Four-Year Screening Interval and Vision-Threatening Retinopathy in Type 2 Diabetes Patients With Good Glycemic Control

Abstract

Objective: To assess whether vision-threatening retinopathy developed after 4 years in patients with type 2 diabetes with good glycemic control during follow-up. Patients and Methods: Using data from the Action to Control Cardiovascular Risk in Diabetes and Action to Control Cardiovascular Risk in Diabetes Follow-on studies (conducted from January 1, 2001, to October 14, 2014), we investigated the incidence of vision-threatening retinopathy after 4 years in patients with type 2 diabetes with good or poor glycemic control. Patients with proliferative diabetic retinopathy at baseline were excluded. Vision-threatening retinopathy was defined as severe nonproliferative diabetic retinopathy, proliferative diabetic retinopathy, laser photocoagulation, or vitrectomy. Good and poor glycemic control was defined as mean glycated hemoglobin level less than 7% and 7% or greater during follow-up, respectively. Results: This study included 2285 patients. Among patients with no retinopathy at baseline, the 4-year incidence of vision-threatening retinopathy was 0% (0 of 386) and 0.8% (6 of 721) in those with good and poor glycemic control, respectively (P¼.54). Similarly, severe retinopathy was not observed at 8 years in patients who did not have retinopathy at 4 years. Among patients with mild to moderate nonproliferative diabetic retinopathy at baseline, the 4-year incidence of vision-threatening retinopathy was significantly higher in those with poor glycemic control than in those with good glycemic control (9.7% [77 of 790] vs 4.4% [13 of 297]; P¼.004). Additionally, the remission rate of diabetic retinopathy was low in patients with a long duration of diabetes. Four-year incidences of vision-threatening retinopathy were higher in patients with retinopathy at baseline who had poorer glycemic control and longer durations of diabetes. Conclusion: It may be safe to extend screening intervals for diabetic retinopathy to 4 years or longer in patients with type 2 diabetes with no retinopathy.

Risk Factors for Progression to Referable Diabetic Eye Disease in People With Diabetes Mellitus in Auckland, New Zealand: A 12-Year Retrospective Cohort Analysis

“…More recently, the 10-year cohort OPHDIAT study reported that the safe screening interval for patients without DR at the first examination for T1DM and T2DM was 2.2 (95% CI, 2.0–2.4) and 3.0 (2.9–3.1) years, respectively 41 . In a subgroup of low-risk patients with Type 2 DM, the safe screening interval can probably be extended out further to 4 years 41,42 . Our findings support these recommendations.…”

“…41 In a subgroup of low-risk patients with Type 2 DM, the safe screening interval can probably be extended out further to 4 years. 41,42 Our findings support these recommendations. Our data suggest that for our study population, screening intervals for individuals with T1DM with no retinopathy at baseline and no risk factors (no retinopathy/ maculopathy, HbA1c <65 mmol, duration of disease <6 years) can be safely extended to at least 3 years, whilst those living with T2DM with no risk factors (no retinopathy/ maculopathy, HbA1c <65 mmol, duration of disease <6 years, age above 65 at diagnosis, not requiring insulin) can be safely extended to beyond 5 years.…”