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Lydia Marahrens, Daniel Röck, Raimar Kern, Tjalf Ziemssen, Andreas Fritsche, Peter Martus, Focke Ziemssen; Prevalence of diabetic retinopathy in dependence on the steps of Diabetes Management Guidelines. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1597.
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© 2017 Association for Research in Vision and Ophthalmology.
Our aim was to assess the differences in prevalence of diabetic retinopathy between the treatment groups as defined by the steps of management guidelines.
The DiabCheck® study was a non-interventional cross-sectional study of 810 adults recruited in 3 secondary diabetes care centers during a period of 4 month. All patients of the investigator initiated study were included after confirmed diagnosis of diabetes and underwent a comprehensive eye examination. 508 patients with Type 2 Diabetes mellitus (T2DM) were divided into 4 distinct groups according to the recommendations of the German Disease Management Guideline on the Treatment of T2DM, also in accordance with the joint statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD): 1) the non-pharmacological basic therapy group (BASIC) characterized by healthy eating, weight control and increased physical activity, 2) the monotherapy group (MONO), 3) the dual therapy group (DUAL) and 4) the combination therapy group with insulin strategies in combination with non-insulin agents (COMBI).For categorical outcomes, χ2-test was used to test for significant differences between the therapy groups. For continuous outcomes, significant differences were evaluated with the one-way ANOVA (α=0.05).
The prevalence of diabetic retinopathy was 3.2% within the BASIC group (69/508), 1.4% in the MONO (69/508), 7.6% in the DUAL and 15.8% in the COMBI group (p<0.001). Corresponding to the four groups, the mean diabetes duration showed a continuous increase: 3.6 yrs (95-CI: 2.1, 5.0) (BASIC), 6.0 yrs. (95-CI: 4.8, 7.3) (MONO), 9.5 yrs. (95-CI: 8.3, 10.7) (DUAL) and 15.9 yrs (95-CI: 14.8, 16.9) (COMBI) (p<0.001). With increasing diabetes duration patients tended to climb in the treatment steps. Thus, after 20 yrs. the large majority of T2DM were in the COMBI group
If there is uncertainty over the duration of disease, the step of escalating management might be used to describe the patient’s risk of developing diabetic retinopathy. This could further enhance the risk awareness of primary care physicians and patients.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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