| Summary: | 博士 === 國立陽明大學 === 公共衛生研究所 === 93 === Background. There are few well-organized community-based screening programs for diabetic retinopathy among type 2 diabetics in Taiwan. This study is conducted with long-term follow-up in Kinmen County to find out the epidemiologic information and best screening model of diabetic retinopathy and to offer the best care to the diabetic patients with the most economic approach.
Purposes. The purposes of this community-based follow-up study include three parts:
1. Investigation of basic epidemiology of diabetic retinopathy.
2. Estimation of multi-state natural history of diabetic retinopathy.
3. Economic evaluation of early detection of diabetic retinopathy.
Methods. From 1991 to 1993, 971 type 2 diabetics, underwent diabetic retinopathy screening performed by a panel of ophthalmologists using on-site indirect ophthalmoscopy and 45-degree color fundus retinal photographs during 1999-2002 and then evaluated utility and willingness-to-pay values in 2003. The basic epidemiology, multi-state natural history and economic evaluation of screening for diabetic retinopathy were estimated.
Results. There are several findings showed in the present study. Firstly, longer duration of type 2 diabetes, fasting plasma glucose at baseline, poorly controlled glucose concentration, and altered blood pressure could increase the risk of prevalent non-proliferative diabetic retinopathy in type 2 diabetics. Secondly, in addition to poor glycemic control, which is the most significant risk factor for the development of diabetic retinopathy and significant prognostic factor for the progression of non-proliferative diabetic retinopathy to proliferative diabetic retinopathy or blindness among type 2 diabetics, longer duration of diabetes, higher systolic blood pressure, and elevated serum triglyceride levels are also associated with the development of diabetic retinopathy. Thirdly, after adjustment for the confounders, our results demonstrated a gender difference in the relationship between insulin resistance and β-cell dysfunction using the HOMA method and the development of diabetic retinopathy among type 2 diabetics. Fourthly, for estimates of disease natural history of diabetic retinopathy, the average time of developing from no diabetic retinopathy to blindness is approximately 26.5 years for type 2 diabetics. Fifthly, the different degrees of diabetic retinopathy revealed to decrease the utility value and increase the willingness-to-pay values in type 2 diabetics after adjustment for the confounders. Finally, assessing the progression of diabetic retinopathy following the proliferative pathway and through economic evaluation suggests that screening for diabetic retinopathy is worthwhile and that annual screening interval for type 2 diabetics should be recommended.
Conclusion. In conclusion, in addition to indicate a series demographic and biochemical markers related to diabetic retinopathy, the present study also demonstrated the screening efficacy and optimal screening interval for early detection of diabetic retinopathy. Further organized evaluating quality of care programs should consider costs and benefits carefully before setting universal screening standards of diabetic retinopathy among type 2 diabetics.
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