1、型糖尿病 DR 筛查成本可降低近四分之一近日，英国埃克塞特大学医药和牙科半岛学院开展的一项研究发现将那些尚未形成糖尿病视网膜病变（DR）的型糖尿病患者的筛查从每年一次改为每两年 1 次会是一个既安全又经济有效的策略。论文近期在线发布于 Diabetes Care 上。美国国立卫生研究组对该研究提供资金，半岛医学院研究协作组进行健康研究和护理（NIHRPenCLAHRC） 。DR 是糖尿病的常见并发症之一。血糖较高时就会损伤视网膜细胞导致 DR，若不进行相关治疗，其可能会导致失明。部分糖尿病视网膜病变患者发病缓慢经过若干年才会发生DR。研究人员提出了一个模型，可模拟型糖尿病患者视网膜病变的进展并
2、进行筛查，进而可预测 DR 失明率。模型中的数据来自英国皇家德文郡和埃克塞特国民保健服务中心（RoyalDevon & Exeter NHS） ，并且研究人员对比了 15 年的预期结果，以评估当前 DR 筛查策略与本研究中的筛查方法。研究表明，既往未诊断 DR 的型糖尿病患者每两年一次筛查是非常安全的，过去患者需每年进行一次筛查。理由是研究人员发现发生 DR 相关的视力缺损患者比例在两次视网膜病变筛查间隔内并无显著性差异。视网膜病变检查皇家德文郡和埃克塞特国民保健服务中心（RoyalDevon & Exeter NHS）这项研究中的 3537名视网膜病变患者进行了筛查，并发现此举使得医疗花费明
3、显降低，从每年 183 万降至136 万美元。在英国 280 万糖尿病患者中，10%的患者确诊为 DR。英国国家临床卓越研究制定的临床指南是每年进行一次 DR 筛查，该协会也承认确定每年一次筛查周期是不太准确，同时期待研究人员能找出更合适的 DR 筛查周期。本研究领头人为 DanielChalk 博士,他是应用运筹学，半岛健康协作组，应用研究与发展部门的副研究员，他谈到，尽管此项研究并非第一次针对 DR 筛查，但却是第一次着重于既往未诊断 DR 的型糖尿病患者。一般来说 DR 病情进展缓慢，因此想将筛查周期由过去的每年一次改为每两年一次。Daniel Chalk 博士补充道：“我们研究发现针对
4、型糖尿病患者的 DR 筛查，无论是每两年一次还是每年一次都无明显差别。因此将 DR 的筛查间期由每年一次改为每两年一次是安全经济有效的。为进一步研究，制定一个有效回访体系加强患者对 DR 筛查的认识活动将是非常有必要的，并且 DR 筛查周期延长决不能降低筛查的有效性。原文摘要：Can the Retinal Screening Interval Be Safely Increased to 2 Years for Type 2 Diabetic Patients Without Retinopathy?Pitt M,Chalk D,Vaidya B,et al.Abstract： OBJECT
5、IVEIn the U.K., people with diabetes are typically screened for retinopathy annually. However, diabetic retinopathy sometimes has a slow progression rate. We developed a simulation model to predict the likely impact of screening patients with type 2 diabetes, who have not been diagnosed with d. OBJE
6、CTIVEIn the U.K., people with diabetes are typically screened for retinopathy annually. However, diabetic retinopathy sometimes has a slow progression rate. We developed a simulation model to predict the likely impact of screening patients with type 2 diabetes, who have not been diagnosed with diabe
7、tic retinopathy, every 2 years rather than annually. We aimed to assess whether or not such a policy would increase the proportion of patients who developed retinopathy-mediated vision loss compared with the current policy, along with the potential cost savings that could be achieved.RESEARCH DESIGN
8、 AND METHODSWe developed a model that simulates the progression of retinopathy in type 2 diabetes patients, and the screening of these patients, to predict rates of retinopathy-mediated vision loss. We populated the model with data obtained from a National Health Service Foundation Trust. We generat
9、ed comparative 15-year forecasts to assess the differences between the current and proposed screening policies.RESULTSThe simulation model predicts that implementing a 2-year screening interval for type 2 diabetes patients without evidence of diabetic retinopathy does not increase their risk of visi
10、on loss. Furthermore, we predict that this policy could reduce screening costs by 25%.CONCLUSIONSScreening people with type 2 diabetes, who have not yet developed retinopathy, every 2 years, rather than annually, is a safe and cost-effective strategy. Our findings support those of other studies, and we therefore recommend a review of the current National Institute for Health and Clinical Excellence (NICE) guidelines for diabetic retinopathy screening implemented in the U.K.
