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First Incidence and Progression Study for Diabetic Retinopathy in Portugal, the RETINODIAB Study: Evaluation of the Screening Program for Lisbon Region.
Ophthalmology. 2015 Dec; 122(12):2473-81.O

Abstract

PURPOSE

To estimate the 5-year incidence and progression of diabetic retinopathy (DR) among persons with type 2 diabetes mellitus (DM).

DESIGN

Population-based, prospective, cohort study.

PARTICIPANTS

The RETINODIAB (Study Group for Diabetic Retinopathy Screening) program was implemented in the Lisbon and Tagus Valley area between July 2009 and December 2014. A total of 109 543 readable screening examinations were performed and corresponded to 56 903 patients who attended the screening program at entry. A total of 30 641 patients (53.85%) had at least 1 further screening event within the study period and were included in the analysis.

METHODS

Participants underwent two 45° nonstereoscopic retinal digital photographs per eye according to RETINODIAB protocol. All images were graded according to the International Clinical Diabetic Retinopathy Scale. Referable diabetic retinopathy (RDR) was defined for all patients graded as moderate nonproliferative DR (NPDR), severe NPDR, or proliferative DR (PDR), with or without maculopathy or mild NPDR with maculopathy. Nonparametric estimates of the annual and cumulative incidences were obtained by Turnbull's estimator. Associations between the potential risk factors and the time to onset/progression of retinopathy were assessed through a parametric survival analysis for interval-censored data.

MAIN OUTCOME MEASURES

The authors estimated the onset and progression incidence rates of DR.

RESULTS

Yearly incidence of any DR in patients without retinopathy at baseline was 4.60% (95% confidence interval [CI], 3.96-4.76) in the first year, decreasing to 3.87% (95% CI, 2.57-5.78) in the fifth year. In participants with mild NPDR at baseline, the progression rate to RDR in year 1 was 1.18% (95% CI, 0.96-1.33). Incidence of any DR and RDR and DR progression rate were associated with known duration of diabetes, age at diagnosis, and use of insulin treatment.

CONCLUSIONS

This longitudinal epidemiologic study provides the first Portuguese incidence DR data in a large-scale population-based cohort of type 2 diabetes after a 5-year follow-up. Duration of diabetes, age at diagnosis, and insulin treatment were associated with increasing risk of incidence and progression of DR. A personalized schedule distribution of screening intervals according to the individual patient's profile should be implemented, with resulting benefits in terms of health costs.

Authors+Show Affiliations

Portuguese Diabetes Association, Lisbon, Portugal; Department of Ophthalmology, Central Lisbon Hospital Center, Lisbon, Portugal; NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal. Electronic address: marcodutramedeiros@gmail.com.University of Minho, Braga, Portugal.Portuguese Diabetes Association, Lisbon, Portugal.Portuguese Diabetes Association, Lisbon, Portugal.Portuguese Diabetes Association, Lisbon, Portugal.Statistics and Informatics Department, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal; Epidemiology and Statistics Unit, Research Centre, Central Lisbon Hospital Center, Lisbon, Portugal; CEAUL (Center of Statistics and Applications); University of Lisbon, Lisbon, Portugal.CEAUL (Center of Statistics and Applications); University of Lisbon, Lisbon, Portugal; Department of Statistics and Operational Research, Faculty of Sciences, University of Lisbon, Lisbon, Portugal.Portuguese Diabetes Association, Lisbon, Portugal; Department of Public Health/CEDOC (Chronic Diseases Research Center), NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26383994

Citation

Dutra Medeiros, Marco, et al. "First Incidence and Progression Study for Diabetic Retinopathy in Portugal, the RETINODIAB Study: Evaluation of the Screening Program for Lisbon Region." Ophthalmology, vol. 122, no. 12, 2015, pp. 2473-81.
Dutra Medeiros M, Mesquita E, Gardete-Correia L, et al. First Incidence and Progression Study for Diabetic Retinopathy in Portugal, the RETINODIAB Study: Evaluation of the Screening Program for Lisbon Region. Ophthalmology. 2015;122(12):2473-81.
Dutra Medeiros, M., Mesquita, E., Gardete-Correia, L., Moita, J., Genro, V., Papoila, A. L., Amaral-Turkman, A., & Raposo, J. F. (2015). First Incidence and Progression Study for Diabetic Retinopathy in Portugal, the RETINODIAB Study: Evaluation of the Screening Program for Lisbon Region. Ophthalmology, 122(12), 2473-81. https://doi.org/10.1016/j.ophtha.2015.08.004
Dutra Medeiros M, et al. First Incidence and Progression Study for Diabetic Retinopathy in Portugal, the RETINODIAB Study: Evaluation of the Screening Program for Lisbon Region. Ophthalmology. 2015;122(12):2473-81. PubMed PMID: 26383994.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - First Incidence and Progression Study for Diabetic Retinopathy in Portugal, the RETINODIAB Study: Evaluation of the Screening Program for Lisbon Region. AU - Dutra Medeiros,Marco, AU - Mesquita,Edgar, AU - Gardete-Correia,Luís, AU - Moita,Joaquim, AU - Genro,Victor, AU - Papoila,Ana Luísa, AU - Amaral-Turkman,Antónia, AU - Raposo,João Filipe, Y1 - 2015/09/15/ PY - 2015/06/08/received PY - 2015/08/03/revised PY - 2015/08/04/accepted PY - 2015/9/19/entrez PY - 2015/9/19/pubmed PY - 2016/3/18/medline SP - 2473 EP - 81 JF - Ophthalmology JO - Ophthalmology VL - 122 IS - 12 N2 - PURPOSE: To estimate the 5-year incidence and progression of diabetic retinopathy (DR) among persons with type 2 diabetes mellitus (DM). DESIGN: Population-based, prospective, cohort study. PARTICIPANTS: The RETINODIAB (Study Group for Diabetic Retinopathy Screening) program was implemented in the Lisbon and Tagus Valley area between July 2009 and December 2014. A total of 109 543 readable screening examinations were performed and corresponded to 56 903 patients who attended the screening program at entry. A total of 30 641 patients (53.85%) had at least 1 further screening event within the study period and were included in the analysis. METHODS: Participants underwent two 45° nonstereoscopic retinal digital photographs per eye according to RETINODIAB protocol. All images were graded according to the International Clinical Diabetic Retinopathy Scale. Referable diabetic retinopathy (RDR) was defined for all patients graded as moderate nonproliferative DR (NPDR), severe NPDR, or proliferative DR (PDR), with or without maculopathy or mild NPDR with maculopathy. Nonparametric estimates of the annual and cumulative incidences were obtained by Turnbull's estimator. Associations between the potential risk factors and the time to onset/progression of retinopathy were assessed through a parametric survival analysis for interval-censored data. MAIN OUTCOME MEASURES: The authors estimated the onset and progression incidence rates of DR. RESULTS: Yearly incidence of any DR in patients without retinopathy at baseline was 4.60% (95% confidence interval [CI], 3.96-4.76) in the first year, decreasing to 3.87% (95% CI, 2.57-5.78) in the fifth year. In participants with mild NPDR at baseline, the progression rate to RDR in year 1 was 1.18% (95% CI, 0.96-1.33). Incidence of any DR and RDR and DR progression rate were associated with known duration of diabetes, age at diagnosis, and use of insulin treatment. CONCLUSIONS: This longitudinal epidemiologic study provides the first Portuguese incidence DR data in a large-scale population-based cohort of type 2 diabetes after a 5-year follow-up. Duration of diabetes, age at diagnosis, and insulin treatment were associated with increasing risk of incidence and progression of DR. A personalized schedule distribution of screening intervals according to the individual patient's profile should be implemented, with resulting benefits in terms of health costs. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/26383994/First_Incidence_and_Progression_Study_for_Diabetic_Retinopathy_in_Portugal_the_RETINODIAB_Study:_Evaluation_of_the_Screening_Program_for_Lisbon_Region_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(15)00781-2 DB - PRIME DP - Unbound Medicine ER -