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OBJECTIVE-In the U.K., people with diabetes are typically screened for retinopathy annually. However, diabetic retinopathy sometimes has a slow progression rate. We developed a simulation model to predict the likely impact of screening patients with type 2 diabetes, who have not been diagnosed with diabetic retinopathy, every 2 years rather than annually. We aimed to assess whether or not such a policy would increase the proportion of patients who developed retinopathy-mediated vision loss compared with the current policy, along with the potential cost savings that could be achieved.
RESEARCH DESIGN AND METHODS-We developed a model that simulates the progression of retinopathy in type 2 diabetic patients, and the screening of these patients, to predict rates of retinopathy-mediated vision loss. We populated the model with data obtained from a National Health Service Foundation Trust. We generated comparative 15-year forecasts to assess the differences between the current and proposed screening policies.
RESULTS-The simulation model predicts that implementing a 2-year screening interval for type 2 diabetic patients without evidence of diabetic retinopathy does not increase their risk of vision loss. Furthermore, we predict that this policy could reduce screening costs by ~25%.
CONCLUSIONS-Screening people with type 2 diabetes, who have not yet developed retinopathy, every 2 years, rather than annually, is a safe and cost-effective strategy. Our findings support those of other studies, and we therefore recommend a review of the current National Institute for Health and Clinical Excellence (NICE) guidelines for diabetic retinopathy screening implemented in the U.K.
Diabetes Care 35:1663-1668, 2012
Diabetic retinopathy is a serious complication for people with diabetes that can lead to blindness or severe vision loss (1). Although retinopathy cannot be cured, its progression can be slowed or halted, and laser treatment can prevent visual loss if offered promptly at the proliferative stage (2). Diabetic digital retinal photography is an effective method of detecting the onset of treatable retinopathy (3). National Institute for Health and Clinical Excellence (NICE) guidelines in the U.K. currently recommend that people with diabetes are screened for retinopathy annually, or every 3-6 months for those patients who have developed beyond mild background retinopathy or who are at higher risk of progression (4). This also forms part of the National Screening Committee's policy of a national screening program...