Systemic factors added to retinal imaging enhance screening for diabetic retinopathy
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Increased HbA1c, systolic blood pressure and triglycerides are associated with increased diabetic retinopathy risk among Irish adults with type 2 diabetes, and may provide screening targets for disease progression, according to a cohort study published in Diabetic Medicine.
“The risk of a person with type 2 diabetes progressing to referable diabetic retinopathy and potentially sight-threatening diabetic retinopathy ... between two consecutive ophthalmic evaluations, which would indeed determine the appropriate screening interval, appears dependent on multiple risk factors, local and systemic,” Noemi Lois, MD, PhD, FRCS(Ed), FRCOphth, clinical professor in the School of Medicine, Dentistry and Biomedical Sciences at Wellcome-Wolfson Institute for Experimental Medicine at Queens University in Belfast, U.K., and colleagues wrote. “Establishing these in different populations is essential if personalized screening intervals are to be introduced.”
Researchers analyzed data from 1,775 adults with type 2 diabetes (98% ethnically Irish; median age, 63 years; range, 17-93 years) who participated in the Diabetes Watch program, a primary care-based screening program in Ireland, between April 2005 and July 2013. BP, HbA1c, serum lipids and BMI were recorded at baseline and every 4 months and were linked to diabetic retinopathy grading results at baseline and then annually. Retinopathy was graded as R1 (background retinopathy with at least one microaneurysm or retinal hemorrhage), R2 (preproliferative), R3 (proliferative diabetic retinopathy), M1 (macular edema), and R0 and M0 (indicating no disease).
During 8 years, 9,604 ophthalmic evaluations were linked to 22,701 systemic evaluations, 84% of which had complete data; 1,770 were included in the Cox proportional hazards model to estimate association between risk factors and development of referable diabetic retinopathy.
At follow-up, 143 participants (8%) developed referable diabetic retinopathy. Compared with no baseline retinopathy, background retinopathy at baseline was “much more likely” to progress to referable diabetic retinopathy, according to researchers, with an HR of 4.02 (95% CI, 2.8-5.78). Increased HbA1c (HR = 1.22; 95% CI, 1.11-1.34), systolic BP (HR = 1.29; 95% CI, 1.15-1.45) and triglycerides (HR = 1.1; 95% CI, 1.03-1.18) were associated with increased risk for developing referable diabetic retinopathy.
Participants with higher BMI (HR = 0.83; 95% CI, 0.73-0.95) and higher diastolic BP (HR = 0.91; 95% CI, 0.85-0.97) were less likely to be referred for diabetic retinopathy.
“The value of adding systemic risk factors to retinopathy grading ... with the goal of increasing the accuracy of estimates of risk of progression to advanced disease ... remains to be fully elucidated. If predicted risk were more accurately determined by inclusion of systemic risk factors in addition to updated retinopathy grading, then combining clinical and screening platform data would be advisable, potentially leading to a more cost-effective screening,” the researchers wrote. – by Erin T. Welsh
Disclosures: The authors report no relevant financial disclosures.
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