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Early detection of type 2 diabetes mellitus and screening for retinopathy are associated with reduced prevalence and severity of retinopathy
Natl Univ Hosp Reykjavik, Dept Ophthalmol, Reykjavik, Iceland.;Univ Iceland, Reykjavik, Iceland.;Orebro Univ Hosp, Dept Ophthalmol, S-70116 Orebro, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
Orebro Univ Hosp, Dept Ophthalmol, S-70116 Orebro, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
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2016 (English)In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 94, no 3, 232-239 p.Article in journal (Refereed) PublishedText
Abstract [en]

PurposeTo explore whether the prevalence and severity of retinopathy differ in diabetes cohorts diagnosed through screening as compared with conventional health care. MethodsA total of 257 diabetes patients, 151 detected through screening and 106 through conventional clinical care, were included. Retinopathy was evaluated by fundus photography. The modified Airlie House adaptation of the Early Treatment Retinopathy Study protocol was used to grade the photographs. Averages of clinically collected fasting blood glucose (FBG), blood pressure and body mass index values were compiled from diabetes diagnosis until the eye examination. Blood chemistry, smoking habits and peripheral neuropathy were assessed at the time of the eye examination. ResultsAmong the screening-detected patients, 22% had retinopathy as compared to 51% among those clinically detected (p<0.0001). In a multivariate analysis, patients with retinopathy were more likely to have increased average FBG (OR 1.42, 95% CI 1.19-1.70 per mmol/l) and peripheral neuropathy (OR 2.75, 95% CI 1.40-5.43), but less likely to have screening-detected diabetes (OR 0.31, 95% CI 0.17-0.57). Similar results were found using increasing severity grade of retinopathy as outcome. The cumulative retinopathy prevalence for the screening-detected diabetes cohort as compared with the clinically diagnosed cohort was significantly lower from 10years' follow-up and onwards (p=0.0002). ConclusionsAmong patients with screening-detected diabetes, the prevalence of retinopathy and increasing severity of retinopathy were significantly lower than among those who had their diabetes diagnosed through conventional care, even when other risk factors for retinopathy such as duration, hyperglycaemia and blood pressure were considered. Early detection of diabetes reduces prediagnostic time spent with hyperglycaemia. In combination with early and regular screening for retinopathy, more effective prevention against retinopathy can be provided.

Place, publisher, year, edition, pages
2016. Vol. 94, no 3, 232-239 p.
Keyword [en]
diabetes duration, longitudinal data, opportunistic case finding, peripheral neuropathy, retinopathy, screening, type 2 diabetes mellitus
National Category
Endocrinology and Diabetes Ophthalmology
Identifiers
URN: urn:nbn:se:uu:diva-297106DOI: 10.1111/aos.12954ISI: 000374693000014PubMedID: 26855250OAI: oai:DiVA.org:uu-297106DiVA: diva2:941236
Available from: 2016-06-22 Created: 2016-06-21 Last updated: 2016-06-22Bibliographically approved

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Svärdsudd, KurtJansson, Stefan P. O.
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