Programa para el cribado poblacional de la retinopatia diabética. Experiencia en el sector sanitario de Barbastro

Abstract

Background: Although ocular examination in diabetic patients is widely recommended, only a small percentage of type 2 diabetes mellitus (DM2) subjects underwent fundus exams. Diabetic retinopathy (DR) remains one of the leading causes of preventable blindness in adults and the disease can be diagnosed with screening programs at community level. Non-mydriatic retinography (RTG) is an effective diagnostic tool that can be implemented in the DM2 population through specific screening programs. Objective: To analyze the results of a screening program for DR with non-mydriatic RTG in DM2 patients living in the regional health care department of Barbastro, Spain. Patients and Methods: The study population consisted of patients with DM2 being included in the RTG screening program between September 2008 and June 2015. An initial period was established (September 2008 – December 2009) to determine the diagnostic agreement between General Practitioners (GP) and Ophtalmologists. The consolidation period (January 2010 – June 2015) was established to expand and consolidate the follow-up visits throughout the region. The incidence of DR was calculated in person-years (p-y) and Kaplan-Meier methods were used to assess the risk of developing DR over time. Co-factors associated with the occurrence of DR were determined using Cox regression models. Results: A total of 6.294 patients with DM2 were eligible and 5.313 (84%) underwent a RTG. Fifty six percent of the study population were men, and median age was 70,3 years (IQR: 60,5 – 78,7 years). Median duration of DM2 was 4,9 years (IQR: 1,7 – 11 years), 69% had history of hypertension, 51,3% dyslipemia and 34,2 % had antecedent of cardiovascular disease. Eighty two percent of patients were treated with oral antidiabetic drugs and 40,8% with insulin. The agreement analysis was carried out in 1.845 patients with kappa 0,56, sensitivity 95,5%, specificity 73,1% and negative predictive value 98,5%. The overall prevalence of DR in patients with DM2 was 15,9%. A total of 4.276 patients with DM2 had no lesions of DR at first RTG. A total of 10.387 RTG were performed during follow-up (median of 3 RTG per patient). The median of follow-up was 2,8 years (IQR: 1,2-4,3 years) and incidence of DR was 2,8 x 100 p-y (95% CI: 2,6-3,2 x 100 p-y). Women, HbA1c level, type of DM2 treatment and history of cardiovascular disease were the 4 independent risk factors for DR. Conclusions: The DR Screening Program in Barbastro, Spain, has contributed to consolidate the collaboration between GPs and Ophthalmologists in the detection and care of patients with DM2.

Date of Award	2 Dec 2019
Original language	Spanish
Supervisor	Roberto Muga Bustamante (Director)