Extending the diabetic retinopathy screening intervals in Singapore: methodology and preliminary findings of a cohort study

Aravindhan, Amudha, Fenwick, Eva K., Chan, Aurora Wing Dan, Man, Ryan Eyn Kidd, Tan, Ngiap Chuan, Wong, Wei Teen, Soo, Wern Fern, Lim, Shin Wei, Wee, Sabrina Yi-Mei, Sabanayagam, Charumathi, Finkelstein, Eric, Tan, Gavin, Hamzah, Haslina, Chakraborty, Bibhas, Acharyya, Sanchalika, Shyong, Tai E., Scanlon, Peter H ORCID: 0000-0001-8513-710X, Wong, Tien Yin and Lamoureux, Ecosse L. (2024) Extending the diabetic retinopathy screening intervals in Singapore: methodology and preliminary findings of a cohort study. BMC Public Health, 24 (1). Art 786. doi:10.1186/s12889-024-18287-2 (In Press)

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Abstract

Background: The Diabetic Retinopathy Extended Screening Study (DRESS) aims to develop and validate a new DR/diabetic macular edema (DME) risk stratification model in patients with Type 2 diabetes (DM) to identify low-risk groups who can be safely assigned to biennial or triennial screening intervals. We describe the study methodology, participants' baseline characteristics, and preliminary DR progression rates at the first annual follow-up. Methods: DRESS is a 3-year ongoing longitudinal study of patients with T2DM and no or mild non-proliferative DR (NPDR, non-referable) who underwent teleophthalmic screening under the Singapore integrated Diabetic Retinopathy Programme (SiDRP) at four SingHealth Polyclinics. Patients with referable DR/DME (> mild NPDR) or ungradable fundus images were excluded. Sociodemographic, lifestyle, medical and clinical information was obtained from medical records and interviewer-administered questionnaires at baseline. These data are extracted from medical records at 12, 24 and 36 months post-enrollment. Baseline descriptive characteristics stratified by DR severity at baseline and rates of progression to referable DR at 12-month follow-up were calculated. Results: Of 5,840 eligible patients, 78.3% (n = 4,570, median [interquartile range [IQR] age 61.0 [55-67] years; 54.7% male; 68.0% Chinese) completed the baseline assessment. At baseline, 97.4% and 2.6% had none and mild NPDR (worse eye), respectively. Most participants had hypertension (79.2%) and dyslipidemia (92.8%); and almost half were obese (43.4%, BMI ≥ 27.5 kg/m2). Participants without DR (vs mild DR) reported shorter DM duration, and had lower haemoglobin A1c, triglycerides and urine albumin/creatinine ratio (all p < 0.05). To date, we have extracted 41.8% (n = 1909) of the 12-month follow-up data. Of these, 99.7% (n = 1,904) did not progress to referable DR. Those who progressed to referable DR status (0.3%) had no DR at baseline. Conclusions: In our prospective study of patients with T2DM and non-referable DR attending polyclinics, we found extremely low annual DR progression rates. These preliminary results suggest that extending screening intervals beyond 12 months may be viable and safe for most participants, although our 3-year follow up data are needed to substantiate this claim and develop the risk stratification model to identify low-risk patients with T2DM who can be assigned biennial or triennial screening intervals.

Item Type:	Article
Article Type:	Article
Uncontrolled Keywords:	Diabetes Mellitus, Type 2; Diabetic retinopathy; Screening; Singapore; Risk stratification; Diabetic macular edema
Subjects:	R Medicine > RA Public aspects of medicine > RA645.A-Z Individual diseases or groups of diseases, A-Z > RA645.D54 Diabetes R Medicine > RE Ophthalmology
Divisions:	Schools and Research Institutes > School of Health and Social Care
Depositing User:	Susan Turner
Date Deposited:	21 Mar 2024 11:53
Last Modified:	21 Mar 2024 12:00
URI:	https://eprints.glos.ac.uk/id/eprint/13853

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