Presence and development of diabetic retinopathy in 153 238 patients with type 2 diabetes in the Danish Registry of Diabetic Retinopathy

Abstract

Purpose The purpose of the study was to evaluate the prevalence and incidence of diabetic retinopathy (DR) along with associated markers in patients with type 2 diabetes in the Danish DR‐screening programme. Methods We included all persons with type 2 diabetes in the Danish Registry of Diabetic Retinopathy, who had attended at least one episode of DR screening in 2013–2018. DR was classified as levels 0–4 indicating increasing severity. Data were linked with various national health registries to retrieve information on diabetes duration, marital status, comorbidity and systemic medication. Results Among 153 238 persons with type 2 diabetes, median age and duration of diabetes were 66.9 and 5.3 years and 56.4% were males. Prevalence and 5‐year incidences of DR, 2‐step‐or‐more progression of DR and progression to proliferative DR (PDR) were 8.8%, 3.8%, 0.7% and 0.2%, respectively. In multivariable models, leading markers of incident DR and progression to PDR were duration of diabetes (HR 1.98, 95% CI 1.87–2.09; HR 2.89, 95% CI 2.34–3.58 per 10 years of duration) and use of insulin (HR 1.88, 95% CI 1.76–2.01; HR 2.40, 95% CI 1.84–3.13), while the use of cholesterol‐lowering medicine was a protecting marker (HR 0.87, 95% CI 0.81–0.93; HR 0.70, 95% CI 0.52–0.93). From 2013 to 2015, 3‐year incidence rates of PDR decreased from 1.22 to 0.45 events per 1000 person‐years. Conclusion Nationally, among Danish individuals with type 2 diabetes attending DR screening, we identified duration of diabetes and use of insulin as the most important predictor for the development of DR, while cholesterol‐lowering medicine was a protective factor.

Diabetic retinopathy among the elderly with type 2 diabetes: A Nationwide longitudinal registry study

“…In contrast, a recent nationwide registry-based study from Denmark with a similar cohort size, n = 153 238, median age 60 years, reported a prevalence rate of 8.8%. The shorter duration of diabetes in the Danish cohort may have contributed to the lower prevalence compared to our study (Grauslund et al, 2023). Data from populationbased studies report slightly lower DR prevalence rates than the present study.…”

Bariatric surgery in individuals with type 2 diabetes is not associated with short or long-term risk of diabetic retinopathy progression: results from a nationwide cohort study

“…Previous studies disagree on the role of pre-surgical HbA1c levels in regards to DR progression; with one study showing that a higher baseline HbA1c with a significant post-surgical drop increased the risk of DR progression [ 17 ], another study did not find an association [ 18 ]. The rates of DR worsening were also lower than seen amongst the general screening population of patients with type 2 diabetes in the Danish screening program [ 19 ] suggesting that patients eligible for bariatric surgery are following the pre-surgical guidelines promoting good pre-surgical glycemic stability, weightloss and lifestyle changes, amongst other initiatives, all intended to ensure optimal results of surgery [ 20 ]. Another reason for good glycemic stability, and generally acceptable biochemical measurements amongst our population as a whole, might be the effectiveness of the screening program itself alongside other healthcare appointments at the patients primary care physician; discovering tendencies towards worsening in DR or irregularities in systemic examinations and bloodwork, thus being able to induct initiatives to improve glycemic stability, and in turn halt further progression.…”

Present and future screening programs for diabetic retinopathy: a narrative review

“…We identified 11 population-based studies that investigated the incidence of PDR over various follow-up periods of four [8,[16][17][18], five [11,[19][20][21][22], nine [23], ten [10] and 25 years [24]. Among these studies, three focused on patients with type 1 diabetes [8,10,24], five on patients with type 2 diabetes [11,16,18,20,23], while four studies encompassed populations that comprised patients with both type 1 and 2 diabetes [17,19,21,22]. The incidences of PDR are displayed in Fig.…”

“…A Danish cohort study of patients with type 2 diabetes who attended the Danish screening program for DR showed a 5 year incidence of 3.8% for DR [ 11 ] compared to 4% in a study from United Kingdom (UK) [ 12 ]. A group from India reported a 4 year incidence of 9.2% [ 13 ], while studies of older date from Hong Kong [ 14 ], Australia [ 15 ] and USA [ 16 ] reported substantially higher 5 year incidences of 15.2, 22.2 and 38.6%, respectively.…”