title: Early detection of type 2 diabetes mellitus and screening for retinopathy are associated with reduced prevalence and severity of retinopathy.
abstract: OBJECTIVE
  To explore whether the prevalence and severity of retinopathy differ in diabetes cohorts diagnosed through screening as compared with conventional health care.
  
  
  METHODS
  A total of 257 diabetes patients, 151 detected through screening and 106 through conventional clinical care, were included. Retinopathy was evaluated by fundus photography. The modified Airlie House adaptation of the Early Treatment Retinopathy Study protocol was used to grade the photographs. Averages of clinically collected fasting blood glucose (FBG), blood pressure and body mass index values were compiled from diabetes diagnosis until the eye examination. Blood chemistry, smoking habits and peripheral neuropathy were assessed at the time of the eye examination.
  
  
  RESULTS
  Among the screening-detected patients, 22% had retinopathy as compared to 51% among those clinically detected (p < 0.0001). In a multivariate analysis, patients with retinopathy were more likely to have increased average FBG (OR 1.42, 95% CI 1.19-1.70 per mmol/l) and peripheral neuropathy (OR 2.75, 95% CI 1.40-5.43), but less likely to have screening-detected diabetes (OR 0.31, 95% CI 0.17-0.57). Similar results were found using increasing severity grade of retinopathy as outcome. The cumulative retinopathy prevalence for the screening-detected diabetes cohort as compared with the clinically diagnosed cohort was significantly lower from 10 years' follow-up and onwards (p = 0.0002).
  
  
  CONCLUSIONS
  Among patients with screening-detected diabetes, the prevalence of retinopathy and increasing severity of retinopathy were significantly lower than among those who had their diabetes diagnosed through conventional care, even when other risk factors for retinopathy such as duration, hyperglycaemia and blood pressure were considered. Early detection of diabetes reduces prediagnostic time spent with hyperglycaemia. In combination with early and regular screening for retinopathy, more effective prevention against retinopathy can be provided.
authors: Department of Ophthalmology, The National University Hospital, Reykjavik, Iceland.|University of Iceland, Reykjavik, Iceland.|Department of Ophthalmology, Orebro University Hospital, Orebro, Sweden.
authors: Eydis
authors: E
authors: Olafsdottir
authors: Family Medicine and Preventive Medicine Section, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
authors: Dan K G
authors: DK
authors: Andersson
authors: Department of Ophthalmology, Orebro University Hospital, Orebro, Sweden.
authors: Inger
authors: I
authors: Dedorsson
authors: Family Medicine and Preventive Medicine Section, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
authors: Kurt
authors: K
authors: Svärdsudd
authors: Family Medicine and Preventive Medicine Section, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.|Family Medicine Research Centre, Orebro County Council, School of Health and Medical Sciences, Orebro University, Sweden.
authors: Stefan P O
authors: SP
authors: Jansson
authors: Department of Ophthalmology, The National University Hospital, Reykjavik, Iceland.|University of Iceland, Reykjavik, Iceland.
authors: Einar
authors: E
authors: Stefánsson
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis*; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000453:epidemiology*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D013548:Sweden / Q000453:epidemiology
chemical_list: D001786:Blood Glucose
keywords: diabetes duration; longitudinal data; opportunistic case finding; peripheral neuropathy; retinopathy; screening; type 2 diabetes mellitus