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Lydia Marahrens, Fritsche Andreas, Daniel Roeck, Focke Ziemssen; Red flags of diabetic retinopathy (DR) in patients with Type 1 Diabetes mellitus (T1DM) using HbA1c level and antihypertensive medication. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1042. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
SCORE-charts (Systematic COronary Risk Evaluation) are a model tool how a risk (here: cardiovascular risk) can be determined based on the knowledge of certain parameters. Although important risk factors are also known for DR such as hypertension, duration of disease and metabolic control, general practitioners (GPs) rarely use them in the context of eye care. Nevertheless, it would be useful to have additional risk assessment tools for easily estimating the risk of DR in T1DM.
The DiabCheckOCT+Study was a non-interventional cross-sectional study of 810 adults recruited in 3 secondary diabetes care centers during a period of 4 months. All patients of the investigator initiated study were included after confirmed diagnosis of diabetes and underwent an examination with a widefield scanning laser fundus imaging (Optos) and SD-OCT (Heidelberg Engineering). DR was assessed independently by independent evaluation of 2 ophthalmologists. Information about patient’s treatment and diabetes type, diabetes duration and laboratory test results was systematically extracted from the patient’s electronic medical records. The average of 3 quarterly HbA1c levels was divided into 4 groups (≤6.50/ 6.51-7.50/ 7.51-8.49/ ≥8.5%). The number of antihypertensive agents was classified into 3 groups (0/1/≥2). Binary logistic regression analysis was used to determine the association between prevalence of DR, HbA1c level and number of antihypertensive agents. The χ2-test was used for categorical outcomes, the one-way ANOVA for normally distributed data (α=0.05).
252 of 810 patients (31.5%) had T1DM, 509 (63.6%) T2DM, 20 (2.5%) LADA and 14 (1.8%) pancreoprive diabetes. The total prevalence of DR in T1DM was 36.4% (90/247). The odds ratio (OR) of antihypertensive agents was 1.69 [95%-CI: 1.19; 2.41] (p=0.004), OR of mean HbA1c level was 2.20 [95%-CI: 1.55; 3.13] (p<0.001). The prevalence of DR without antihypertensive agents and HbA1c levels ≤6.50 was 14.8% (4/27), for levels ≥8.5% at 64.3% (9/14). Mean HbA1c levels between 6.51% and 7.50% showed a prevalence of DR without antihypertensive agents of 25.4% (16/63) and increased to 56.5% (13/23) with at least 2 antihypertensive agents.
With the help of red flags for DR patients, GPs could identify "at-risk" patients and improve awareness as well as adherence to diabetic control and guidelines.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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