Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan; Department of Diabetes and Endocrinology, Toranomon Hospital Kajigaya, Kanagawa, Japan.
Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan.
Mayo Clin Proc. 2021 Feb;96(2):322-331. doi: 10.1016/j.mayocp.2020.07.031.
To assess whether vision-threatening retinopathy developed after 4 years in patients with type 2 diabetes with good glycemic control during follow-up.
Using data from the Action to Control Cardiovascular Risk in Diabetes and Action to Control Cardiovascular Risk in Diabetes Follow-on studies (conducted from January 1, 2001, to October 14, 2014), we investigated the incidence of vision-threatening retinopathy after 4 years in patients with type 2 diabetes with good or poor glycemic control. Patients with proliferative diabetic retinopathy at baseline were excluded. Vision-threatening retinopathy was defined as severe nonproliferative diabetic retinopathy, proliferative diabetic retinopathy, laser photocoagulation, or vitrectomy. Good and poor glycemic control was defined as mean glycated hemoglobin level less than 7% and 7% or greater during follow-up, respectively.
This study included 2285 patients. Among patients with no retinopathy at baseline, the 4-year incidence of vision-threatening retinopathy was 0% (0 of 386) and 0.8% (6 of 721) in those with good and poor glycemic control, respectively (P=.54). Similarly, severe retinopathy was not observed at 8 years in patients who did not have retinopathy at 4 years. Among patients with mild to moderate nonproliferative diabetic retinopathy at baseline, the 4-year incidence of vision-threatening retinopathy was significantly higher in those with poor glycemic control than in those with good glycemic control (9.7% [77 of 790] vs 4.4% [13 of 297]; P=.004). Additionally, the remission rate of diabetic retinopathy was low in patients with a long duration of diabetes. Four-year incidences of vision-threatening retinopathy were higher in patients with retinopathy at baseline who had poorer glycemic control and longer durations of diabetes.
It may be safe to extend screening intervals for diabetic retinopathy to 4 years or longer in patients with type 2 diabetes with no retinopathy.
评估在随访期间血糖控制良好的 2 型糖尿病患者，4 年后是否会发生威胁视力的视网膜病变。
利用来自心血管风险行动控制糖尿病（ACTION TO CONTROL CARDIOVASCULAR RISK IN DIABETES）和心血管风险行动控制糖尿病随访研究（ACTION TO CONTROL CARDIOVASCULAR RISK IN DIABETES FOLLOW-UP STUDY）的数据（这些研究从 2001 年 1 月 1 日至 2014 年 10 月 14 日进行），我们调查了血糖控制良好或不佳的 2 型糖尿病患者在 4 年后发生威胁视力的视网膜病变的发生率。基线时患有增殖性糖尿病视网膜病变的患者被排除在外。威胁视力的视网膜病变定义为严重非增殖性糖尿病视网膜病变、增殖性糖尿病视网膜病变、激光光凝或玻璃体切除术。良好和不佳的血糖控制分别定义为随访期间平均糖化血红蛋白水平＜7%和≥7%。
本研究共纳入 2285 例患者。在基线时无视网膜病变的患者中，分别有 0%（386 例中 0 例）和 0.8%（721 例中 6 例）的患者在血糖控制良好和不佳的情况下发生威胁视力的视网膜病变，差异无统计学意义（P=0.54）。同样，在 4 年内未发生视网膜病变的患者中，8 年内也未观察到严重视网膜病变。在基线时患有轻度至中度非增殖性糖尿病视网膜病变的患者中，血糖控制不佳的患者发生威胁视力的视网膜病变的 4 年发生率显著高于血糖控制良好的患者（9.7%[77/790] vs. 4.4%[13/297]；P=0.004）。此外，糖尿病视网膜病变的缓解率在糖尿病病程较长的患者中较低。在基线时患有视网膜病变且血糖控制较差和糖尿病病程较长的患者中，4 年内发生威胁视力的视网膜病变的发生率较高。
对于无视网膜病变的 2 型糖尿病患者，将糖尿病视网膜病变的筛查间隔延长至 4 年或更长时间可能是安全的。
