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Ahmed Sallam, Irene Stratton, Steve Aldington, Mark Histed, Peter Scanlon; Twenty Years On. More or Less Diabetic Retinopathy at Diagnosis of Type 2 Diabetes?. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1541.
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To compare characteristics of patients newly diagnosed with Type 2 diabetes mellitus with those recruited to UK Prospective Diabetes Study (UKPDS), a large-scale clinical trial on 5102 people newly diagnosed with Type 2 diabetes between 1978 and1990
In England the Diabetic Eye Screening programme advises annual digital retinal screening for everyone aged 12 or above. Data were collected for patients on the screening register of Gloucestershire Programme in UK. Grading outcomes were extracted from the screening programme database and clinical information extracted from primary care records for those diagnosed with Type 2 diabetes between 2005 and 2012. Clinical characteristics and diabetic retinopathy (DR) grading outcomes from Gloucestershire patients aged 65 or below were compared with data from patients in UKPDS.
Data were available for 2,070 men and 1,375 women of whom 1,403 (68%) men and 990 (72%) women had no retinopathy. Of those with DR, 20% had microaneurysms in one eye, 9% had microaneurysms in both eyes and 2% had more advanced retinopathy that required referral to the hospital eye service defined as moderate to severe non proliferative DR equivalent to levels 43 - 53 on the Early Treatment Diabetic Retinopathy Study (ETDRS) scale; proliferative DR equivalent to a minimum of ETDRS level 61 or the presence of 2-dimensional photographic markers of diabetic maculopathy, specifically exudate within 1 disc diameter (DD) of the centre of the fovea, circinate or group of exudates within the macula or any microaneurysm or haemorrhage within 1DD of the centre of the fovea but only if associated with VA of worse than 0.3 LogMAR. There was more retinopathy in men than women (p=0.0033). Patients were of similar age to those in UKPDS but had lower HbA1c (mean difference -1.8%), higher systolic and diastolic blood pressure (+7 and+2 mmHg, respectively) and were heavier (BMI +4 kg/m2). Proportionately more in UKPDS had DR (39% men and 34% women) and more had referable DR (15% and 11%, p<0.0001).
Patients in this screening programme have lower rates of any DR and referable DR, and are less hyperglycaemic. However they have higher blood pressure and are heavier than those recruited to UKPDS. This has implications for screening programs and risk estimation.
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