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Frequency of Evidence-Based Screening for Retinopathy in Type 1 Diabetes.

Abstract In patients who have had type 1 diabetes for 5 years, current recommendations regarding screening for diabetic retinopathy include annual dilated retinal examinations to detect proliferative retinopathy or clinically significant macular edema, both of which require timely intervention to preserve vision. During 30 years of the Diabetes Control and Complications Trial (DCCT) and its longitudinal follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study, retinal photography was performed at intervals of 6 months to 4 years.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title the new england journal of medicine
Publication Year Start




PMID- 28423305
OWN - NLM
STAT- In-Process
DA  - 20170419
LR  - 20170425
IS  - 1533-4406 (Electronic)
IS  - 0028-4793 (Linking)
VI  - 376
IP  - 16
DP  - 2017 Apr 20
TI  - Frequency of Evidence-Based Screening for Retinopathy in Type 1 Diabetes.
PG  - 1507-1516
LID - 10.1056/NEJMoa1612836 [doi]
AB  - BACKGROUND: In patients who have had type 1 diabetes for 5 years, current
      recommendations regarding screening for diabetic retinopathy include annual
      dilated retinal examinations to detect proliferative retinopathy or clinically
      significant macular edema, both of which require timely intervention to preserve 
      vision. During 30 years of the Diabetes Control and Complications Trial (DCCT)
      and its longitudinal follow-up Epidemiology of Diabetes Interventions and
      Complications (EDIC) study, retinal photography was performed at intervals of 6
      months to 4 years. METHODS: We used retinal photographs from the DCCT/EDIC study 
      to develop a rational screening frequency for retinopathy. Markov modeling was
      used to determine the likelihood of progression to proliferative diabetic
      retinopathy or clinically significant macular edema in patients with various
      initial retinopathy levels (no retinopathy or mild, moderate, or severe
      nonproliferative diabetic retinopathy). The models included recognized risk
      factors for progression of retinopathy. RESULTS: Overall, the probability of
      progression to proliferative diabetic retinopathy or clinically significant
      macular edema was limited to approximately 5% between retinal screening
      examinations at 4 years among patients who had no retinopathy, 3 years among
      those with mild retinopathy, 6 months among those with moderate retinopathy, and 
      3 months among those with severe nonproliferative diabetic retinopathy. The risk 
      of progression was also closely related to mean glycated hemoglobin levels. The
      risk of progression from no retinopathy to proliferative diabetic retinopathy or 
      clinically significant macular edema was 1.0% over 5 years among patients with a 
      glycated hemoglobin level of 6%, as compared with 4.3% over 3 years among
      patients with a glycated hemoglobin level of 10%. Over a 20-year period, the
      frequency of eye examinations was 58% lower with our practical, evidence-based
      schedule than with routine annual examinations, which resulted in substantial
      cost savings. CONCLUSIONS: Our model for establishing an individualized schedule 
      for retinopathy screening on the basis of the patient's current state of
      retinopathy and glycated hemoglobin level reduced the frequency of eye
      examinations without delaying the diagnosis of clinically significant disease.
      (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases
      and others; DCCT/EDIC ClinicalTrials.gov numbers, NCT00360893 and NCT00360815 .).
CN  - DCCT/EDIC Research Group
LA  - eng
SI  - ClinicalTrials.gov/NCT00360893
SI  - ClinicalTrials.gov/NCT00360815
GR  - U01 DK094176/DK/NIDDK NIH HHS/United States
GR  - U01 DK094157/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - N Engl J Med
JT  - The New England journal of medicine
JID - 0255562
CIN - N Engl J Med. 2017 Apr 20;376(16):1587-1588. PMID: 28423293
EDAT- 2017/04/20 06:00
MHDA- 2017/04/20 06:00
CRDT- 2017/04/20 06:00
AID - 10.1056/NEJMoa1612836 [doi]
PST - ppublish
SO  - N Engl J Med. 2017 Apr 20;376(16):1507-1516. doi: 10.1056/NEJMoa1612836.

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