Elsevier

Diabetes & Metabolism

Volume 38, Issue 3, June 2012, Pages 225-229
Diabetes & Metabolism

Original article
A study of the 3-year incidence of diabetic retinopathy in a French diabetic population seen at Lariboisière Hospital, ParisÉtude de l’incidence durant trois ans de la rétinopathie diabétique dans une population suivie à l’hôpital Lariboisière à Paris

https://doi.org/10.1016/j.diabet.2012.01.001Get rights and content

Abstract

Aim

This study evaluated the incidence of diabetic retinopathy (DR) over a 3-year period in a French population that was followed by OPHDIAT®, and assessed the clinical and biological risk factors associated with incident retinopathy.

Methods

The studied patients were screened for DR during hospitalization for their annual diabetes check-up in the endocrinology department by two examinations three years apart. DR screening used the OPHDIAT® telemedical network, and the examination included clinical and biological data.

Results

A total of 254 patients were studied. At the 3-year follow-up, the incidence was 14.0%, (CI: 9.5–18.4%). Longer duration of diabetes and the presence of micro- or macroalbuminuria were significantly associated with incident retinopathy (P < 0.05). Other potential risk factors were not statistically significantly related to DR progression, and only treatment with insulin showed a trend towards significance (P < 0.20).

Conclusion

This study provides the first French data on the incidence of DR, which was estimated after a 3-year follow-up at 14.0%. Longer duration of time from the onset of diabetes and higher baseline albuminuria were the only statistically significant risk factors found for the incidence of DR after our 3-year study. Nevertheless, microalbuminuria should be more widely used in ophthalmological practice in the assessment of DR, as is already the case for both blood pressure and HbA1c.

Résumé

Buts

Évaluer l’incidence de la rétinopathie diabétique à trois ans dans une population hospitalière française issu du réseau OPHDIAT®, et estimer les facteurs de risques cliniques et biologiques associés à la progression de la rétinopathie.

Méthodes

Lors d’une hospitalisation annuelle dans un service d’endocrinologie pour bilan annuel de leur diabète, les patients étudiés ont fait l’objet d’un dépistage de la rétinopathie diabétique à trois ans d’intervalle. Le dépistage a été effectué grâce au réseau OPHDIAT®, et les données cliniques et biologiques ont été étudiées.

Résultats

Deux cent cinquante-quatre patients ont été étudiés. À trois ans, l’incidence était de 14,0 %, (IC 9,5–18,4). Une plus longue durée du diabète et la présence d’une micro- ou macroalbuminurie étaient significativement associées à l’incidence de la rétinopathie diabétique, P < 0,05. Les autres facteurs de risques potentiels n’étaient pas significativement associés, et seul le traitement par insuline avait une tendance à être significative (P < 0,02).

Conclusion

Il s’agit de la première étude française concernant le taux d’incidence de la rétinopathie diabétique à trois ans, évaluée à 14 %. La plus grande durée du diabète et la présence d’une micro- ou macroalbuminurie étaient les deux seuls facteurs significativement associés à l’incidence de la rétinopathie diabétique. Tout comme la pression artérielle et l’HbA1c, l’évaluation de la microalbuminurie devrait être plus souvent effectuée en pratique clinique.

Introduction

Diabetic retinopathy (DR) is the primary cause of legal blindness in Western countries [1]. Better management of diabetic patients and, in particular, better glycaemic control, lower blood pressure [2], [3] and regular eye follow-up [4], [5], have reduced both the incidence and progression of DR in several countries. However, screening for DR remains a major public-health issue because of the alarming increase in the prevalence of diabetes around the world. In France between 2000 and 2009, the number of people treated for diabetes increased from 2.6% to 4.4% of the population [6]. Access to an ophthalmologist is difficult in France, and this remains a genuine handicap for proper follow-up. In response to these two problems, the telemedical network OPHDIAT® was specifically designed to facilitate access to regular annual eye evaluations in patients with diabetes [7]. The network was set up in 2004 and, since then, it has continued to function routinely.

The purpose of the present study was to evaluate the incidence of DR over a 3-year period in a French population that was followed-up by this network, and to assess the clinical and biological risk factors associated with incident retinopathy.

Section snippets

Study population

This retrospective study included 254 diabetic patients, whatever their type of diabetes, who visited the endocrinology department of the Lariboisière Hospital in Paris, France, between 2004 and 2011. All of the patients studied were screened for DR during hospitalization for their annual diabetes check-up by two examinations three years apart.

Procedure

All patients in the study underwent complete examinations during hospitalization that included:

  • a questionnaire detailing the time since diabetes onset,

Results

A total of 254 patients were studied. At baseline, 236 patients (93%) showed no DR whereas 18 patients (7%) did. These 18 patients were not included in the calculation of the incidence of DR. At the 3-year follow-up, retinopathy had developed in 33 of the 236 patients in whom retinopathy was not present at baseline, thereby giving an incidence of 14.0% (CI: 9.5–18.4%; Table 1). Neither severe non-proliferative diabetic retinopathy (NPDR) nor any proliferative DR was found in our study. On

Discussion

Our present study showed the rate of incident retinopathy after three years of follow-up, while most epidemiological studies have used a 5-year follow-up timescale. For this reason and to compare studies, the incidences are presented here as annual rates.

Our results are similar to those of the Blue Mountains Eye Study (BMES), which had an incidence at five years of 22.2% [10], but are significantly higher than those of the Australian Diabetes, Obesity and Lifestyle (AusDiab) study [11] and the

Disclosure of interest

The authors declare that they have no conflicts of interest concerning this article.

References (21)

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