MedicalResearch.com Interview with:
John M. Lachin, Sc.D.
Research Professor of Biostatistics and of Epidemiology, and of Statistics
The George Washington University Biostatistics Center and
David Matthew Nathan, M.D.
Professor of Medicine, Diabetes Unit
Massachusetts General Hospital
MedicalResearch.com: What is the background for this study?
Response: Traditional guidelines for screening for retinopathy, based on indirect evidence, call for annual examinations. The automatic annual screening for retinopathy, without considering potential risk factors for progression, appears excessive based on the slow rate of progression through sub-clinical states of retinopathy.
MedicalResearch.com: What are the main findings?
Response: Based on 24 thousand retinal examinations in 1400 subjects over an average of 24 years, we showed that an examination after 5 years could still provide a low (~5%) chance of progression to treatable levels of proliferative retinopathy (or clinically significant macular edema) among subjects with no or mild retinopathy and good glycemic control, whereas much more frequent re-examination, as often as after 3 months or less, would be indicated for those with more advanced severe non-proliferative retinopathy and/or poor glycemic control.
MedicalResearch.com: What should readers take away from your report?
Response: It is possible to implement an individualized frequency of screening that is safe, with a low probability of progression to sight threatening levels of retinopathy, by selecting a screening interval based on each subject’s current retinopathy level and historical level of HbA1c.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: We are planning to conduct a similar evaluation to construct evidence-based recommendations for screening for progression of nephropathy. If similar data exist for type 2 diabetes, the screening frequency for retinopathy in that population should be investigated as we did in type 1 diabetes
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Frequency of Evidence-Based Screening for Retinopathy in Type 1 Diabetes
The DCCT/EDIC Research Group
N Engl J Med 2017; 376:1507-1516
April 20, 2017
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