Department of Medicine, Division of Nephrology, Toronto General Hospital, University of Toronto, Toronto, ON; Temerty Faculty of Medicine, University of Toronto, Toronto, ON.
Department of Ophthalmology and Vision Sciences, Department of Medicine, University of Toronto, Toronto, ON; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON.
Can J Ophthalmol. 2024 Jun;59(3):e245-e251. doi: 10.1016/j.jcjo.2023.02.014. Epub 2023 Apr 3.
To characterize patients referred for diabetic retinopathy (DR) screening in a unique multidisciplinary diabetes care clinic at a tertiary care centre.
A retrospective study was conducted involving patients who were referred to the Cardiac and Renal Endocrine Clinic at a tertiary care centre (University Health Network) for DR screening between April 2019-March 2020 and November 2020-August 2021. Patients' demographics; micro- and macrovascular disease measurements; visual acuity, intraocular pressure, fundus imaging, and optical coherence tomography results were collected and analyzed.
Of the 64 patients who attended the clinic, 21 patients (33%) with type 2 diabetes had on-site DR screening. The remaining 43 patients had DR screening within 6 months of the appointment or were under ophthalmology care with annual screening visits elsewhere. Of the 21 patients who underwent retinopathy screening, 7 patients (33%) had DR: 4 had mild nonproliferative DR, 2 had moderate nonproliferative DR, 1 had proliferative DR, and 1 had macular edema. Patients with DR had a significantly longer diabetes duration than patients without DR (24.5 ± 10.2 years vs 12.5 ± 5.8 years; p = 0.0247). No significant differences were observed in glycemic control, blood pressure, lipid profiles, kidney function, visual acuity, or intraocular pressure.
Our analysis suggests a potential benefit of integrated DR screening in patients with long-standing diabetes as part of a multidisciplinary diabetes care clinic to diagnose and manage DR. Future work is needed to further develop such clinics and investigate their long-term effect on patient outcomes.
描述在一家三级保健中心的独特多学科糖尿病护理诊所中，因糖尿病视网膜病变（DR）而被转诊的患者的特征。
本回顾性研究纳入了 2019 年 4 月至 2020 年 3 月和 2020 年 11 月至 2021 年 8 月期间在一家三级保健中心（多伦多大学健康网络）的心脏和肾脏内分泌科就诊，进行 DR 筛查的患者。收集并分析了患者的人口统计学特征、微血管和大血管疾病测量、视力、眼压、眼底成像和光学相干断层扫描结果。
在参加该诊所的 64 名患者中，有 21 名（33%）2 型糖尿病患者进行了现场 DR 筛查。其余 43 名患者在预约后 6 个月内进行了 DR 筛查，或正在接受眼科护理，每年在其他地方进行筛查。在接受视网膜病变筛查的 21 名患者中，有 7 名（33%）患有 DR：4 名患有轻度非增殖性 DR，2 名患有中度非增殖性 DR，1 名患有增殖性 DR，1 名患有黄斑水肿。患有 DR 的患者的糖尿病病程明显长于未患有 DR 的患者（24.5±10.2 年比 12.5±5.8 年；p=0.0247）。两组患者的血糖控制、血压、血脂谱、肾功能、视力或眼压均无显著差异。
我们的分析表明，在患有长期糖尿病的患者中，作为多学科糖尿病护理诊所的一部分，进行综合的 DR 筛查可能具有潜在益处，以诊断和管理 DR。需要进一步开展相关工作，以进一步开发此类诊所，并研究其对患者结局的长期影响。
