HealthDay News — Patients with type 1 diabetes and low risk for diabetic retinopathy may need less-frequent ophthalmologic screenings, while patients at high risk may need to be seen more often than once a year, according to a study published in the New England Journal of Medicine.
Investigators focused on individuals with type 1 diabetes (aged 13 to 39) who had enrolled in a large, national diabetes trial between 1983 and 1989. The latest analysis involved 24,000 eye exams conducted over 30 years among 1441 patients with type 1 diabetes. Retinal photographs were taken every 6 months until 1993, and then — in a follow-up study — once every 4 years until 2012. The study participants’ vision, advanced retinopathy status, and general diabetes history were tracked for an average of nearly 29 years.
The researchers determined that those participants who had an average HbA1c level of 6%, but no signs of retinopathy, could forgo the annual screening in favor of just 1 exam every 4 years. Similar patients with mild retinopathy should be screened once every 3 years, the team concluded. By contrast, those with severe or moderate retinopathy would do well to get screened every 3 to 6 months, respectively, the study authors suggested. Patients with higher HbA1c levels (8% to 10%) might also need to be screened more often.
On average, the new recommendations for patients with type 1 diabetes would likely cut the need for eye exams in half over a 2-decade period. That would translate into an overall savings of $1 billion, while ensuring that those facing the highest risk got more timely treatment, the researchers said.
- The DCCT/EDIC Research Group. Frequency of evidence-based screening for retinopathy in type 1 diabetes. N Engl J Med. 2017;376:1507-1516. doi:10.1056/NEJMoa1612836
- Rosenberg JB, Rsui I. Screening for diabetic retinopathy. N Engl J Med. 2017;376:1587-1588. doi:10.1056/NEJMe1701820