Prevalence, incidence and future projection of diabetic eye disease in Europe: a systematic review and meta-analysis
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To examine the prevalence and incidence of diabetic eye disease (DED) among individuals with diabetes in Europe, a systematic review to identify all published European prevalence and incidence studies of DED in individuals with diabetes managed in primary health care was performed according to the MOOSE and PRISMA guidelines. The databases Medline, Embase and Web of Science were searched to 2 September 2017. Meta-analyses and meta-regressions were performed. The pooled prevalence estimates were applied to diabetes prevalence rates provided by the International Diabetes Foundation atlas and Eurostat population data, and extrapolated to the year 2050. Data of 35 prevalence and four incidence studies were meta-analyzed. Any diabetic retinopathy (DR) and diabetic macular edema (DME) were prevalent in 25.7% (95% CI 22.8–28.8%) and 3.7% (95% CI 2.2–6.2%), respectively. In meta-regression, the prevalence of DR in persons with type 1 diabetes was significantly higher compared to persons with type 2 diabetes (54.4% vs. 25.0%). The pooled mean annual incidence of any DR and DME in in persons with type 2 diabetes was 4.6% (95% CI 2.3–8.8%) and 0.4% (95% CI 0.5–1.4%), respectively. We estimated that persons with diabetes affected by any DED in Europe will increase from 6.4 million today to 8.6 million in 2050, of whom 30% require close monitoring and/or treatment. DED is estimated to be present in more than a quarter of persons with type 2 diabetes and half of persons with type 1 diabetes underlining the importance of regular monitoring. Future health services need to be planned accordingly.
KeywordsDiabetic retinopathy Epidemiology Prevalence Incidence Diabetic eye disease Diabetic macular edema Extrapolation
RPF conceived and designed the study. JQL, JLe, CW, and IPC undertook the literature search, extracted data and performed quality assessment of the included studies. JQL, TW, and MS performed the data analysis. JQL, TW, MS, FGH, and RPF interpreted data. JQL and RPF wrote the first draft of the report. RPF as guarantor accepts full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish. All authors provided critical comments and approved the final version.
European Society of Retina Specialists (EURETINA) project grant, the Jackstaedt Stiftung, and the Else Kroehner Fresenius Stiftung. None of the funders were involved in the study design, in the collection, analysis, and interpretation of data, in the writing of the report, or in the decision to submit the article for publication. All researchers confirm their independence from funders. All authors, external and internal, had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.
Compliance with ethical standards
Conflict of interest
None of the authors had any financial relationships with any of the organisations that might have an interest in the submitted work (ADA Policy Statement on Duality of Interest). No other relationships or activities that could appear to have influenced the submitted work.
Ethics committee approval or written informed consent was not required, as our review relied entirely on publicly available published data.
- 2.Bourne RRA, Jonas JB, Bron AM, Cicinelli MV, Das A, Flaxman SR, et al. Prevalence and causes of vision loss in high-income countries and in Eastern and Central Europe in 2015: magnitude, temporal trends and projections. Br J Ophthalmol. 2018;102:575–85. https://doi.org/10.1136/bjophthalmol-2017-31125.CrossRefGoogle Scholar
- 5.Wong TY, Sun J, Kawasaki R, Ruamviboonsuk P, Gupta N, van Lansingh C, et al. Guidelines on diabetic eye care: the international council of ophthalmology recommendations for screening, follow-up, referral, and treatment based on resource settings. Ophthalmology. 2018;125:1608–22.CrossRefGoogle Scholar
- 6.International Diabetes Federation. IDF diabetes atlas. 8th ed. Brussels: International Diabetes Federation; 2017.Google Scholar
- 12.Meurer P, Schluchter M. Wissenschaftliches Arbeiten mit Citavi 5. Hinweise zum Schreiben wissenschaftlicher Arbeiten mit der Software» Citavi–Literaturverwaltung und Wissensorganisation « 2015: Zugriff am.Google Scholar
- 15.R Core Team. R. A language and environment for statistical computing. 2015. https://www.R-project.org. Accessed 2 Sept 2017
- 16.Schwarzer G. Meta: an R package for meta-analysis. R News. 2007;7:40–5.Google Scholar
- 19.United Nations Statistics Division. Standard Country and area codes for statistical use (M49). https://unstats.un.org/unsd/methodology/m49/. Accessed 3 May 2019.
- 20.Friberg E, Orsini N, Mantzoros CS, Wolk A. Diabetes mellitus and risk of endometrial cancer: a meta-analysis. New York: Springer; 2007.Google Scholar
- 22.Eurostat. Population on 1 January. 2016. http://ec.europa.eu/eurostat/tgm/table.do?tab=table&init=1&plugin=1&language=en&pcode=tps00001. Accessed 11 May 2017.
- 23.Eurostat. People in the EU – population projections. http://ec.europa.eu/eurostat/statistics-explained/index.php/People_in_the_EU_%E2%80%93_population_projections (2015). Accessed 14 Jul 2017.
- 24.Eurostat. Population projections. http://ec.europa.eu/eurostat/tgm/table.do?tab=table&init=1&plugin=1&language=de&pcode=tps00002 (2016). Accessed 11 May 2017.
- 31.Goldaracena MB, Escudero JM, Arrondo A, Villarrubia A, Aramendia B, Iturralde R. Prevalencia de retinopatía diabética en una población diabética registrada en atención primaria. Prevalence of diabetic retinopathy. A population based study in primary health care. 1998.Google Scholar
- 32.Hernández Mira G, Macarro Merino A, Fernández Perianes J, Fernández Vigo J. Prevalencia de retinopatía diabética en Extremadura. Av Diabetol. 1996;12:165–71.Google Scholar
- 33.Gil Hernández MA, Abreu Reyes P, Pareja Rios A, Martinez Piñero A. Estudio de la retinopatía diabética en la población de la isla de Hierro. Arch Soc Canar Oftal. 2000;11:23–6.Google Scholar
- 37.Romero-Aroca P, Fernandez-Alart J, Baget-Bernaldiz M, Mendez-Marin I, Salvat-Serra M. Diabetic retinopathy epidemiology in type II diabetic patients. Effect of the changes in the diagnostic criteria and stricter control of the diabetes between 1993 and 2005 on the incidence of diabetic retinopathy. Arch Soc Esp Oftalmol. 2007;82:209–18.CrossRefGoogle Scholar
- 38.Bueso E, Fernandez-Vigo J, Perez C, Merino A, Perianes J. Prevalence of diabetic retinopathy in the Regional Community of Extremadura. 1997–2001 (Extremadura Project to Prevent Blindness). Arch Soc Esp Oftalmol. 2005;80:187–94.Google Scholar
- 39.Santos Bueso E, Macarro Merino A, Garrote Florencio T, Fernández-Vigo López J. Prevalencia de retinopatía diabética en el centro de salud de Torrejoncillo (Cáceres). Av Diabetol. 2002;18:203–7.Google Scholar
- 40.Santos-Bueso E, Fernandez-Perez C, Macarro A, Fernandez-Vigo J. Prevalence of diabetic retinopathy in the city of Badajoz 2002 (Extremadura project to prevent blindness). Arch Soc Esp Oftalmol. 2007;82:153–8.Google Scholar
- 41.Teruel MC, Fernandez-Real JM, Ricart W, Valent FR, Valles PM. Prevalence of diabetic retinopathy in the region of Girona. Study of related factors. Arch Soc Esp Oftalmol. 2005;80:85–91.Google Scholar
- 45.Ellis JD, Zvandasara T, Leese G, McAlpine R, Macewen CJ, Baines PS, et al. Clues to duration of undiagnosed disease from retinopathy and maculopathy at diagnosis in type 2 diabetes: a cross-sectional study. Br J Ophthalmol. 2011;95:1229–33. https://doi.org/10.1136/bjo.2010.196204.CrossRefGoogle Scholar
- 48.Leese GP, Morris AD, Swaminathan K, Petrie JR, Sinharay R, Ellingford A, et al. Implementation of national diabetes retinal screening programme is associated with a lower proportion of patients referred to ophthalmology. Diabet Med. 2005;22:1112–5. https://doi.org/10.1111/j.1464-5491.2005.01603.x.CrossRefGoogle Scholar
- 53.Gunnlaugsdottir E, Halldorsdottir S, Klein R, Eiriksdottir G, Klein BE, Benediktsson R, et al. Retinopathy in old persons with and without diabetes mellitus: the Age, Gene/Environment Susceptibility-Reykjavik Study (AGES-R). Diabetologia. 2012;55:671–80. https://doi.org/10.1007/s00125-011-2395-y.CrossRefGoogle Scholar
- 57.Medeiros MD, Mesquita E, Papoila AL, Genro V, Raposo JF. First diabetic retinopathy prevalence study in Portugal: RETINODIAB Study—evaluation of the screening programme for Lisbon and Tagus Valley region. Br J Ophthalmol. 2015;99:1328–33. https://doi.org/10.1136/bjophthalmol-2015-306727.CrossRefGoogle Scholar
- 63.The Royal College of Ophthalmologists. Diabetic Retinopathy Guidelines December 2012; 2012.Google Scholar
- 66.Thomas RL, Dunstan F, Luzio SD, Roy CS, Hale SL, North RV, et al. Incidence of diabetic retinopathy in people with type 2 diabetes mellitus attending the Diabetic Retinopathy Screening Service for Wales: retrospective analysis. BMJ. 2012;344:e874. https://doi.org/10.1136/bmj.e874.CrossRefGoogle Scholar
- 72.Centers for Disease Control and Prevention. Age-adjusted percentage of adults with diabetes using diabetes medication, by type of medication, United States, 1997–2011; 2015.Google Scholar
- 76.Higgins JP, Deeks JJ, Higgins J, Green S. 9.5. 4 Incorporating heterogeneity into random-effects models. Cochrane handbook for systematic reviews of interventions, Version. 2011;5.Google Scholar
- 77.Hocking A, Laurence C, Lorimer M. Patients’ knowledge of their chronic disease: the influence of socio-demographic characteristics. Aust Fam Physician. 2013;42:411.Google Scholar
- 79.Diabetic Retinopathy Study Research Group. Report No. 7: a modification of the Airlie House classification of diabetic retinopathy. Investig Ophthalmol Vis Sci. 1981;21:210–26.Google Scholar
- 80.Massin P, Angioi-Duprez K, Bacin F, Cathelineau B, Cathelineau G, Chaine G, et al. Detection, monitoring and treatment of diabetic retinopathy. Recommendations of ALFEDIAM. Committee of above-mentioned experts and validated by the board of directors and scientific board of ALFEDIAM. Diabetes Metab. 1996;22:203–9.Google Scholar
- 82.Facey K, Cummins E, Macpherson K, Morris A, Reay L, Slattery J. Health technology assessment report 1: organisations of services for diabetic retinopathy screening. Glasgow: Health Technology Board for Scotland; 2002.Google Scholar