Four-Year Screening Interval and Vision-Threatening Retinopathy in Type 2 Diabetes Patients With Good Glycemic Control
Four-Year Screening Interval and Vision-Threatening Retinopathy in Type 2 Diabetes Patients With Good Glycemic Control
复制标题
血糖控制良好的 2 型糖尿病患者的四年筛查间隔和威胁视力的视网膜病变
DOI：
10.1016/j.mayocp.2020.07.031
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发表时间：
2021
影响因子：
8.9
通讯作者：
Kajio Hiroshi
中科院分区：
文献类型：
--
作者：
Tsujimoto Tetsuro;Kajio Hiroshi
目的评价血糖控制良好的2型糖尿病患者在随访4年后是否发生视力威胁视网膜病变。方法利用2001年1月1日至2014年10月14日进行的糖尿病心血管危险控制行动和糖尿病心血管风险控制行动随访研究，调查血糖控制良好或差的2型糖尿病患者4年后视力威胁视网膜病变的发生率。排除基线时有增殖性糖尿病视网膜病变的患者。威胁视力的视网膜病变被定义为严重的非增殖性糖尿病视网膜病变、增殖性糖尿病视网膜病变、激光光凝或玻璃体切割术。血糖控制良好和不良分别定义为随访期间平均糖化血红蛋白水平低于7%和7%或更高。结果共纳入2285名患者。在基线无视网膜病变的患者中，血糖控制良好和差的患者4年内视力威胁视网膜病变的发生率分别为0%(0/386)和0.8%(6/721)(P=.54)。同样，在4年没有视网膜病变的患者中，8年后没有观察到严重的视网膜病变。在基线水平的轻中度非增殖性糖尿病视网膜病变患者中，血糖控制不良的患者4年内威胁视力的视网膜病变的发生率显著高于血糖控制良好的患者(9.7%[790例]vs4.4%[297例]；P=0.004)。此外，糖尿病病程较长的患者糖尿病视网膜病变缓解率较低。血糖控制越差、糖尿病病程越长的视网膜病变患者，4年内发生危及视力的视网膜病变的几率越高。结论在无视网膜病变的2型糖尿病患者中，将糖尿病视网膜病变的筛查间隔延长至4年或更长时间可能是安全的。
ObjectiveTo assess whether vision-threatening retinopathy developed after 4 years in patients with type 2 diabetes with good glycemic control during follow-up.Patients and MethodsUsing data from the Action to Control Cardiovascular Risk in Diabetes and Action to Control Cardiovascular Risk in Diabetes Follow-on studies (conducted from January 1, 2001, to October 14, 2014), we investigated the incidence of vision-threatening retinopathy after 4 years in patients with type 2 diabetes with good or poor glycemic control. Patients with proliferative diabetic retinopathy at baseline were excluded. Vision-threatening retinopathy was defined as severe nonproliferative diabetic retinopathy, proliferative diabetic retinopathy, laser photocoagulation, or vitrectomy. Good and poor glycemic control was defined as mean glycated hemoglobin level less than 7% and 7% or greater during follow-up, respectively.ResultsThis study included 2285 patients. Among patients with no retinopathy at baseline, the 4-year incidence of vision-threatening retinopathy was 0% (0 of 386) and 0.8% (6 of 721) in those with good and poor glycemic control, respectively (P=.54). Similarly, severe retinopathy was not observed at 8 years in patients who did not have retinopathy at 4 years. Among patients with mild to moderate nonproliferative diabetic retinopathy at baseline, the 4-year incidence of vision-threatening retinopathy was significantly higher in those with poor glycemic control than in those with good glycemic control (9.7% [77 of 790] vs 4.4% [13 of 297];P=.004). Additionally, the remission rate of diabetic retinopathy was low in patients with a long duration of diabetes. Four-year incidences of vision-threatening retinopathy were higher in patients with retinopathy at baseline who had poorer glycemic control and longer durations of diabetes.ConclusionIt may be safe to extend screening intervals for diabetic retinopathy to 4 years or longer in patients with type 2 diabetes with no retinopathy.