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University of Copenhagen The Danish registry of diabetic retinopathy Andersen, Mads Varis Nis; Hjortdal, Jesper Østergaard; Schielke, Katja Christina; Bek, Toke; Grauslund, Jakob; Laugesen, Caroline Schmidt; Lund-Andersen, Henrik; Cerqueira, Charlotte; Andresen, Jens Published in: Clinical Epidemiology DOI: 10.2147/CLEP.S99507 Publication date: 2016 Document version Publisher's PDF, also known as Version of record Document license: CC BY-NC Citation for published version (APA): Andersen, M. V. N., Hjortdal, J. Ø., Schielke, K. C., Bek, T., Grauslund, J., Laugesen, C. S., Lund-Andersen, H., Cerqueira, C., & Andresen, J. (2016). The Danish registry of diabetic retinopathy. Clinical Epidemiology, 8, 613- 619. https://doi.org/10.2147/CLEP.S99507 Download date: 26. sep.. 2021 Journal name: Clinical Epidemiology Article Designation: Review Year: 2016 Volume: 8 Clinical Epidemiology Dovepress Running head verso: Andersen et al Running head recto: The Danish Registry of Diabetic Retinopathy open access to scientific and medical research DOI: http://dx.doi.org/10.2147/CLEP.S99507 Open Access Full Text Article REVIEW The Danish Registry of Diabetic Retinopathy Nis Andersen1,2 Aim of database: To monitor the development of diabetic eye disease in Denmark and to Jesper Østergaard evaluate the accessibility and effectiveness of diabetic eye screening programs with focus on Hjortdal1,3 interregional variations. Katja Christina Schielke4 Target population: The target population includes all patients diagnosed with diabetes. Toke Bek3 Denmark (5.5 million inhabitants) has ~320,000 diabetes patients with an annual increase of 27,000 newly diagnosed patients. The Danish Registry of Diabetic Retinopathy (DiaBase) Jakob Grauslund5 collects data on all diabetes patients aged ≥18 years who attend screening for diabetic eye disease Caroline Schmidt Laugesen6 in hospital eye departments and in private ophthalmological practice. In 2014–2015, DiaBase 7 Henrik Lund-Andersen included data collected from 77,968 diabetes patients. Charlotte Cerqueira8 For personal use only. Main variables: The main variables provide data for calculation of performance indicators to 2 Jens Andresen monitor the quality of diabetic eye screening and development of diabetic retinopathy. Data with 1Danish Ophthalmological Society, respect to age, sex, best corrected visual acuity, screening frequency, grading of diabetic retinopa- 2 Copenhagen, Organization of thy and maculopathy at each visit, progression/regression of diabetic eye disease, and prevalence of Danish Ophthalmologists in Private Practice, Copenhagen, 3Department blindness were obtained. Data analysis from DiaBase’s latest annual report (2014–2015) indicates of Ophthalmology, Aarhus University that the prevalence of no diabetic retinopathy, nonproliferative diabetic retinopathy, and prolifera- 4 Hospital, Aarhus, Department of tive diabetic retinopathy is 78%, 18%, and 4%, respectively. The percentage of patients without Ophthalmology, Aalborg University Hospital, Aalborg, 5Department of diabetic maculopathy is 97%. The proportion of patients with regression of diabetic retinopathy Ophthalmology, Odense University (20%) is greater than the proportion of patients with progression of diabetic retinopathy (10%). Hospital, Odense, 6Department The collection of data from diabetic eye screening is still expanding in Denmark. of Ophthalmology, Copenhagen Conclusion: University Hospital Roskilde, Roskilde, Analysis of the data collected during the period 2014–2015 reveals an overall decrease of diabetic Clinical Epidemiology downloaded from https://www.dovepress.com/ by 130.225.178.2 on 05-Jan-2018 7Department of Ophthalmology, retinopathy compared to the previous year, although the number of patients newly diagnosed Glostrup Hospital, 8Registry Support Centre (East) – Epidemiology and with diabetes has been increasing in Denmark. DiaBase is a useful tool to observe the quality Biostatistics, Research Centre for of screening, prevalence, and progression/regression of diabetic eye disease. Prevention and Health, Keywords: diabetes, DiaBase, Danish Diabetes Database, national annual report, quality of Rigshospitalet – Glostrup, University of Copenhagen, Copenhagen, care, database, registry, quality indicator Denmark Introduction Diabetic retinopathy is the most common complication in diabetes.1,2 It is a chronic, progressive, potentially sight-threatening disease of the retinal microvasculature that is associated with prolonged hyperglycemia and other conditions linked to diabetes mellitus such as hypertension.3 The threat to sight is due to either growth Correspondence: Nis Andersen Amagerbro Øjenklinik, Amagerbrogade of new vessels leading to intraocular hemorrhage and possible retinal detachment 62, 2300 København, Denmark with profound sight loss or localized damage to the macula of the eye with loss of Tel +45 3295 6129 Email [email protected] central visual acuity.3 submit your manuscript | www.dovepress.com Clinical Epidemiology 2016:8 613–619 (Thematic series on clinical quality databases in Denmark) 613 Dovepress © 2016 Andersen et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work http://dx.doi.org/10.2147/CLEP.S99507 you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Powered by TCPDF (www.tcpdf.org) 1 / 1 Andersen et al Dovepress Grading of diabetic retinopathy is based on visible signs inhabitants) has ~320,000 diabetes patients with an annual of increasing severity on ophthalmoscopy and on imag- increase of ~27,000 newly diagnosed patients.10 The preva- ing. Diabetic retinopathy is classified as proliferative or lence of diabetes in Denmark has more than doubled since nonproliferative (background/preproliferative) retinopathy 1996 and was 5737 per 100,000 people in 2012.10 DiaBase based on the presence or absence of abnormal new vessels, contains data on all diabetes patients aged ≥18 years who respectively. attend screening for diabetic eye disease in the five regions Subgroups of nonproliferative diabetic retinopathy of Denmark. Eye examination of children with diabetes is (mild, moderate, preproliferative) reflect increasing severity recorded in the Children Diabetes Registry (DanDiabKids of the disease, which consequently results in shortening of [children and teenagers with diabetes <18 years old]). In screening intervals.4 Nonproliferative diabetic retinopathy is 2011, the Adult Diabetes Registry (adult patients with dia- typically managed by optimizing the patient’s general health. betes from 18 years old), the DiaBase, and the DanDiabKids Treatment of proliferative diabetic retinopathy comprises joined to form the Danish Diabetes Database.9 panretinal photocoagulation. It is hypothesized that this DiaBase receives data collected from hospital eye depart- technique reduces the amount of ischemic retina, and thus ments and private ophthalmological practices where diabetes the production of angiogenic molecules. patients aged ≥18 years attend diabetic eye screening. In Retinopathy affecting the macula is separately described Denmark, diabetes care is managed by both primary care as diabetic maculopathy. Diabetic maculopathy is a leading physicians in private practice and hospital-based endocrinolo- cause of visual loss in diabetic retinopathy. It usually affects gists. Diabetic eye screening for most patients attending their older, noninsulin-dependent diabetes patients. Diabetic primary care physician is delivered by an ophthalmologist maculopathy is divided into three types, based on whether in private practice. Patients being followed in endocrinology it causes focal, ischemic or diffuse edema, and may include departments receive diabetic eye screening in the eye depart- tractional (vitreoretinal) or nontractional (intraretinal) com- ment of the respective hospital. Data from each screening ponents.3 The management of diabetic macular edema has visit are collected and sent electronically to DiaBase. An For personal use only. advanced significantly with the introduction of anti-VEGF annual report analyzing diabetes screening data from the (vascular endothelial growth factor) treatments.3 However, previous year is issued every spring by the steering commit- macular laser treatment still plays a major role in treating tee. National guidelines, based on international guidelines,3,5 noncenter-involving macular edema.5 determine screening intervals and treatment protocols. Vision loss due to diabetic retinopathy is one of the DiaBase was established between 2003 and 2006 and is leading causes of visual loss worldwide and is an important still in the development process. The systematic collection cause of impaired vision and disability in the working-age of outpatient data from hospitals in Denmark started in 2007 population.6,7,8 Advanced diabetic eye disease has a negative and was extended nationwide in 2010. Data collection on influence on quality of life.6 Therefore, eye screening for the patients screened by ophthalmologists in private practice Clinical Epidemiology downloaded from https://www.dovepress.com/
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