A Multi-Center Diabetes Eye Screening Study in Community Settings: Study Design and Methodology

<p><i><b>Purpose</b></i>: Diabetes is the leading cause of new cases of blindness among adults aged 20–74 years within the United States. The Innovative Network for Sight Research group (INSIGHT) designed the Diabetic Eye Screening Study (DESS) to examine the feasibility and short-term effectiveness of non-mydriatic diabetic retinopathy (DR) screening for adults with diabetes in community-based settings.</p> <p><i><b>Methods</b></i>: Study enrollment began in December 2011 at four sites: an internal medicine clinic at a county hospital in Birmingham, Alabama; a Federally-qualified community healthcare center in Miami-Dade County, Florida; a university-affiliated outpatient pharmacy in Philadelphia, Pennsylvania; and a medical home in Winston-Salem, North Carolina. People 18 years or older with previously diagnosed diabetes were offered free DR screening using non-mydriatic retinal photography that was preceded by a brief questionnaire addressing demographic information and previous eye care use. Visual acuity was also measured for each eye. Images were evaluated at a telemedicine reading center by trained evaluators using the National Health System DR grading classification. Participants and their physicians were sent screening report results and telephoned for a follow-up survey 3 months post-screening to determine whether participants had sought follow-up comprehensive eye care and their experiences with the screening process.</p> <p><i><b>Results</b></i>: Target enrollment at each site was a minimum of 500 persons. Three of the four sites met this enrollment goal.</p> <p><i><b>Conclusion</b></i>: The INSIGHT/DESS is intended to establish the feasibility and short-term effectiveness of DR screening using non-mydriatic retinal photography in persons with diabetes who seek services in community-based clinic and pharmacy settings.</p

Prevalence, progression and modifiable risk factors for diabetic retinopathy in youth and young adults with youth-onset type 1 and type 2 diabetes: The SEARCH for Diabetes in Youth Study

   Objective: To determine the prevalence, progression and modifiable risk factors associated with development of DR in a population-based cohort of youth-onset diabetes.  Research Design and Methods: We conducted a multicenter, population-based prospective cohort study (2002 to 2019) of youth and young adults with youth-onset type 1 (n=2519) and type 2 diabetes (n=447). Modifiable factors included baseline and change from baseline to follow-up in BMI z-score, waist/height ratio, systolic and diastolic blood pressure z-score, and A1C. DR included evidence of mild or moderate non-proliferative DR or proliferative retinopathy. Prevalence estimates were standardized to estimate the burden of DR and inverse probability weighting for censoring was applied for estimating risk factors for DR at two points of follow-up.  Results: DR in youth-onset type 1 and type 2 diabetes is highly prevalent, with 52% of those with type 1 diabetes and 56% of those with type 2 diabetes demonstrating retinal changes at follow-up (12.5 [SD: 2.2] years from diagnosis). Higher baseline A1C, increase in A1C across follow-up, and increase in diastolic and systolic blood pressure were associated with observation of DR at follow-up for both diabetes types. Increase in A1C across follow-up was associated with retinopathy progression. BMI z-score and waist/height ratio were inconsistently associated, with both positive and inverse associations noted.  Conclusions: Extrapolated to all youth-onset diabetes in the U.S., we estimate 110,051 cases of DR developing within ~12 years post-diagnosis. Tight glucose and blood pressure management may offer opportunity to mitigate development and progression of DR in youth-onset diabetes. </p

Effect of lifestyle interventions on cardiovascular risk factors among adults without impaired glucose tolerance or diabetes: A systematic review and meta-analysis

<div><p>Structured lifestyle interventions can reduce diabetes incidence and cardiovascular disease (CVD) risk among persons with impaired glucose tolerance (IGT), but it is unclear whether they should be implemented among persons without IGT. We conducted a systematic review and meta-analyses to assess the effectiveness of lifestyle interventions on CVD risk among adults without IGT or diabetes. We systematically searched MEDLINE, EMBASE, CINAHL, Web of Science, the Cochrane Library, and PsychInfo databases, from inception to May 4, 2016. We selected randomized controlled trials of lifestyle interventions, involving physical activity (PA), dietary (D), or combined strategies (PA+D) with follow-up duration ≥12 months. We excluded all studies that included individuals with IGT, confirmed by 2-hours oral glucose tolerance test (75g), but included all other studies recruiting populations with different glycemic levels. We stratified studies by baseline glycemic levels: (1) low-range group with mean fasting plasma glucose (FPG) <5.5mmol/L or glycated hemoglobin (A1C) <5.5%, and (2) high-range group with FPG ≥5.5mmol/L or A1C ≥5.5%, and synthesized data using random-effects models. Primary outcomes in this review included systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), and triglycerides (TG). Totally 79 studies met inclusion criteria. Compared to usual care (UC), lifestyle interventions achieved significant improvements in SBP (-2.16mmHg[95%CI, -2.93, -1.39]), DBP (-1.83mmHg[-2.34, -1.31]), TC (-0.10mmol/L[-0.15, -0.05]), LDL-C (-0.09mmol/L[-0.13, -0.04]), HDL-C (0.03mmol/L[0.01, 0.04]), and TG (-0.08mmol/L[-0.14, -0.03]). Similar effects were observed among both low-and high-range study groups except for TC and TG. Similar effects also appeared in SBP and DBP categories regardless of follow-up duration. PA+D interventions had larger improvement effects on CVD risk factors than PA alone interventions. In adults without IGT or diabetes, lifestyle interventions resulted in significant improvements in SBP, DBP, TC, LDL-C, HDL-C, and TG, and might further reduce CVD risk.</p></div

Correlation between CVD Risk Reduction and FPG and Weight.

<p>Correlation between CVD Risk Reduction and FPG and Weight.</p

changes in high density lipoprotein cholesterol in the intervention versus usual care groups (mmol/L).

<p>Group 1: low-range glycemic group (FPG<5.5mmol/L or A1C <5.5%). Group 2: high-range glycemic group (FPG ≥5.5mmol/L or A1C ≥5.5%). D, diet, PA, physical activity. UC, usual care, vs, versus.</p

changes in low density lipoprotein cholesterol in the intervention versus usual care groups (mmol/L).

<p>Group 1: low-range glycemic group (FPG<5.5mmol/L or A1C <5.5%). Group 2: high-range glycemic group (FPG ≥5.5mmol/L or A1C ≥5.5%). D, diet, PA, physical activity, UC, usual care, vs, versus.</p

Study flow diagram.

<p>CINAHL, Cumulative Index to Nursing and Allied Health Literature EMBASE, Excerpta Medica Database MEDLINE, Medical Literature Analysis and Retrieval System Online PsycInfo, Psychological Information Database WOS, Web of Science.</p

Characteristics of study participants.

<p>Characteristics of study participants.</p

changes in diastolic blood pressure in the intervention versus usual care groups (mmHg).

<p>Group 1: low-range glycemic group (FPG<5.5mmol/L or A1C <5.5%). Group 2: high-range glycemic group (FPG ≥5.5mmol/L or A1C ≥5.5%). D, diet, PA, physical activity, UC, usual care, vs, versus.</p

Lifestyle interventional effect: Meta-analyses results.

<p>Lifestyle interventional effect: Meta-analyses results.</p