation, will be needed to reduce the risk of renal disease among Maori with diabetes.
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23
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Stolk RP, van Schooneveld MJ, Cruickshank JK, Hughes AD, Stanton A, Lu J, Patel A, Thom SAM, Grobbee DE, Vingerling JR. Retinal vascular lesions in patients of Caucasian and Asian origin with type 2 diabetes: baseline results from the ADVANCE Retinal Measurements (AdRem) study. Diabetes Care 2008; 31:708-13. [PMID: 18184903 DOI: 10.2337/dc07-1657] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of this study was to describe prevalent vascular retinal lesions among patients with type 2 diabetes enrolled in the ADVANCE Retinal Measurements (AdRem) study, a substudy of the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial. RESEARCH DESIGN AND METHODS Seven-field stereoscopic photographs of both eyes were obtained at the baseline assessment of the ADVANCE trial. All photographs were graded in a central reading center. Gradable retinal images were received from 1,605 patients. RESULTS The number of patients with any retinopathy (Early Treatment of Diabetic Retinopathy Study [ETDRS] score > or = 20) was 645 (40.2% [95% CI 37.8-42.6]); of these, 35 (2.2% [1.6-3.0]) had severe diabetic retinopathy (ETDRS score > or = 50). Focal arterial narrowing, venous beading, and arteriovenous nicking were present in 3.8, 5.1, and 9.8% of participants, respectively. Among participants included in this study, Chinese and South-Asian patients had more retinopathy than Caucasians, as defined both by ETDRS score (49.4, 46.0, and 31.3%, respectively; P < 0.001, adjusted for age, sex, A1C, systolic blood pressure, and duration of diabetes) and specific vascular lesions (e.g., arteriovenous nicking 12.3, 8.5, and 7.5%, respectively; adjusted P < 0.005). A1C, duration of diabetes, and systolic blood pressure were similarly associated with increased retinal lesions in Chinese, South-Asian, and Caucasian patients. CONCLUSIONS Using a sensitive diagnostic procedure, more than one-third of patients with type 2 diabetes enrolled in the AdRem study had retinal lesions at baseline. Despite differences in prevalence and severity of retinopathy among Chinese, South-Asian, and Caucasian patients included in this study, the cross-sectional associations among established risk factors for retinopathy and retinal lesions were similar across ethnic groups.
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Affiliation(s)
- Ronald P Stolk
- Department of Epidemiology, University Medical Center Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands.
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