Diabetes Research Unit, Centre for Endocrine and Diabetes Sciences, University Hospital of Wales, Cardiff CF14 4XW, UK.
BMJ. 2012 Feb 22;344:e874. doi: 10.1136/bmj.e874.
To determine the incidence of any and referable diabetic retinopathy in people with type 2 diabetes mellitus attending an annual screening service for retinopathy and whose first screening episode indicated no evidence of retinopathy.
Retrospective four year analysis.
Screenings at the community based Diabetic Retinopathy Screening Service for Wales, United Kingdom.
57,199 people with type 2 diabetes mellitus, who were diagnosed at age 30 years or older and who had no evidence of diabetic retinopathy at their first screening event between 2005 and 2009. 49,763 (87%) had at least one further screening event within the study period and were included in the analysis.
Annual incidence and cumulative incidence after four years of any and referable diabetic retinopathy. Relations between available putative risk factors and the onset and progression of retinopathy.
Cumulative incidence of any and referable retinopathy at four years was 360.27 and 11.64 per 1000 people, respectively. From the first to fourth year, the annual incidence of any retinopathy fell from 124.94 to 66.59 per 1000 people, compared with referable retinopathy, which increased slightly from 2.02 to 3.54 per 1000 people. Incidence of referable retinopathy was independently associated with known duration of diabetes, age at diagnosis, and use of insulin treatment. For participants needing insulin treatment with a duration of diabetes of 10 years or more, cumulative incidence of referable retinopathy at one and four years was 9.61 and 30.99 per 1000 people, respectively.
Our analysis supports the extension of the screening interval for people with type 2 diabetes mellitus beyond the currently recommended 12 months, with the possible exception of those with diabetes duration of 10 years or more and on insulin treatment.
确定在参加年度视网膜病变筛查服务且首次筛查无视网膜病变证据的 2 型糖尿病患者中，任何和可引致视力丧失的糖尿病视网膜病变的发病率。
四年回顾性分析。
英国威尔士社区为糖尿病患者提供的视网膜病变筛查服务处。
57199 名 2 型糖尿病患者，他们在 30 岁或以上被确诊，且在 2005 年至 2009 年间的首次筛查中没有任何糖尿病视网膜病变的证据。49763 人（87%）在研究期间至少进行了一次进一步的筛查，被纳入分析。
任何和可引致视力丧失的糖尿病视网膜病变的年度发病率和四年后的累积发病率。分析可获得的潜在危险因素与视网膜病变的发生和进展之间的关系。
四年后任何和可引致视力丧失的糖尿病视网膜病变的累积发病率分别为 360.27 和 11.64/1000 人。从第一年到第四年，任何糖尿病视网膜病变的年发病率从 124.94 降至 66.59/1000 人，而可引致视力丧失的糖尿病视网膜病变略有上升，从 2.02 升至 3.54/1000 人。可引致视力丧失的糖尿病视网膜病变的发病率与已知的糖尿病病程、诊断时的年龄和胰岛素治疗的使用独立相关。对于需要胰岛素治疗且糖尿病病程为 10 年或以上的患者，一年和四年时的可引致视力丧失的糖尿病视网膜病变的累积发病率分别为 9.61 和 30.99/1000 人。
我们的分析支持将 2 型糖尿病患者的筛查间隔延长至目前建议的 12 个月以上，可能除外病程 10 年或以上且正在接受胰岛素治疗的患者。
