A Pilot Study of Implementing Diabetic Retinopathy Screening in the Oslo Region, Norway: Baseline Results

Ellen Steffenssen Sauesund; Øystein Kalsnes Jørstad; Cathrine Brunborg; Morten Carstens Moe; Maja Gran Erke; Dag Sigurd Fosmark; Goran Petrovski

doi:10.3390/biomedicines11041222

A Pilot Study of Implementing Diabetic Retinopathy Screening in the Oslo Region, Norway: Baseline Results

Biomedicines. 2023 Apr 19;11(4):1222. doi: 10.3390/biomedicines11041222.

Authors

Ellen Steffenssen Sauesund^{1

2}, Øystein Kalsnes Jørstad¹, Cathrine Brunborg³, Morten Carstens Moe^{1

2}, Maja Gran Erke¹, Dag Sigurd Fosmark¹, Goran Petrovski^{1

2}

Affiliations

¹ Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway.
² Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway.
³ Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, 0450 Oslo, Norway.

Abstract

Purpose: to gain insight into the baseline parameters of a population with diabetes mellitus (DM) included in a pilot diabetic retinopathy (DR) screening program at Oslo University Hospital (OUH), Norway.

Methods: This was a cross-sectional study of a cohort of adult patients (≥18 years) with type 1 or 2 DM (T1D and T2D). We measured the best-corrected visual acuity (BCVA), blood pressure (BP), heart rate (HR), intraocular pressure (IOP), height and weight. We also collected HbA1c, total serum cholesterol and urine-albumin, -creatinine and -albumin-to-creatinine ratio (ACR), as well as socio-demographic parameters, medications and previous screening history. We obtained color fundus photographs, which were graded by two experienced ophthalmologists according to the International Clinical Disease Severity Scale for DR.

Results: The study included 180 eyes of 90 patients: 12 patients (13.3%) had T1D and 78 (86.7%) had T2D. In the T1D group, 5 patients (41.7%) had no DR, and 7 (58.3%) had some degree of DR. In the T2D group, 60 patients (76.9%) had no DR, and 18 (23.1%) had some degree of DR. None of the patients had proliferative DR. Of the 43 patients not newly diagnosed (time of diagnosis > 5 years for T1D and >1 years for T2D), 37.5% of the T1D patients and 5.7% of the T2D patients had previously undergone regular screening. Univariate analyses found for the whole cohort significant associations between DR and age, HbA1c, urine albumin-to-creatinine ratio, body mass index (BMI) and duration of DM. For the T2D group alone, there were significant associations between DR and HbA1c, BMI, urine creatinine, urine albumin-to-creatinine ratio and duration of DM. The analysis also showed three times higher odds for DR in the T1D group than the T2D group.

Conclusions: This study underscores the need for implementing a systematic DR screening program in the Oslo region, Norway, to better reach out to patients with DM and improve their screening adherence. Timely and proper treatment can prevent or mitigate vision loss and improve the prognosis. A considerable number of patients were referred from general practitioners for not being followed by an ophthalmologist.Among patients not newly diagnosed with DM, 62.8% had never had an eye exam, and the duration of DM for these patients was up to 18 years (median: 8 years).

Keywords: Norway; diabetes mellitus; diabetic retinopathy; screening.

Grants and funding

Research was funded in the frames of the Baltic Research Programme’s project Nr.EEA-RESEARCH-60 “Integrated model for personalized diabetic retinopathy screening and monitoring using risk-stratification and automated AI-based fundus image analysis (PerDiRe)” fi-nancially supported by the European Economic Area (EEA) Grants (Contract No. EEZ/BPP/VIAA/2021/8).