A community-based follow-up study on diabetic retinopathy among type 2 diabetics in Kinmen

The purpose of this follow-up study was conducted to assess the incidence and risk factors of diabetic retinopathy (DR) among type 2 diabetics in Kinmen, Taiwan. A penal of eye screening regimes were performed yearly for 971 type 2 diabetics by two senior ophthalmologists using indirect ophthalmoscopy and 45-degree color fundus photography to examine fundus after dilating pupils from 1999 to 2002. 74.7% (725/971) of diabetics had been screened at least two times during this period. Among the 548 type 2 diabetics who had no DR at first screening, 93 subjects developed any type of DR. The 3-year cumulative incidence was 18.2% (95% CI 14.8–21.5%) and incidence density was 6.62% per year (95% CI: 5.36–8.06% per year). Using Cox regression model, HbA1c revealed the significantly dose–response relationship to the development of DR (X²-test for trend = 9.41, p < 0.05) after controlling for confounding factors. Other independent predictors related to the development of DR included duration of diabetes (RR: 1.09, 95% CI: 1.05–1.13), higher systolic blood pressure ( 140 vs. < 140 mm Hg, RR: 1.96, 95% CI: 1.23–3.12), and higher triglyceride ( 200 vs. < 200 mg/dl, RR: 1.60, 95% CI: 1.01–2.54). In conclusion, in addition to poor glycemic control of which is the most significant risk factor for the development of DR, longer duration of diabetes, higher systolic blood pressure, and elevated serum triglyceride levels were also associated with the development of DR among type 2 diabetics in Kinmen.     

A community-based study of the willingness to pay associated with screening for diabetic retinopathy among type 2 diabetes in Kinmen, Taiwan

BACKGROUND: In Taiwan, there were few population-based studies of WTP values related to DR screening among persons with type 2 diabetes. This community-based study was to explore the willingness- to-pay (WTP) values for screening for diabetic retinopathy (DR) associated with varying degrees of DR among persons with type 2 diabetes in Kinmen, Taiwan. METHODS: A total of 725 eligible community-dwelling adults diagnosed with type 2 diabetes received DR screening during 1999-2002 and then evaluated WTP values in 2003. Diagnosis of DR was performed by a panel of ophthalmologists using ophthalmoscopy and a 45-degree color retinal photographs to examine fundus after dilating pupils. WTP values were measured by discrete-choice method. RESULTS: The 406 adults with type 2 diabetes participating in the WTP survey had a 56% response rate. Of 406 subjects, 265 (65.3%) said they would be willing to pay for DR screening to reduce blindness. The overall mean WTP value was New Taiwan Dollars 468.9 +/- 327.7 (US dollars 14.3 +/- 10.0). Age was borderline significant (p=0.07) related to WTP values. Those with severe stage DR had higher WTP values for screening than subjects with mild stage. CONCLUSIONS: Degree of DR was the independent factor affecting WTP values in DR screening among community-dwelling adults with type 2 diabetes.     

Community-based study of cataracts among type 2 diabetics in Kinmen

The purpose of this study was to assess the prevalence and risk factors of each type of cataract among type 2 diabetics in Kinmen, Taiwan. There were 971 type 2 diabetics ascertained from a community-based mass screening between 1991 and 1993. In 1999, a total of 578 (59.5%) patients with type 2 diabetes were examined with an eye screening performed by two senior ophthalmologists using a 45-degree thin slit-lamp biomicroscopy and ophthalmoscopy to examine the lens after dilating the pupils. The overall prevalence, including subjects with or without surgery, was 31.0% (179/578, 95% CI: 27.3–34.7%), and had a statistically significant difference for gender (χ²=8.78, p = 0.003) and age (χ²-trend = 11.89, p < 0.0001). Based on multiple logistic regression, the significant risk factors of all types of cataracts were age (OR = 1.16, 95% CI: 1.12–1.20), lower diastolic blood pressure (DBP) at baseline (OR = 0.47, 95% CI: 0.25–0.88), and higher triglyceride at baseline (OR = 2.19, 95% CI: 1.07–4.45). In conclusion, our results found that in addition to age, lower DBP and higher triglyceride at baseline may increase the risk of prevalent cataracts in type 2 diabetics.     

Evaluation of a population-based screening for type 2 diabetes: a community-based screening project in Puli, Taiwan

BACKGROUND: A Markov method incorporating the relationships between prevalence, incidence, and mortality with respect to type 2 diabetes was used to assess a population-based screening for this disease. METHODS: Data from a population-based screening project for residents of Puli, Taiwan, over 30 years of age (n= 1,219) were used to estimate the annual incidence of asymptomatic type 2 diabetes, the prevalence to incidence (P/I) ratio, and the hazard rate of death due to type 2 diabetes. These parameters were employed to develop a Markov process to evaluate the effects of early detection of type 2 diabetes on the risk of death from this disease in a simulated population (n= 10,000) receiving biennial, 5-year interval, or no screening. RESULTS: The estimated annual incidence, average duration from asymptomatic to symptomatic type 2 diabetes (P/I ratio), and hazard rate for death from this disease were 0.86% (95% CI 0.50-1.48), 10 years (95% CI 7.69-14.01), and 1.1% per year, respectively. This yields an optimal screening interval of 5 years. Simulation of a 5-year interval screening regimen versus no screen ing yielded a relative risk reduction of 31% (95% CI 12-46%). A similar value was found for a biennial screening regime. CONCLUSIONS: The results suggest that early detection of type 2 diabetes via a community-based screening project in developing countries with high prevalence is worthwhile.     

上海市中心城区2型糖尿病患者视网膜病变现况调查

目的评价上海市中心城区成年人2型糖尿病患者糖尿病视网膜病变的患病率及相关因素。方法采用整群抽样方法选取上海市中心城区30岁以上已诊断为2型糖尿病的患者1039例，其中资料完整者767例纳入本研究。结果（1）767例患者完成1534张眼底摄片，其中不能分级者95例（12．4％），可以分级者672例（87．6％）；（2）非增殖期糖尿病视网膜病变145例，占可分级2型糖尿病患者的21．6％，其中轻度59例（8．8％）、中度75例（11．2％）、重度11例（1．6％），增殖期糖尿病视网膜病变9例（1．3％）；（3）糖尿病视网膜病变者较非病变者年龄更长，糖化血红蛋白、尿素氮和肌酐更高，逐步logistic回归分析显示糖尿病病程及空腹血糖水平为糖尿病视网膜病变的危险因素。结论上海市中心城区30岁以上已诊断2型糖尿病患者视网膜病变的现患率为22．9％，空腹血糖和糖尿病病程是影响因素。     

2型糖尿病视网膜病变影响因素的巢式病例对照研究

目的  探讨2型糖尿病患者中糖尿病视网膜病变(diabetic retinopathy, DR)的影响因素。方法  以2013-2014年“社区糖尿病综合干预及应用项目”淮安市35岁以上2型糖尿病人群队列为基础,对其开展问卷调查、身体测量,实验室检测,并将随访期间发生DR的1 544人作为病例组,按照性别,年龄(±4岁)随机抽取对照进行1∶1匹配,建立对照组(1 544人)。采用巢式病例对照研究方法,对糖化血红蛋白、糖尿病病程、SBP等DR的影响因素进行Logistic回归分析,计算OR及其95% CI。此外,使用多分类Logistic回归分析模型分析轻中度DR和重度DR的影响因素。结果  病例组平均年龄为(58.09±8.55)岁,对照组平均年龄为(58.15±8.50)岁,中位随访时间为6年。单因素Logistic回归分析显示胰岛素使用(OR=2.26, 95% CI: 1.75~2.92),高TG(OR=1.06, 95% CI: 1.02~1.11),腰臀比增加(0.1为变化量)(OR=1.28, 95% CI: 1.15~1.43),高糖化血红蛋白(OR=1.65, 95% CI: 1.57~1.73),SBP高(OR=1.01, 95% CI: 1.00~1.01),糖尿病病程长[5-10年vs. < 5年(OR=1.69, 95% CI: 1.42~2.01), ≥10年vs. < 5年(OR=2.38, 95% CI: 1.94~2.91)]是DR发生的危险因素。结论  胰岛素使用、TG、腰臀比、糖化血红蛋白、SBP和糖尿病病程是2型糖尿病患者发生DR的影响因素。应加强2型糖尿病病人的DR筛查力度。     

Costs of mobile screening for diabetic retinopathy: a practical framework for rural populations

ABSTRACT: Australia's rural and remote residents experience considerably higher hospitalisation and death rates due to diabetes than their metropolitan counterparts. There is clearly a need for improved diabetes care services in these areas and interventions that target conditions associated with diabetes will yield beneficial results for the community. All people with diabetes are at risk for diabetic retinopathy, which can cause vision loss and blindness. Although vision loss and blindness due to diabetes is nearly 100% preventable through regular eye examinations, 35% of Victoria's rural population with diabetes do not have their eyes examined on a regular basis. A pilot, mobile screening program for the early detection of diabetic eye disease was conducted in rural Victoria and proved to be a successful model of adjunct eye care for people with diabetes. Actual costs from the pilot screening were applied to a permanent model for rural eye care. At A$41 per participant, costs for mobile screening were competitive with Medicare rebate costs for eye examinations. The model addresses barriers of accessibility and availability, targets a portion of the rural population with diabetes that is not otherwise having eye examinations, and is cost-saving to the Government.     

Feasibility of screening for diabetic retinopathy using artificial intelligence,Brazil

ProblemThere is currently no national strategy or standardized approach to diabetic retinopathy screening in the Brazilian public health system, and multiple socioeconomic barriers prevent access to eye examination in Brazil’s poorest regions.ApproachFrom September 2021 to March 2022 we carried out a pilot project with an artificial intelligence system for diabetic retinopathy screening, embedded in a portable retinal camera. Patients with a diagnosis of diabetes according to the municipality registry were invited to attend nearby clinics for screening on designated days. Trained health-care technicians acquired images which were automatically evaluated by the system, with instant remote evaluation by retinal specialists in selected cases.Local settingOur study was based in Sergipe State, located at a region with high illiteracy rates and no local availability of specialized retina care. The average number of laser treatments performed annually in the last 5 years is 126, for a total State population of 2.3 million.Relevant changesEven though screening was performed free of charge in a convenient location for patients, from a total 2052 eligible individuals, only 1083 attended for screening.Lessons learntEfforts to raise awareness on the condition screened and to provide health education for patients and local health-care personnel are fundamental for increased attendance. Tailoring screening systems to the local setting, such as determining the trade-off between sensitivity and specificity, is challenging in regions with no current benchmarks. Standards for retinopathy screening based on the strategies adopted by high-income countries may not be realistic in low- and middle-income countries.     

Community-based study on summer-winter differences of component of metabolic syndrome in Kinmen, Taiwan

BACKGROUND: A community-based study was conducted to investigate summer-winter differences of component of metabolic syndrome in Kinmen, Taiwan. METHODS: A total of 8251 residents aged 40 and over were enrolled in the mass survey in Kinmen. They were investigated while on summer (July and August) and winter vacation (January and February) during 2000-2003. Demographics, physical examination findings, lifestyle variables and biochemical data were collected. RESULTS: After controlling for age, body mass index, diet, lifestyle and other risk factors for component of metabolic syndrome, there were independent and significant relationships between summer-winter difference and component of metabolic syndrome. Winter season was positively correlated with blood pressure, fasting plasma glucose level, high-density lipoprotein-cholesterol (HDL-C) and waist circumference, but was negatively associated with fasting triglycerides and metabolic syndrome. CONCLUSIONS: Summer season is positively associated with hypertriglyceridemia, low HDL-C and metabolic syndrome. These findings imply that cross-sectional, experimental and cohort studies of component of metabolic syndrome or metabolic syndrome should take season into account as possible confounding effects.     

社区2型糖尿病患者自我管理水平与糖尿病视网膜病变的相关性研究

目的探讨社区人群2型糖尿病(type 2 diabetes mellitus,T2DM)患者自我管理相关行为与糖尿病视网膜病变(diabetic retinopathy,DR)的关系。方法 2012年4—5月在苏州市金阊区随机抽取四个街道社区,招募社区T2DM患者,患者在签订知情同意书的前提下被纳入调查。由经过培训的调查员采用统一设计的调查表,收集并记录调查对象的人口统计学特征、生活行为方式、病程、家族史、DM微血管并发症等资料。正态分布资料用x珋±s表示,两组间的比较用t检验;非正态分布资料用中位数(四分位数间距)表示,两组间比较用Wilcoxon秩和检验;计数资料用率表示,两组间的比较用χ2检验。采用Logistic回归模型分析自我管理水平与DR的相关性。检验水准α=0.05,P0.05为差异有统计学意义。结果 887例患者中,有34.3%的患者HbA1c控制达标。有DR的T2DM患者比无DR的T2DM患者具有更长的病程[7(3~11)年vs.5(2~9)年]、更高的收缩压[(140.0±16.1)mm Hg(1mmHg=0.133kPa)vs(137.0±16.9)mm Hg]、更高的空腹血糖(8.01±2.73)mmol/L vs(7.57±2.30)mmol/L)和HbA1c水平[(7.84±1.40)%vs.(7.53±1.31)%]。多因素Logistic回归分析结果表明,与HbA1c未达标者相比,HbA1c达标者合并DR的危险性显著降低,其OR(95%CI)为0.63(0.44~0.91)。结论 HbA1c达标是T2DM患者合并DR的保护因素,控制血糖并使其达标是防止T2DM患者合并DR的关键。     

Healthcare costs associated with progressive diabetic retinopathy among National Health Insurance enrollees in Taiwan, 2000-2004

Background  

Diabetic retinopathy is one of the most common microvascular complications of diabetes and one of the major causes of adult visual impairment in national surveys in Taiwan. This study aimed to identify the healthcare costs of Taiwan's National Health Insurance program on behalf of diabetic patients with stable or progressive retinopathy.     

秦皇岛地区2型糖尿病患者并发糖尿病视网膜病变的流行病学分析

目的 本文探究秦皇岛地区2型糖尿病(type 2 diabetes mellitus, T2DM)患者并发糖尿病视网膜病变(diabetic retinopathy, DR)的流行病学分析。方法 应用整群抽样调查方法,选择秦皇岛地区3个社区作为调查点,选择2015年6月—2018年12月期间符合纳排标准的1 133例T2DM患者作为研究对象,检测其视网膜病变情况,采用单因素χ²检验与多因素非条件logistic回归分析发生DR的危险因素。结果 在1 133例T2DM患者中,DR发病率为19.24%(218/1 133),其中非增殖性DR发病率为13.15%,增殖性DR发病率为6.09%;logistic回归分析表明年龄(≤60岁)(OR=2.824,95%CI:2.254~3.537)、学历-初中及以下(OR=1.169,95%CI:1.106~1.235)、居住地-郊县(OR=3.102,95%CI:1.867~5.153)、内眼手术史(OR=5.124,95%CI:2.637~9.959)、糖尿病病程(>10年) (OR=2.782,95%CI:2.468~3.135)、高血压(OR=2.726,95%CI:1.453~5.115)及空腹血糖(>6.11 mmol/L),(OR=3.146,95%CI:2.491~3.972)等7项指标是发生DR的独立危险因素(P<0.05)。结论 秦皇岛地区1 133例T2DM患者DR患病率为18.65%,年龄(≤60岁)、学历-初中及以下、居住地-郊县、内眼手术史、糖尿病病程(>10年)、高血压及空腹血糖(>6.11 mmol/L)等因素是DR的独立危险因素,该研究有望应用于指导、预测及干预治疗T2DM患者DR,降低DR发生率,改善T2DM患者视力水平。     

Anthropometric surrogates for screening of low birth weight newborns: a community-based study

In developing countries, where about 75% of births occur at home or in the community, logistic problems prevent the weighing of every newborn child. This study compares various anthropometric surrogates for identification of low birth weight neonates. A longitudinal community based study was done in an urban resettlement colony and 283 singleton neonates within 7 days of birth were examined for the anthropometric measurements such as head, chest, mid upper arm circumference and foot length as a screening tool for low birth weight. Chest circumference measured within 7 days of birth appeared to be the most appropriate surrogate of low birth weight with highest sensitivity (75.4%), specificity (78.4%), and positive predictive value (48.9%) as compared with other anthropometric parameters. Low birth weight neonates in absence of weighing scales can be early identified by using simple anthropometric measurements for enhanced home-based care and timely referral.     

Screening for diabetic retinopathy in remote Australia: a program description and evaluation of a devolved model

Objectives: To describe the diabetic retinopathy screening program operating in the Kimberley and evaluate recruitment into and the quality and timeliness of, the screening procedure. Method: Review of the documents relating to the Kimberley diabetic retinopathy screening program and analysis of Kimberley diabetic retinopathy screening database. Results: The Kimberley Public Health Unit developed and maintains a program of training, credentialing and ongoing professional development for retinal camera practitioners and a Kimberley‐wide database of retinal photographs taken for diabetic retinopathy screening. As a result of this program, diabetic retinopathy screening is available in or close to most diabetics’ home towns/communities and 58% had undergone retinopathy screening in the preceding 2 years. Over 90% of sets of photographs were of excellent or adequate quality. There was a positive relationship between credentialing and photograph quality and timeliness of photographs being sent away for reporting. Conclusions: Quality diabetic retinopathy screening, at prevalences comparable to, or higher than, other urban and rural populations, can be achieved in a remote area. What is already known: Screening and early treatment of diabetic retinopathy can prevent visual loss associated with diabetes. However, there is little published literature about the operational aspects of diabetic retinopathy screening programs in remote area settings. What this study adds: Diabetic retinopathy screening in remote areas can be successfully implemented using non‐mydriatic retinal photography performed by credentialed local health professionals, such as Aboriginal health workers and nurses.     

Diabetic retinopathy and health-related quality of life among Chinese with known type 2 diabetes mellitus

Purpose

We aim to describe the impact of diabetic retinopathy (DR) on health-related quality of life (HRQOL) among community-dwelling Chinese adults who had been previously diagnosed with type 2 diabetes mellitus (T2DM).

Methods

A community-based survey including 913 patients with T2DM was conducted in Suzhou, China. Retinopathy lesions were graded according to the Airlie House classification system of the Early Treatment Diabetic Retinopathy Study. The HRQOL was measured by the Chinese version of the EuroQol Group’s five-level EuroQol five-dimensional questionnaire (EQ-5D-5L). A Gamma distribution with log link was incorporated into linear regression models to assess the associations between DR and EQ-5D-5L health utility score.

Results

The mean EQ-5D-5L index scores were 0.971?±?0.082 among individuals with unilateral DR and 0.970?±?0.145 among those with bilateral DR, which were lower compared with those without DR (0.986?±?0.045, P?=?0.02). In multivariate analysis adjusting for confounders, people with bilateral DR reported lower the EQ-5D index scores compared with those without DR. The presence of DR was significantly associated with problems in usual activities (odds ratio [OR]?=?0.16, P?=?0.02, comparing participants with unilateral vs. no DR; OR?=?0.11; P?=?0.01, comparing participants with bilateral vs. no DR). No significant variations in EQ-5D-5L index scores as well as different domains of health problems between individuals with unilateral and bilateral DR were observed (P?>?0.05).

Conclusion

Chinese T2DM patients with bilateral DR tend to report lower HRQOL scores compared with those without DR, especially in health problems associated with usual activities.

     

乳腺超声和钼靶X线对中国女性乳腺癌筛查的卫生经济学评价

目的:评价中国女性使用乳腺超声、钼靶X线和不筛查三种乳腺癌筛查方式的成本效果和成本效用。方法:采用中国数据,建立Markov决策模型,对每年进行一次乳腺超声筛查、每年进行一次钼靶X线筛查和不筛查的40岁以上女性进行终生队列模拟,以3%贴现率进行贴现。以不筛查组的成本和效用作为基线得到增量成本效用比,并使用单因素敏感度分析和概率敏感度分析验证模型的稳健性,同时对中东西部地区和不同类型城市进行亚组分层分析。结果:与不筛查相比,乳腺超声筛查和钼靶X线筛查的增量成本效用比分别为102 653元/QALY和201 309元/QALY。概率敏感度分析结果显示,乳腺超声和钼靶X线具有成本效用的概率分别为54.5%和26.2%。乳腺超声筛查在不同地区和不同类型城市的亚组分析结果无差异,钼靶X线筛查在东部地区的增量成本效用比与意愿支付阈值接近。结论:乳腺超声筛查可考虑作为我国乳腺癌筛查项目的主要方法,但钼靶X线筛查只适合在东部经济较发达地区使用。     

社区2型糖尿病老年患者个体化自我管理效果评估

【目的】评价个体化的自我管理对社区老年2型糖尿病患者稳定控制血糖的效果。【方法】2015年4月至2015年9月,在上海市奉贤区邬桥、西渡社区共计招募97例与家庭医生签约的门诊2型糖尿病患者纳入研究,研究对象随机分为两组,干预组49例,对照组48例。干预组:针对患者不同情况实施个体化的自我管理教育和病情评估,采用专家解疑、家庭医生服务团队上门及指导、强化家庭成员及糖友参与的综合模式;对照组:实施常规健康教育。两组病例随访6个月,前后均进行2型糖尿病患者自我管理行为量表(DSCA)生活运动方式的调查、血糖和糖化血红蛋白的检测,低血糖的发生率等。【结果】干预组:男28例,女21例;年龄(62.56±12.54)岁;对照组:男27例,女22例;年龄(62.02±11.73)岁;两组病人在年龄、性别、文化程度、病程和治疗方法等方面差异均无统计学意义(P0.05)。干预前,二组在饮食、运动、用药行为,血糖监测、低血糖知识认知等各项指标较对照组差异均无统计学意义(P0.05)。干预6个月后,干预组的健康行为得分:饮食(59.92±2.38)分、运动(33.44±3.29)分、用药行为(27.30±1.46)分,血糖监测(29.22±2.85)分、低血糖知识认知(24.12±1.72)分;血糖检测指标:空腹血糖(5.52±0.73)mmol/L、餐后2 h血糖(8.14±1.73)mmol/L及糖化血红蛋白(6.76±0.62)%,较对照组有明显改善(P0.001)。干预6个月后,干预组健康行为得分、血糖指标的改变值均高于对照组,差异有统计学意义(P0.001)。干预组低血糖的发生率较对照组明显下降,差异有统计学意义(P0.001)。【结论】开展个体化的自我管理能获得更好的血糖控制,降低老年糖尿病患者低血糖的发生率。     

上海市延吉社区2型糖尿病患者糖尿病视网膜病变巢式病例对照研究

目的 分析上海市延吉社区2型糖尿病患者糖尿病视网膜病变(diabetic retinopathy,DR)的发病率及其相关的影响因素,为早期预防及干预治疗提供依据.方法 选取在2017年7月基线调查中无糖尿病视网膜病变(non-diabetic retinopathy,NDR)的597名研究对象,随访2年后2019年8月...     

Use of the emergency department for less-urgent care among type 2 diabetics under a disease management program

Background  

This study analyzed the likelihood of less-urgent emergency department (ED) visits among type 2 diabetic patients receiving care under a diabetes disease management (DM) program offered by the Louisiana State University Health Care Services Division (LSU HCSD).