OBJECTIVES:

To determine the burden of DR in people with diabetes (PWD) in Gloucestershire between 2013 and 2016.

METHODS:

The cohort comprised PWD 18+ years with a screening encounter in the Diabetic Eye Screening Programme or with DR assessment recorded in HES. Early Treatment Diabetic Retinopathy Study (ETDRS) classification was used. Incidence was defined as first diagnosis of DR. In addition, Office for National Statistics data were used to estimate the general population of Gloucestershire (aged 18+).

RESULTS:

In the cohort of 34,559 PWD, 5,920 were newly diagnosed with DR between 2013 and 2016, (diabetes duration 7.8 years (4.7-11.6) (median, i.q. range), 96.4% had type 2 diabetes mellitus (T2DM)). In 2016, prevalences (95% CI) per 1,000 PWD of mild non-proliferative DR (NPDR) (ETDRS20-35/R1), moderate-severe NPDR(ETDRS43-53/R2) and proliferative DR (ETDRS61+/R3), were 225(220-230), 27.1(25.4-28.9), and 23.8(22.2-25.5), respectively. In PWD prevalence of all severity groups remained constant except for NPDR 53 which decreased from 0.85% in 2013 to 0.62% in 2016(p=0.001). In 2016, prevalence of any DR increased from 19.9% in those with known duration of diabetes <1 year to 44.9% in those with known duration 12+years (p<0.001). In those with Type 1 diabetes mellitus (T1DM) the incidence of NPDR 43 or worse, and prevalence of any DR (0.94% and 5.3% respectively) were significantly higher than in those with T2DM (0.37% and 26.6% (p<0.001 for both)) in 2016. No gender differences were found. In general population of Gloucestershire, DR prevalence increased from 17.2(16.9-17.6) per 1,000 in 2013 to 18.7(18.3-19.0) in 2016 (p<0.001)(during which time the prevalence of diabetes increased from 6.4% to 6.9%(p<0.001))

CONCLUSIONS:

DR prevalence rates in PWD generally did not increase over the study period. They were higher in those with T1DM or longer known diabetes duration. The increase in DR prevalence and incidence in the general population reflected the local increase of diabetes.