Sauesund Ellen Steffenssen, Jørstad Øystein Kalsnes, Brunborg Cathrine, Moe Morten Carstens, Erke Maja Gran, Fosmark Dag Sigurd, Petrovski Goran
Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway.
Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway.
Biomedicines. 2023 Apr 19;11(4):1222. doi: 10.3390/biomedicines11041222.
to gain insight into the baseline parameters of a population with diabetes mellitus (DM) included in a pilot diabetic retinopathy (DR) screening program at Oslo University Hospital (OUH), Norway.
This was a cross-sectional study of a cohort of adult patients (≥18 years) with type 1 or 2 DM (T1D and T2D). We measured the best-corrected visual acuity (BCVA), blood pressure (BP), heart rate (HR), intraocular pressure (IOP), height and weight. We also collected HbA1c, total serum cholesterol and urine-albumin, -creatinine and -albumin-to-creatinine ratio (ACR), as well as socio-demographic parameters, medications and previous screening history. We obtained color fundus photographs, which were graded by two experienced ophthalmologists according to the International Clinical Disease Severity Scale for DR.
The study included 180 eyes of 90 patients: 12 patients (13.3%) had T1D and 78 (86.7%) had T2D. In the T1D group, 5 patients (41.7%) had no DR, and 7 (58.3%) had some degree of DR. In the T2D group, 60 patients (76.9%) had no DR, and 18 (23.1%) had some degree of DR. None of the patients had proliferative DR. Of the 43 patients not newly diagnosed (time of diagnosis > 5 years for T1D and >1 years for T2D), 37.5% of the T1D patients and 5.7% of the T2D patients had previously undergone regular screening. Univariate analyses found for the whole cohort significant associations between DR and age, HbA1c, urine albumin-to-creatinine ratio, body mass index (BMI) and duration of DM. For the T2D group alone, there were significant associations between DR and HbA1c, BMI, urine creatinine, urine albumin-to-creatinine ratio and duration of DM. The analysis also showed three times higher odds for DR in the T1D group than the T2D group.
This study underscores the need for implementing a systematic DR screening program in the Oslo region, Norway, to better reach out to patients with DM and improve their screening adherence. Timely and proper treatment can prevent or mitigate vision loss and improve the prognosis. A considerable number of patients were referred from general practitioners for not being followed by an ophthalmologist.Among patients not newly diagnosed with DM, 62.8% had never had an eye exam, and the duration of DM for these patients was up to 18 years (median: 8 years).
深入了解挪威奥斯陆大学医院（OUH）一项糖尿病视网膜病变（DR）筛查试点项目中糖尿病（DM）患者的基线参数。
这是一项对1型或2型糖尿病（T1D和T2D）成年患者（≥18岁）队列的横断面研究。我们测量了最佳矫正视力（BCVA）、血压（BP）、心率（HR）、眼压（IOP）、身高和体重。我们还收集了糖化血红蛋白（HbA1c）、总血清胆固醇以及尿白蛋白、肌酐和白蛋白与肌酐比值（ACR），以及社会人口统计学参数、用药情况和既往筛查史。我们获取了彩色眼底照片，由两位经验丰富的眼科医生根据DR的国际临床疾病严重程度量表进行分级。
该研究纳入了90例患者的180只眼：12例患者（13.3%）患有T1D，78例（86.7%）患有T2D。在T1D组中，5例患者（41.7%）无DR，7例（58.3%）有一定程度的DR。在T2D组中，60例患者（76.9%）无DR，18例（23.1%）有一定程度的DR。所有患者均无增殖性DR。在43例非新诊断患者中（T1D诊断时间＞5年，T2D诊断时间＞1年），37.5%的T1D患者和5.7%的T2D患者此前接受过定期筛查。单因素分析发现，对于整个队列，DR与年龄、HbA1c、尿白蛋白与肌酐比值、体重指数（BMI）和糖尿病病程之间存在显著关联。仅对于T2D组，DR与HbA1c、BMI、尿肌酐、尿白蛋白与肌酐比值和糖尿病病程之间存在显著关联。分析还显示，T1D组患DR的几率是T2D组的三倍。
本研究强调在挪威奥斯陆地区实施系统性DR筛查项目的必要性，以便更好地覆盖糖尿病患者并提高他们的筛查依从性。及时、恰当的治疗可以预防或减轻视力丧失并改善预后。相当一部分患者是由全科医生转诊而来，因为他们未接受眼科医生的随访。在非新诊断的糖尿病患者中，62.8%从未进行过眼科检查，这些患者的糖尿病病程长达18年（中位数：8年）。
