VA St. Louis Healthcare System, USA.
VA St. Louis Healthcare System, USA; Washington University in St. Louis School of Medicine, USA.
Comput Biol Med. 2014 Apr;47:7-12. doi: 10.1016/j.compbiomed.2014.01.007. Epub 2014 Jan 21.
To examine the effect of changes to screening interval on the incidence of vision loss in a simulated cohort of Veterans with diabetic retinopathy (DR). This simulation allows us to examine potential interventions without putting patients at risk.
Simulated randomized controlled trial. We develop a hybrid agent-based/discrete event simulation which incorporates a population of simulated Veterans--using abstracted data from a retrospective cohort of real-world diabetic Veterans--with a discrete event simulation (DES) eye clinic at which it seeks treatment for DR. We compare vision loss under varying screening policies, in a simulated population of 5000 Veterans over 50 independent ten-year simulation runs for each group.
Diabetic Retinopathy associated vision loss increased as the screening interval was extended from one to five years (p<0.0001). This increase was concentrated in the third year of the screening interval (p<0.01). There was no increase in vision loss associated with increasing the screening interval from one year to two years (p=0.98).
Increasing the screening interval for diabetic patients who have not yet developed diabetic retinopathy from 1 to 2 years appears safe, while increasing the interval to 3 years heightens risk for vision loss.
研究在糖尿病视网膜病变（DR）模拟队列中改变筛查间隔对视力丧失发生率的影响。这种模拟使我们能够在不使患者面临风险的情况下检查潜在的干预措施。
模拟随机对照试验。我们开发了一种混合基于代理的/离散事件模拟，该模拟使用从现实世界糖尿病退伍军人回顾性队列中提取的数据来模拟一群模拟退伍军人，并在一个离散事件模拟（DES）眼科诊所中为他们治疗 DR。我们在 5000 名退伍军人的模拟人群中，在 50 个独立的十年模拟运行中，对不同的筛查政策下的视力丧失进行了比较。
随着筛查间隔从一年延长至五年，与糖尿病视网膜病变相关的视力丧失增加（p<0.0001）。这种增加主要集中在筛查间隔的第三年（p<0.01）。将筛查间隔从一年延长至两年不会增加与视力丧失相关的风险（p=0.98）。
对于尚未发生糖尿病视网膜病变的糖尿病患者，将筛查间隔从 1 年延长至 2 年似乎是安全的，而将间隔延长至 3 年则会增加视力丧失的风险。
