Reduced incidence of blindness in relation to diabetes mellitus in southern Germany?

Development of diabetes complications within coordinated and structured primary health care: a 10-year retrospective cohort study in Germany

BACKGROUND

Diabetes mellitus is a growing, costly, and potentially preventable public health issue. In 2004, Germany introduced the GP-centred healthcare programme to strengthen primary care.

AIM

To assess the hazards of the most common diabetes-related complications in patients enrolled in GP-centred health care in comparison with usual primary care.

DESIGN & SETTING

A retrospective cohort study based on German claims data (4 million members) from 2011-2020.

METHOD

In total, 217 964 patients with diabetes were monitored from 2011-2020. Endpoints were blindness, amputation, myocardial infarction, stroke, coronary heart disease, dialysis, hypoglycaemia, and all-cause mortality. Cox proportional-hazards regression models were used for multivariable analysis and adjusted for sociodemographic, practice, and disease-specific characteristics.

RESULTS

Compared with usual care (n = 98 609 patients), GP-centred health care (n = 119 355 patients) showed a relative risk reduction of blindness of 12%, and amputation of 20% over 10 years. The estimated impact of GP-centred health care on myocardial infarction, stroke, coronary artery disease, dialysis, and all-cause mortality is significantly favourable in comparison with usual care. However, the proportional risk of hypoglycaemia (+1.2%) in the interventional group is higher than in usual care.

CONCLUSION

Enrolment in GP-centred health care appears to result in a consistent reduction of the relative risk of diabetes-related complications over 10 years. The significant difference in contrast to usual care may be explained by robust, structured primary care provision, including the diabetes disease management programme, and improved coordination and networking of care within primary and secondary care.

Assessing the barriers and facilitators of access to diabetic retinopathy screening in sub- Saharan Africa: a literature review

Diabetic retinopathy (DR) is the leading cause of blindness in working age adults. An increase in visual loss has been projected for sub-Saharan Africa (SSA) with the diabetes epidemic in the region. Screening is a cost-effective way to reduce this scourge, but adequate services are scarce. This review aims to evaluate the evidence on barriers and facilitators of access to DR screening with a view to making evidence-based recommendations for the development of effective and sustainable programmes in SSA. A systematic literature search of Africa-Wide Information, Embase, Cochrane library, Global Health, and Medline databases was done using diabetic retinopathy, screening, and Sub-Saharan Africa as concepts. Google Scholar was also searched to identify relevant literature. Studies were included if they were done in SSA and reported on barriers and/or facilitators of access to DR screening. The database search yielded 616 papers and google scholar yielded 9223 papers. Of these, 54 papers were assessed for eligibility and 18 met the inclusion criteria. These were appraised with appropriate checklists. Fourteen themes were synthesised. Most were supply challenges affecting all dimensions of access and the six components of the health systems building blocks. Several studies had poor methodologies, and this has implications for the evidence provided. The findings of this review show a weakness in the health systems suggesting this is the major indirect barrier to DR screening in SSA. Measures to strengthen the health system for DR screening is strongly recommended.

Incidence, individual, and macro level risk factors of severe binocular visual impairment and blindness in persons aged 50 and older

OBJECTIVE

This study aims to estimate the incidence of severe binocular vision impairment and blindness (SVI/B) and to identify eye diseases and regional risk factors of persons with SVI/B at ages 50 years and older.

METHODS

We designed an observational cohort study based on longitudinal, multifactorial, and administrative information of a random sample of 250,000 persons at ages 50+. All individuals were included in the process-produced health claims register of the Allgemeine Ortskrankenkasse in 2004, and were followed until 2015. We analyzed ten selected eye diseases and regional characteristics as risk factors for SVI/B using Cox models, adjusting for demographic characteristics and multi-morbidity.

RESULTS

The age-standardized incidence was 79 new diagnoses of SVI/B per 100,000 person-years (95%-CI: 76-82); 77 for males (72-82) and 81 for females (77-85). By adjusting for multiple factors, the model revealed and confirmed that individuals who were very old (Hazard ratio90+: 6.67; 3.59-12.71), male (1.18; 1.01-1.38), had multi-morbidities (three+ diseases: 3.36; 2.51-4.49), or had diabetes (1.26; 1.07-1.49) had an increased risk of SVI/B. Compared to persons without the particular eye disease (all p<0.001), persons diagnosed with secondary glaucoma had a multiple-adjusted 4.66 times (3.17-6.85) higher risk, those with retinal vascular occlusion had a 4.51 times (3.27-6.23) higher risk, and those with angle-closure glaucoma had a 4.22 times (2.60-6.85) higher risk. Population density was not a risk factor, while persons living in wealthier regions had 0.75 times (p=0.003) to 0.70 times (p<0.001) the risk of SVI/B than persons in the least wealthy regions of Germany.

CONCLUSION

The study revealed and confirmed some profound risk factors of SVI/B at both the individual and the macro level. The sizes of the effects of the characteristics of the living context were smaller than those of the individual characteristics, especially for some severe eye diseases. While urbanity and access to health services had no effect, regional economic wealth was a risk factor for SVI/B. Future health care measures and advice by physicians should take these dimensions of inequalities in SVI/B into account.

First nation-wide study of diabetic retinopathy in Poland in the years 2013-2017

AIMS

To assess the prevalence and time trends of diabetic retinopathy (DR) in the overall population of Poland from 2013 to 2017 and diagnose the risk factors of occurring DR among patients with diabetes mellitus (DM).

METHODS

Data from all levels of healthcare services at public and private institutions recorded in the National Health Fund (NHF) database were evaluated. International Classification of Diseases codes (ICD-9 and ICD-10) and unique NHF codes were used to identify DM type 1 and type 2 patients, DR and treatment procedures including laser photocoagulation, pars plana vitrectomy (PPV), anti-VEGF and steroid intravitreal injections.

RESULTS

The overall registered prevalence of DR in the entire population of Poland was 0.81%. The mean prevalence of DR was 20.01% in the population with type 1 DM and 9.70% in the population with type 2 DM. In the study period, women represented 56.36% of all individuals registered with DR and 55.09% of all DM patients. In Poland, only 6.34% of all DM patients with DR received specific treatment with laser photocoagulation of the retina (82.32%), PPV (11.56%), anti-VEGF or steroid injections (5.15% and 0.97%, respectively). Cox regression hazard analysis showed that the risk of DR was associated with DM treatment only by GPs, female sex, coexisting systemic diseases and urban residence in both type 1 and type 2 DM.

CONCLUSIONS

A 5-year retrospective analysis reveals the mean prevalence of DR in the population with type 1 and type 2 DM in Poland was rather low.

Markedly decreasing incidence of cause-specific blindness in Saxony (Eastern Germany)

PURPOSE

To analyze the recent time trend in Saxony.

METHODS

Data were based on administrative files in Saxony (Eastern Germany) to assess recipients of blindness allowance newly registered between January 1, 2009, and December 31, 2017. We estimated age-sex standardized incidence of all-cause and cause-specific blindness and used Poisson regression to examine age- and sex-adjusted time trends.

RESULTS

We identified 5114 new cases of blindness (63.3% female, 59.9% ≥ 80 years). We observed a markedly decrease in incidence of blindness: all-causes 2009: 15.7 per 100,000 person years [95% confidence interval: 14.6-17.0]; 2017: 8.9 [8.1-9.8]; age-related macular degeneration 2009: 6.9 [6.1-7.7], 2017: 3.8 [3.3-4.3]; glaucoma 2009: 2.6 [2.2-3.1], 2017: 1.8 [1.4-2.2]; diabetic retinopathy 2009: 1.5 [1.2-1.9], 2017: 0.7 [0.5-1.0]; myopia 2009: 0.7 [0.5-1.1], 2017: 0.4 [0.2-0.5]; optic atrophy 2009: 0.9 [0.6-1.2], 2017: 0.5 [0.3-0.7]; and cataract 2009: 0.5 [0.3-0.8], 2017: 0.1 [0.1-0.3]. The annual reduction was between 5 (glaucoma, relative risk 0.95 [0.92-0.98]) and 16% (cataract, relative risk 0.84 [0.78-0.91]).

CONCLUSION

The age- and sex-standardized incidence of blindness decreased among all common causes of blindness in Saxony in the last decade.

Increased vitreal levels of interleukin-10 in diabetic retinopathy: a Meta-analysis

AIM

To conduct a Meta-analysis for the change of interleukin-10 (IL-10) concentration in vitreous samples of patients with diabetic retinopathy (DR).

METHODS

Systemic search for literature was conducted from the databases of PubMed, Web of Science and Cochrane Library by August 2019. Statistical analyses including standard mean difference (SMD) and its 95% confidence interval (CI) were performed by using RevMan 5.3 software.

RESULTS

Totally 194 studies were screened and finally 11 studies were included in the Meta-analysis. The concentration of IL-10 in the DR group was higher than in the control group (P=0.003, SMD: 0.77, 95%CI: 0.25-1.28). Significant heterogeneity was found among all studies (P<0.00001, I ²=92%). The subgroup analysis showed that the concentration of IL-10 increased in vitreous samples from patients with DR compared to the non-DR controls (P=0.004, SMD: 1.44, 95%CI: 0.46-2.42). Moreover, the concentration of IL-10 in samples of proliferative diabetic retinopathy (PDR) patients was significantly higher than that of non-proliferative diabetic retinopathy (NPDR) patients (P=0.01, SMD: 0.61, 95%CI: 0.13-1.08).

CONCLUSION

The vitreal concentration of IL-10 is significantly increased in patients with DR. Further studies are needed to reveal the mechanisms of IL-10 in DR.

Serum vascular endothelial growth factor is a biomolecular biomarker of severity of diabetic retinopathy

Background

Elevated serum vascular endothelial growth factor (VEGF) levels are associated with diabetic retinopathy (DR). Serum VEGF levels correlate with vitreous levels. Neuroretinal changes occur even before the appearance of vascular signs in DR. Role of VEGF as a biomarker for DR has not been assessed. Serum VEGF as a biomarker for severity of DR, was evaluated for the first time.

Methods

Consecutive cases of type 2 diabetes mellitus [without DR, (no DR, n = 38); non-proliferative DR, (NPDR, n = 38); proliferative DR, (PDR, n = 40)] and healthy controls (n = 40) were included. Serum VEGF was measured using enzyme linked immunosorbent assay. Accuracy of VEGF as a biomarker for severity of retinopathy was measured using the area under the receiver operator characteristic (ROC) curve.

Results

Serum VEGF levels in controls, No DR, NPDR and PDR groups showed significant incremental trend from 138.96 ± 63.37 pg/ml (controls) to 457.18 ± 165.69 pg/ml (PDR) (F = 48.47; p < 0.001). Serum VEGF levels were observed to be significantly elevated even before DR had set in clinically. ROC for serum VEGF levels was significant in discriminating between the cases and the controls and had good accuracy in discerning between subjects with and without retinopathy. The area under curve (AUC ± SE) for discrimination was significant: (a) cases and controls (n = 156): AUC = 0.858 ± 0.029, p < 0.001; (b) DR (NPDR + PDR) and No DR (n = 116): AUC = 0.791 ± 0.044, p < 0.001; and (c) NPDR and PDR (n = 78): AUC = 0.761 ± 0.056, p < 0.001, with over 90% projected sensitivity and specificity at various cut off values.

Conclusion

Serum VEGF level is a simple, effective laboratory investigative test in predicting the onset of DR in eyes showing no evidence of DR and serves as a reliable biomolecular biomarker for severity of DR.

Schuster A, M. Elflein H, Nickels S, Schulz A, S. Wild P, E. Beutel M, Blettner M, Münzel T, J. Lackner K, Pfeiffer N. The Prevalence of Visual Impairment in the Adult Population

BACKGROUND

The distribution of visual impairment is an indicator of the health status of the population and for the frequency of diseases of the eye.

METHODS

The Gutenberg Health Study (GHS) is a population-based cohort study in Germany concerning adults aged 35 to 74. 15 010 subjects from the Mainz-Bingen region underwent general medical and ophthalmological examination, with measurement of the distance-corrected visual acuity in each eye separately. As per the World Health Organization criteria, visual impairment was defined as an acuity below 0.3 in the better eye, and blindness as an acuity below 0.05. All patients who were found to be visually impaired or blind underwent further individual study with clinical history-taking, split-lamp examination, and fundus photography.

RESULTS

Data from 14 687 subjects were evaluated. The mean age of the partici- pants was 55.0 years (standard deviation, 11.1 years). The prevalence of visual im- pairment was 0.37% (95% confidence interval [0.28; 0.49]) (n = 55) and was higher in women (0.44%) than in men (0.31%). Blindness was present in 0.05% [0.03; 0.11] (n = 8) of the subjects. The prevalence of visual impairment from age 65 on- ward was 0.79%, three times higher than in the younger age groups. 54.5% of the visually impaired subjects had multiple underlying ophthalmological pathologies.

CONCLUSION

The causes of visual impairment are manifold. Loss of vision is often the combined effect of multiple pathological factors. The etiology of visual impair- ment is thus a more complex matter than is commonly assumed.

How do patients with diabetes report their comorbidities? Comparison with administrative data

AIMS

Patients with diabetes are probably often unaware of their comorbidities. We estimated agreement between self-reported comorbidities and administrative data.

METHODS

In a random sample of 464 diabetes patients, data from a questionnaire asking about the presence of 14 comorbidities closely related to diabetes were individually linked with statutory health insurance data.

RESULTS

Specificities were >97%, except cardiac insufficiency (94.5%), eye diseases (93.8%), peripheral arterial disease (92.6%), hypertension (90.9%), and peripheral neuropathy (85.8%). Sensitivities were <60%, except amputation (100%), hypertension (83.1%), and myocardial infarction (67.2%). A few positive predictive values were >90% (hypertension, myocardial infarction, and eye disease), and six were below 70%. Six negative predictive values were >90%, and two <70% (hypertension and eye disease). Total agreement was between 42.7% (eye disease) and 100% (dialysis and amputation). Overall, substantial agreement was observed for three morbidities (kappa 0.61-0.80: hypertension, myocardial infarction, and amputation). Moderate agreement (kappa 0.41-0.60) was estimated for angina pectoris, heart failure, stroke, peripheral neuropathy, and kidney disease. Factors associated with agreement were the number of comorbidities, diabetes duration, age, sex, and education.

CONCLUSIONS

Myocardial infarction and amputation were well reported by patients as comorbidities; eye diseases and foot ulceration rather poorly, particularly in older, male, or less educated patients. Patient information needs improving.

Markedly Decreasing Incidence of Blindness in People With and Without Diabetes in Southern Germany

OBJECTIVE

Studies comparing the incidence of blindness in persons with and without diabetes are scarce worldwide. In Germany, a decline in the incidence of blindness was found during the 1990s. The aim of this study was to analyze the recent time trend.

RESEARCH DESIGN AND METHODS

Data were based on administrative files in southern Germany to assess recipients of blindness allowance newly registered between 1 January 2008 and 31 December 2012. We estimated age- and sex-standardized incidence of blindness in people with and people without diabetes and the corresponding relative risk. Poisson regression was used to examine age- and sex-adjusted time trends.

RESULTS

We identified 1,897 new cases of blindness (23.7% of which were associated with diabetes). We observed a strong decrease in incidence in both the population with diabetes (2008, 17.3 per 100,000 person-years [95% CI 13.6-21.1], and 2012, 8.9 per 100,000 person-years [6.3-11.6]: 16% decrease [10-22] per year) and that without diabetes (2008, 9.3 per 100,000 person-years [8.3-10.3], and 2012, 6.6 [5.8-7.4]: 9% decrease [5-13] per year). The relative risk comparing those incidences was 1.70 (95% CI 1.32-2.16) and remained constant in the observation period. Regarding time trend, we found similar results for both sexes.

CONCLUSIONS

We found a significant reduction in incidence of blindness in the populations with and without diabetes, which was more prominent among individuals with diabetes compared with the 1990s. Our findings may be explained by effective secondary prevention therapies and improved ophthalmologic care beyond diabetic retinopathy, particularly regarding macular degeneration, which means earlier detection and earlier and better treatment.

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

AIMS

To describe trends in the incidence of visual impairment and blindness due to diabetic retinopathy among adults aged 18-69years in Ireland between 2004 and 2013.

METHODS

Data on visual impairment due to diabetic retinopathy in adults aged 18-69years or over who are registered with the National Council for the Blind of Ireland, (2004-2013) were analysed. Annual incidence rates were calculated for the adult population and the population with diagnosed diabetes. Poisson regression was used to test for changes in rates over time. The relative, attributable and population risk of blindness and visual impairment due to diabetic retinopathy were calculated for 2013.

RESULTS

Over the decade, the prevalence of diagnosed diabetes increased from 2.1% to 3.6%. Among people with diagnosed diabetes, the incidence of visual impairment due to diabetic retinopathy increased from 6.4 (95% CI 2.4-13.9) per 100,000 in 2004 to 11.7 (95% CI 5.9-21.0) per 100,000 in 2013. The incidence of blindness due to diabetic retinopathy varied from 31.9 per 100,000 (95% CI 21.6-45.7) in 2004 to 14.9 per 100,000 (95% CI 8.2-25.1) in 2013.

CONCLUSIONS

Our findings indicate the need for increased attention to preventive measures for microvascular complications among adults with diabetes in Ireland. Retinopathy screening has been standardised in Ireland, these findings provide useful baseline statistics to monitor the impact of this population-based screening programme.

Changes in diabetes care indicators: findings from German National Health Interview and Examination Surveys 1997-1999 and 2008-2011

OBJECTIVES

To investigate changes in type 2 diabetes care indicators over time in Germany.

METHODS

Adults aged 45-79 years with type 2 diabetes were identified from two national health examination surveys conducted in 1997-1999 (GNHIES98, n=333) and in 2008-2011 (DEGS1, n=526). We examined diabetes care indicators including treatment and preventive targets (glycemic control, blood pressure (BP), total cholesterol (TC), smoking, weight reduction, sports activity), self-management and care process measures (glucose self-monitoring, holding a diabetes passport, annual foot and eye examination; statin use), and the presence of diabetes-specific complications (diabetic nephropathy, retinopathy, neuropathy, diabetic foot, amputations) and comorbid cardiovascular disease (CVD) or chronic kidney disease (CKD). We calculated proportions of persons meeting these care indicators by survey and examined unadjusted and adjusted changes between surveys.

RESULTS

Significant improvement (GNHIES98 vs DEGS1) over time was observed for glycated hemoglobin (HbA1c) <7.0% (53 mmol/mol) (32.4% vs 65.4%), BP <130/80 mm Hg (32.0% vs 47.2%), TC <190 mg/dL (13.5% vs 41.9%), statin use (11.7% vs 35.9%), eye (51.1% vs 78.4%) and foot (48.0% vs 61.4%) examination within the past 12 months, diabetes-specific complications (29.7% vs 21.8%), and CVD (44.5% vs 37.1%). Blood glucose self-monitoring significantly increased (37.4% vs 62.8%), while holding a diabetes passport did not change. Current smoking did not change and obesity rose, although sports activity significantly increased over time. Proportions of adults achieving combination goals of HbA1c, BP, TC, and smoking cessation were low in both surveys in spite of significant improvement.

CONCLUSIONS

In Germany, the quality of diabetes care improved over time. There is much room for improvement, in particular regarding preventive goals and diabetes self-management.

Prevalence, incidence and concomitant co-morbidities of type 2 diabetes mellitus in South Western Germany--a retrospective cohort and case control study in claims data of a large statutory health insurance

Background

Type 2 diabetes mellitus (T2DM) has become a world-wide epidemic. This chronic metabolic disease has a major impact on life expectancy and on quality of life. The burden of this disease includes a number of co-morbidities. However, estimates of prevalence, incidence and associated diseases as well as the current temporal development and regional differences are largely missing for South Western Germany.

Methods

Lifetime diagnosis-based prevalence, incidence and presence of concomitant co-morbidities were examined between the years 2007 and 2010 in the claims data set of all insured persons of the AOK Baden-Wuerttemberg, a large statutory health insurance. The analysis was based on the respective WHO-ICD-10 codes. Data were standardized for age and sex on the residential population of about 10 million inhabitants of South Western Germany.

Results

The total study cohort involved approximately 3.5 million persons each year. The standardized diagnosis-based prevalence (SDP) of T2DM rose from 6.6 %, 7.4 %, 8.0 %, up to 8.6 % in the years 2007 to 2010. Yearly SDP was between 14.0 % and 18.9 % at an age range of 60 to 64 years and between 26.7 % and 31.8 % at an age of 75 years or older. In the year 2010 the regional distributions of standardized diagnosis-based prevalence were between 7.6 % and 11.6 %, respectively. Incidence rates were 8.3 in 2008, 7.8 in 2009, and 8.7 in 2010 (all rates per 1000). The excess disease risk (odds ratio) of T2DM was for adiposity 2.8 to 3.0, hypertension 2.4 to 3.7, coronary heart disease 1.8 to 1.9, stroke 1.7 to 1.8, renal insufficiency 2.8 to 3.4, and retinopathy 2.8 to 2.9 in the years 2007 to 2010. These co-morbidities appeared several years earlier compared to the non-diabetic population.

Conclusions

T2DM is common and increasing in South Western Germany. In particular a quarter of the population in higher ages was afflicted by T2DM. Interestingly a region-specific pattern was observed as well as an increase in numbers during earlier years in life. Our data underline the need for diabetes awareness programmes including early diagnosis measures as well as structured and timely health surveys for major diseases such as T2DM and its concomitant co-morbidities.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2188-1) contains supplementary material, which is available to authorized users.

[Increase in examinations for cataracts, glaucoma, diabetic retinopathy and age-related macular degeneration : Comparative cross-sectional study between 2010 and 1997 in ophthalmological practices]

BACKGROUND

The importance of the four most commonly occurring vision-threatening diseases, age-related macular degeneration (AMD), glaucoma, diabetic retinopathy and cataract in ophthalmological practices has changed due to demographic developments, medical progress and transference of inpatient treatment to the outpatient area of private practice.

METHODS

In the fourth quarter year of 2010 a survey of 15,125 patients (approximately 10%) from 96 private ophthalmology practices (mean 149 patients per ophthalmologist, range 45-376) was carried out. The results for the four most commonly occurring vision-threatening diseases were compared with the result from a previous survey carried out for the fourth quarter year of 1997.

RESULTS

Compared to 1997 there was an increase in the age-adjusted proportion of examinations in 2010 for cataracts by 29 %, for glaucoma by 21 %, for diabetic retinopathy by 39 % and for vitreoretinal diseases by 19 %. The number of AMD examinations in the age group over 70 years old showed a particularly high increase.

CONCLUSIONS

The number of patients examined for the four most commonly occurring vision-threatening diseases increased from 1997 to 2010 not only in absolute numbers but also in relation to age. In the future financial and personnel resources must be made available for the early and guidelines-conform detection, diagnostics and therapy by ophthalmologists.

[Analysis of type 2 diabetes-induced late effects based on administrative data of social insurance in Austria and implications for the evaluation of the DMP diabetes mellitus]

The present study analyses administrative data of medical services related to the distribution of diabetes mellitus type 2-induced late effects. Pseudonymous statutory health insurance data of all Austrian social security institutions for the years 2006/2007 in outpatient and inpatient (performance and diagnostic data) setting were used. Type 2 diabetics have been identified by prescribed medication. The specific late effects were defined as endpoints and the respective diagnoses and health performances were extracted. The study population included 7,945,774 insured. The percentage of the defined late effects was significantly higher in diabetics than in persons from the general population, with exception for kidney transplantation. The risk of a late effect was greatest among diabetics for an amputation. The results of this study can be used as a baseline for the evaluation of DMP diabetes. The administrative data used are limited for answering the defined research questions. Anyway, the data quality must be improved and unified in Austria.

Epidemiology of blindness attributable to diabetes in Scotland: change over 20 years in a defined population

AIMS

To establish the incidence and prevalence of blindness attributable to diabetes in a defined population in Scotland during the period 2000-2009, and to compare these figures with published data from the previous decade in the same population.

METHODS

All blind registrations during 2000-2009 in Fife, Scotland, UK were examined and included if diabetic retinopathy/maculopathy was the main cause of blindness. The annual incidence and point prevalence on 31 December 2009 of registered blindness attributable to diabetes were calculated in both the total population and the population with diabetes. These data were compared with figures for the period 1990-1999, using a two-tailed t-test, and subjected to Poisson regression analysis.

RESULTS

In the population with diabetes, the mean incidence of blindness attributable to diabetes was 42.7 (sd 24.2, 95% CI 25- 60) per 100 000 per year for 2000-2009, compared with 64.3 for 1990-1999 (P = 0.062). The relative risk of developing blindness per year was 0.894 (95% CI 0.811- 0.988, P = 0.028) for 2000- 2009. The point prevalence on 31 December 2009 was 167 per 100 000 in the population with diabetes, vs 210 on 31 December 1999.

CONCLUSION

Compared with the previous decade, the prevalence of blindness attributable to diabetes has decreased in the population with diabetes, with a trend towards a decrease in its incidence. This may be a consequence of an increased denominator population, resulting from better recording of diabetes and changes to the diagnostic criteria. Over the decade 2000-2009, the incidence of blindness attributable to diabetes fell by a mean of 10.6% per year in the population with diabetes.

Type 2 diabetes: prevalence and relevance of genetic and acquired factors for its prediction

BACKGROUND

The epidemiology of type 2 diabetes in Germany is of major societal interest, as is the question of the predictive value of genetic and acquired risk factors.

METHODS

We present clinically relevant aspects of these topics on the basis of a selective review of pertinent literature retrieved by a PubMed search that centered on population-based studies.

RESULTS

The German Health Interview and Examination Survey for Adults (Studie zur Gesundheit Erwachsener in Deutschland [DEGS1], 2008-2011) revealed that diabetes was diagnosed in 7.2% of the population aged 18 to 79 years (women 7.4%, men 7.0%). These figures are two percentage points higher than those found in the preceding national survey (1998). The percentage of cases that were not captured by these surveys is estimated at 2% to 7% depending on the method. Independently of personal factors (the individual's life style), it seems that living in a disadvantaged region characterized by high unemployment, air pollution, and poor infrastructure raises the risk of diabetes. Moreover, type 2 diabetes has a substantial hereditary component. More than 60 genetic regions have been identified to date that affect the risk of type 2 diabetes, yet all of them together account for only 10% to 15% of the genetic background of the disease.

CONCLUSION

The prevalence of type 2 diabetes in Germany has risen in recent years. The discovery of new genetic variants that confer a higher risk of developing the disease has improved our understanding of insulin secretion in diabetes pathogenesis rather than the prediction of individual diabetes risk ("personalized medicine").

Validation of diabetic retinopathy and maculopathy diagnoses recorded in a U.K. primary care database

OBJECTIVE

To describe the validity of recorded diabetic retinopathy (DR) and diabetic maculopathy (DMP) diagnoses, including edema (DMO) in The Health Improvement Network (THIN) database.

RESEARCH DESIGN AND METHODS

In two independent computer searches, we detected 20,838 patients with diabetes aged 1-84 years with a first DR computer Read entry in 2000-2008 and 4,064 with a first DMP entry. A two-step strategy was used to validate both outcomes as follows: 1) review of patient profiles including free-text comments from primary care practitioners (PCPs) (containing referral information and test results) of a random sample of 500 DR and all DMP computer-detected patients. We classified them in probable, possible, and noncase according to the diagnosis plausibility based on the manual review of the computerized information; and 2) review of questionnaires sent by PCPs and medical records in a random sample (N = 200 for each outcome including 36 diabetic macular edema [DMO]). Gold standard was PCPs' confirmation.

RESULTS

After profiles review, we categorized 418 as probable/possible DR. In addition, 3,676 DMP were categorized as probable/possible (including 711 DMO). After review of information sent by PCPs, confirmation rates were 87.3 and 87.2%, respectively (90.3% for DMO). When we applied them to the whole sample of computer-detected patients, the weighted confirmation rate was 78.0% for DR and 78.8% for DMP (86.2% for DMO).

CONCLUSIONS

Read codes for DR, DM, and DMO are moderately accurate in identifying incident case subjects of these ophthalmologic complications. The validity improved when incorporating PCPs' text comments to the patient's profile. THIN database proved to be a valuable resource to study ophthalmological diabetes complications.