Direct medical cost associated with diabetic retinopathy severity in type 2 diabetes in Singapore

<div><p>Diabetic retinopathy (DR) is a leading cause of vision-loss globally among type 2 diabetes (T2DM) patients. Information on the economic burden of DR in Singapore is limited. We aim to identify the total annual direct medical costs of DR at different stages, and to examine factors influencing the costs. Four hundreds and seventy T2DM patients who attended the Diabetes Centre in a secondary hospital in Singapore in 2011–2014 were included. Digital color fundus photographs were assessed for DR in a masked fashion. Retinopathy severity was further categorized into non-proliferative DR (NPDR), including mild, moderate and severe NPDR, and proliferative DR (PDR). Medical costs were assessed using hospital administrative data. DR was diagnosed in 172 (39.5%) patients, including 51 mild, 62 moderate and 18 severe NPDR, and 41 PDR. The median cost in DR [2012.0 (1111.2–4192.3)] was significantly higher than that in non-DR patients [1158.1 (724.1–1838.9)] (p<0.001). The corresponding costs for mild, moderate, severe NPDR and PDR were [1167.1 (895.4–2012.0)], [2212.0 (1215.5–3825.5)], [2717.5 (1444.0–6310.7)], and [3594.8.1 (1978.4–8427.7)], respectively. After adjustment, the corresponding cost ratios for mild, moderate, severe NPDR, and PDR relative to non-DR were 1.1 (p = 0.827), 1.8 (p = 0.003), 2.0 (p = 0.031) and 2.3 (p<0.001), respectively. The other factors affecting the total cost include smoking (ratio = 1.7, p = 0.019), neuropathy (ratio = 1.9, p = 0.001) and chronic kidney disease (CKD) (ratio = 1.4, p = 0.019). The presence and severity of DR was associated with increased direct medical costs in T2DM. Our results suggest that preventing progression of DR may reduce the economic burden of DR.</p></div

The total cost and distribution categorized by the severity of DR.

<p>The total cost and distribution categorized by the severity of DR.</p

Distribution of cost.

<p>(A) cost in DR (B) cost in non-DR patients.</p

Association of medical costs and the severity of DR (n = 435).

<p>Association of medical costs and the severity of DR (n = 435).</p

The total cost and cost distribution of individuals with T2DM stratified by presence of DR (n = 435).

<p>The total cost and cost distribution of individuals with T2DM stratified by presence of DR (n = 435).</p

Urine leucine-rich alpha-2 glycoprotein 1 (LRG1) predicts the risk for progression to end stage kidney disease in patients with type 2 diabetes

   Objective: Leucine-rich alpha-2 glycoprotein 1 (LRG1) is recently identified as an amplifier of transforming growth factor (TGF)- beta- induced kidney fibrosis in animal models. We aim to study whether urine LRG1 is associated with risk for progression to end stage kidney disease (ESKD) in individuals with type 2 diabetes.  Design and Methods: 1837 participants with type 2 diabetes and eGFR above 30 ml/min/1.73m2 were recruited from a regional hospital and a primary care facility. Association of urine LRG1 with risk for ESKD (progression to sustained eGFR Results: 134 incident ESKD events were identified during a median follow-up of 8.6 (IQR 5.8-9.6) years. As compared to the lowest tertile, participants with baseline urine LRG1 in the highest tertile had 1.91 (95% CI 1.04- 3.50) folds increased risk for progression to ESKD after adjustment for cardio-renal risk factors including eGFR and albuminuria. As a continuous variable, one SD increment in urine LRG1 was associated with 1.53 (95% CI 1.19-1.98) folds adjusted risk for ESKD. Of note, the association of urine LRG1 with ESKD was independent of plasma LRG1. Moreover, urine LRG1 was associated with rapid kidney function decline and progression to macroalbuminuria, two common pathways leading to ESKD.  Conclusions: Urine LRG1, a TGF-beta signalling modulator, predicts risk for progression to ESKD independent of clinical risk factors in patients with type 2 diabetes, suggesting that it may be a novel factor involving in the pathophysiological pathway leading to kidney disease progression. </p

dvdres-dec-2017-00206-File004 – Supplemental material for Long-term prospective observation suggests that glomerular hyperfiltration is associated with rapid decline in renal filtration function: A multiethnic study

<p>Supplemental material, dvdres-dec-2017-00206-File004 for Long-term prospective observation suggests that glomerular hyperfiltration is associated with rapid decline in renal filtration function: A multiethnic study by Serena Low, Xiao Zhang, Jiexun Wang, Lee Ying Yeoh, Yan Lun Liu, Keven Kue Loong Ang, Wern Ee Tang, Pek Yee Kwan, Subramaniam Tavintharan, Chee Fang Sum and Su Chi Lim in Diabetes & Vascular Disease Research</p