Brazionis L, Jenkins A, Keech A, Ryan C, Brown A, Boffa J, Bursell S
Department of Medicine, University of Melbourne, Melbourne, Australia.
National Health and Medical Research Council of Australia Clinical Trials Centre, University of Sydney, Sydney, Australia.
Diabet Med. 2018 May;35(5):630-639. doi: 10.1111/dme.13596. Epub 2018 Feb 27.
To determine diabetic retinopathy prevalence and severity among remote Indigenous Australians.
A cross-sectional diabetic retinopathy screening study of Indigenous adults with Type 2 diabetes was conducted by locally trained non-ophthalmic retinal imagers in a remote Aboriginal community-controlled primary healthcare clinic in Central Australia and certified non-ophthalmic graders in a retinal grading centre in Melbourne, Australia. The main outcome measure was prevalence of any diabetic retinopathy and sight-threatening diabetic retinopathy.
Among 301 participants (33% male), gradable image rates were 78.7% (n = 237) for diabetic retinopathy and 83.1% (n = 250) for diabetic macular oedema, and 77.7% (n = 234) were gradable for both diabetic retinopathy and diabetic macular oedema. For the gradable subset, the median (range) age was 48 (19-86) years and known diabetes duration 9.0 (0-24) years. The prevalence of diabetic retinopathy was 47% (n = 110) and for diabetic macular oedema it was 14.4% (n = 36). In the fully gradable imaging studies, sight-threatening diabetic retinopathy prevalence was 16.2% (n = 38): 14.1% (n = 33) for clinically significant macular oedema, 1.3% (n = 3) for proliferative diabetic retinopathy and 0.9% (n = 2) for both. Sight-threatening diabetic retinopathy had been treated in 78% of detected cases.
A novel telemedicine diabetic retinopathy screening service detected a higher prevalence of 'any' diabetic retinopathy and sight-threatening diabetic retinopathy in a remote primary care setting than reported in earlier surveys among Indigenous and non-Indigenous populations. Whether the observed high prevalence of diabetic retinopathy was attributable to greater detection, increasing diabetic retinopathy prevalence, local factors, or a combination of these requires further investigation and, potentially, specific primary care guidelines for diabetic retinopathy management in remote Australia. Clinical Trials registration number: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN 12616000370404.
确定澳大利亚偏远地区原住民糖尿病视网膜病变的患病率及严重程度。
由当地培训的非眼科视网膜成像人员在澳大利亚中部一个偏远的原住民社区控制的初级医疗诊所，以及澳大利亚墨尔本一家视网膜分级中心经认证的非眼科分级人员，对患有2型糖尿病的原住民成年人进行糖尿病视网膜病变横断面筛查研究。主要观察指标为任何糖尿病视网膜病变和威胁视力的糖尿病视网膜病变患病率。
在301名参与者中（33%为男性），糖尿病视网膜病变的可分级图像率为78.7%（n = 237），糖尿病黄斑水肿的可分级图像率为83.1%（n = 250），糖尿病视网膜病变和糖尿病黄斑水肿两者均可分级的为77.7%（n = 234）。对于可分级亚组，年龄中位数（范围）为48（19 - 86）岁，已知糖尿病病程为9.0（0 - 24）年。糖尿病视网膜病变患病率为47%（n = 110），糖尿病黄斑水肿患病率为14.4%（n = 36）。在完全可分级的成像研究中，威胁视力的糖尿病视网膜病变患病率为16.2%（n = 38）：临床显著性黄斑水肿为14.1%（n = 33），增殖性糖尿病视网膜病变为1.3%（n = 3），两者皆有为0.9%（n = 2）。在检测出的病例中，78%的威胁视力的糖尿病视网膜病变已得到治疗。
一项新型远程医疗糖尿病视网膜病变筛查服务在偏远初级医疗环境中检测到的“任何”糖尿病视网膜病变和威胁视力的糖尿病视网膜病变患病率高于早期针对原住民和非原住民人群的调查所报告的患病率。观察到的糖尿病视网膜病变高患病率是归因于检测率提高、糖尿病视网膜病变患病率上升、当地因素还是这些因素的综合作用，需要进一步调查，并且可能需要针对澳大利亚偏远地区糖尿病视网膜病变管理制定特定的初级医疗指南。临床试验注册号：澳大利亚和新西兰临床试验注册中心（ANZCTR）：ACTRN 12616000370404。
