Statistical Considerations for Meta-analysis of Diabetic Retinopathy Prevalence

Zhou, Shouhao; Shen, Chan

doi:10.1001/jamaophthalmol.2022.3470

Cited by 3 publications

(9 citation statements)

References 8 publications

(16 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…32,33 To verify the results of the Freeman-Tukey double arcsine analysis and to control for sampling error and bias, an exploratory analysis was also conducted using the random intercept mixed-effects logistic regression model, recognizing that the model does not account for study weights. 34 In addition to 95% CIs, we also estimated 95% prediction intervals (PIs) to assess the possible range of new values in the present study. 35 Both inconsistency index (I 2 statistic) and χ 2 P values were used to quantify heterogeneity.…”

Section: Discussionmentioning

confidence: 99%

“…The primary outcome was the global pooled prevalence (with 95% CI) of DR. We conducted the meta-analysis with prevalence estimates transformed using the Freeman-Tukey double arcsine method to prevent the need to stabilize variances because some studies reported prevalence rates of 0%, and we transformed the results back to prevalence estimates for interpretation . To verify the results of the Freeman-Tukey double arcsine analysis and to control for sampling error and bias, an exploratory analysis was also conducted using the random intercept mixed-effects logistic regression model, recognizing that the model does not account for study weights . In addition to 95% CIs, we also estimated 95% prediction intervals (PIs) to assess the possible range of new values in the present study .…”

Section: Methodsmentioning

confidence: 99%

“…In addition, the small number of DR cases in the included studies can have implications for the reliability of the variance and pooled estimates. 34 For this reason, we used the Freeman-Tukey double arcsine transformation 99,100 to stabilize variance in our meta-analysis. We also conducted a generalized linear mixed analysis for each outcome to assess the robustness of the results 99,100 (eTable 11 in Supplement 1).…”

Section: Limitationsmentioning

confidence: 99%

See 2 more Smart Citations

Global Prevalence of Diabetic Retinopathy in Pediatric Type 2 Diabetes

et al. 2023

View full text Add to dashboard Cite

ImportanceType 2 diabetes (T2D) is increasing globally. Diabetic retinopathy (DR) is a leading cause of blindness in adults with T2D; however, the global burden of DR in pediatric T2D is unknown. This knowledge can inform retinopathy screening and treatments to preserve vision in this population.ObjectiveTo estimate the global prevalence of DR in pediatric T2D.Data SourcesMEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, the Web of Science, and the gray literature (ie, literature containing information that is not available through traditional publishing and distribution channels) were searched for relevant records from the date of database inception to April 4, 2021, with updated searches conducted on May 17, 2022. Searches were limited to human studies. No language restrictions were applied. Search terms included diabetic retinopathy; diabetes mellitus, type 2; prevalence studies; and child, adolescent, teenage, youth, and pediatric.Study SelectionThree teams, each with 2 reviewers, independently screened for observational studies with 10 or more participants that reported the prevalence of DR. Among 1989 screened articles, 27 studies met the inclusion criteria for the pooled analysis.Data Extraction and SynthesisThis systematic review and meta-analysis followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines for systematic reviews and meta-analyses. Two independent reviewers performed the risk of bias and level of evidence analyses. The results were pooled using a random-effects model, and heterogeneity was reported using χ2 and I2 statistics.Main Outcomes and MeasuresThe main outcome was the estimated pooled global prevalence of DR in pediatric T2D. Other outcomes included DR severity and current DR assessment methods. The association of diabetes duration, sex, race, age, and obesity with DR prevalence was also assessed.ResultsAmong the 27 studies included in the pooled analysis (5924 unique patients; age range at T2D diagnosis, 6.5-21.0 years), the global prevalence of DR in pediatric T2D was 6.99% (95% CI, 3.75%-11.00%; I2 = 95%; 615 patients). Fundoscopy was less sensitive than 7-field stereoscopic fundus photography in detecting retinopathy (0.47% [95% CI, 0%-3.30%; I2 = 0%] vs 13.55% [95% CI, 5.43%-24.29%; I2 = 92%]). The prevalence of DR increased over time and was 1.11% (95% CI, 0.04%-3.06%; I2 = 5%) at less than 2.5 years after T2D diagnosis, 9.04% (95% CI, 2.24%-19.55%; I2 = 88%) at 2.5 to 5.0 years after T2D diagnosis, and 28.14% (95% CI, 12.84%-46.45%; I2 = 96%) at more than 5 years after T2D diagnosis. The prevalence of DR increased with age, and no differences were noted based on sex, race, or obesity. Heterogeneity was high among studies.Conclusions and RelevanceIn this study, DR prevalence in pediatric T2D increased significantly at more than 5 years after diagnosis. These findings suggest that retinal microvasculature is an early target of T2D in children and adolescents, and annual screening with fundus photography beginning at diagnosis offers the best assessment method for early detection of DR in pediatric patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

See 1 more Smart Citation

Global Prevalence of Diabetic Retinopathy in Pediatric Type 2 Diabetes

et al. 2023

View full text Add to dashboard Cite

show abstract

“…The IRIS Registry data collection methods have been described previously. 2 We used a database version frozen on December 20, 2021, and accessed on March 30, 2022.…”

Section: Conflict Of Interest Disclosures: Dr Lim Reported Grants Fro...mentioning

confidence: 99%

“…4 Therefore, as an exercise, we have repeated our meta-analyses using GLMM methods and present the outcomes from both the (published) FTT and GLMM methods with the inclusion of prediction intervals, as suggested by Zhou and Shen. 2 Methods | Detailed methodology around study selection and statistical methods has been described in our original article. 1 In addition, here, the Stata IC (Stata Corp) version 15.1 additional module command metapreg 5 was used to construct random intercept logistic regression models (a relevant GLMM, as described by Stijnen et al 6 ) for the metaanalytic outcomes of interest published previously.…”

mentioning

confidence: 99%

Global Estimates of Diabetic Retinopathy Prevalence and Progression in Pregnant Individuals With Preexisting Diabetes: A Meta-analysis

Widyaputri

Rogers

2022

JAMA Ophthalmol

View full text Add to dashboard Cite

show abstract

Jin-Gui-Shen-Qi Wan ameliorates diabetic retinopathy by inhibiting apoptosis of retinal ganglion cells through the Akt/HIF-1α pathway

Liang,

Qi,

Liu

et al. 2023

Chin Med

View full text Add to dashboard Cite

Background Jin-Gui-Shen-Qi Wan (JGSQ) has been used in China for thousands of years to treat various ailments, including frequent urination, blurred vision, and soreness in the waist and knees. It has traditional therapeutic advantages in improving eye diseases. Aim of the study Clinical studies have confirmed the therapeutic efficacy of JGSQ in improving diabetes and vision; however, its efficacy and pharmacological effects in treating diabetic retinopathy (DR) remain unclear. Therefore, the aim of this study was to investigate the specific pharmacological effects and potential mechanisms of JGSQ in improving DR through a db/db model. Materials and methods db/db mice were given three different doses of orally administered JGSQ and metformin for 8 weeks, and then PAS staining of the retinal vascular network patch, transmission electron microscopy, H&E staining, and TUNEL staining were performed to determine the potential role of JGSQ in improving DR-induced neuronal cell apoptosis. Furthermore, network pharmacology analysis and molecular docking were carried out to identify the main potential targets of JGSQ, and the efficacy of JGSQ in improving DR was evaluated through western blotting and immunofluorescence staining, revealing its mechanism of action. Results According to the results from H&E, TUNEL, and PAS staining of the retinal vascular network patch and transmission electron microscopy, JGSQ does not have an advantage in improving the abnormal morphology of vascular endothelial cells, but it has a significant effect on protecting retinal ganglion cells from apoptosis. Through network pharmacology and molecular docking, AKT, GAPDH, TNF, TP53, and IL-6 were identified as the main core targets of JGSQ. Subsequently, through western blot and immunofluorescence staining, it was found that JGSQ can inhibit HIF-1α, promote p-AKT expression, and inhibit TP53 expression. At the same time, inhibiting the release of inflammatory factors protects retinal ganglion cells and improves apoptosis in DR. Conclusion These results indicated that in the db/db DR mouse model, JGSQ can inhibit the expression of inflammatory cytokines and protect retinal ganglion cells from apoptosis, possibly by modulating the Akt/HIF-1α pathway. Graphical Abstract

show abstract

Statistical Considerations for Meta-analysis of Diabetic Retinopathy Prevalence

Cited by 3 publications

References 8 publications

Global Prevalence of Diabetic Retinopathy in Pediatric Type 2 Diabetes

Global Prevalence of Diabetic Retinopathy in Pediatric Type 2 Diabetes

Global Estimates of Diabetic Retinopathy Prevalence and Progression in Pregnant Individuals With Preexisting Diabetes: A Meta-analysis

Jin-Gui-Shen-Qi Wan ameliorates diabetic retinopathy by inhibiting apoptosis of retinal ganglion cells through the Akt/HIF-1α pathway

Contact Info

Product

Resources

About