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Proliferative diabetic retinopathy in long-term diabetic patients with and without clinical osteoarthritis.

ABSTRACT: OBJECTIVE: To determine whether some long-term diabetic patients with coexisting clinical osteoarthritis (OA) are less likely to develop diabetic retinopathy (DR) than other diabetic patients and whether there is a relation between the timing of the clinical OA onset and DR. DESIGN, SETTING, AND PARTICIPANTS: Retrospective case-control study of 85 osteoarthritic patients with 20 years or more diabetes (A/DM) control group and of 85 non-osteoarthritic diabetic patients (NoA/DM) matched for age, race, duration, and type of diabetes. Digital fundus photographs were graded for retinopathy in masked manner. RESULTS: Glycosylated hemoglobin, hypertension, and smoking showed no significant difference. Twelve out of 85 patients (12.9%) in A/DM group developed proliferative diabetic retinopathy (PDR) whereas 79/85 (92.9%) NoA/DM patients developed PDR (P<0.001). The onset of OA symptoms was known in 80/85 of the A/D patients, including 47 patients with onset before or at the same year as DM and 33 patients with relative onset after the year of DM. All the 10 patients with PDR (10/33) developed OA subsequent to their initiation for diabetic treatment while 0/47 A/DM patients with the onset of osteoarthritic symptoms present before or the same year as their onset of diabetes developed PDR (P<0.001). CONCLUSION: Our study suggests that in long-term DM, PDR was significantly associated with the absence of concomitant clinical OA. This observation was highly significant if the onset of the arthritis was the same year or before the onset of the diabetes.

SUBMITTER: Skolik SA

PROVIDER: S-EPMC3545377 | biostudies-other | 2013 Jan

REPOSITORIES: biostudies-other

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Project description:IntroductionFew qualitative studies have explored the patient experience of daily life with proliferative diabetic retinopathy (PDR) and associated treatments. Herein, a conceptual model was developed to comprehensively examine symptoms, functional impacts, and treatment experiences in PDR.MethodsA qualitative, mixed-methods study comprising a literature search and semi-structured interviews with clinicians and patients was conducted. Published literature and online patient resources were searched to identify concepts relevant to patients, including symptoms, functional impacts, and treatment experiences of PDR. Semi-structured interviews with experienced clinicians were conducted to identify symptoms and impacts reported by patients with PDR and to receive feedback regarding concepts identified from the literature search. A preliminary conceptual model was then developed based on findings from the literature search and clinician interviews. Patients with PDR participated in two rounds of semi-structured interviews to identify additional concepts relevant to the patient experience in PDR and associated treatments, which informed revisions to the conceptual model. Saturation of patient interviews was assessed.ResultsFindings from the literature search and clinician interviews yielded 109 concepts that were included in a preliminary conceptual model with three overarching domains: symptoms, impacts, and managing the disease. Clinicians confirmed concepts identified from the literature search. During interviews, patients reported a broad spectrum of symptoms (e.g., red vision); functional impacts relating to activities of daily living (e.g., reading), emotional functioning (e.g., loss of independence), and social functioning (e.g., problems recognizing faces); and treatment experiences (e.g., improves eye problems, no change) associated with PDR. Additional concepts elicited in patient interviews informed revisions to the conceptual model. Saturation was achieved in the patient sample.ConclusionsA wide variety of symptoms, functional impacts, and treatment experiences that significantly affect health-related quality of life were identified in patients with PDR. These insights are critical for understanding PDR symptomology and assessing treatment response.

Project description:Purpose:This study determined the clinical impact and causes of loss to follow-up (LTFU) from the patients' perspective in individuals with proliferative diabetic retinopathy (PDR) who received panretinal photocoagulation (PRP) and/or intravitreal injections (IVIs) of antivascular endothelial growth factor (VEGF). Methods:This prospective cohort study included 467 patients with PDR who received PRP and/or IVIs of anti-VEGF between May 2013 and June 2018. LTFU was defined as missing any follow-up visit for any interval exceeding 6 months, provided that patients eventually resumed care. Main outcome measures include rates and causes of LTFU. Results:A total of 391 patients (83.7%) were followed up, and 76 patients (16.3%) were LTFU over the study period. Rates of LTFU decreased with age (P=0.005). Questionnaire analysis conducted for patients' LTFU showed a significant positive correlation between best corrected visual activity (BCVA) loss and patient's lack of trust and satisfaction with treatment (rs?=?0.458, P=0.005). Questionnaire analysis conducted for patients' LTFU showed a significant positive correlation between best corrected visual activity (BCVA) loss and patient's lack of trust and satisfaction with treatment (rs?=?0.458, P=0.005). Questionnaire analysis conducted for patients' LTFU showed a significant positive correlation between best corrected visual activity (BCVA) loss and patient's lack of trust and satisfaction with treatment (rs?=?0.458, P=0.005). Questionnaire analysis conducted for patients' LTFU showed a significant positive correlation between best corrected visual activity (BCVA) loss and patient's lack of trust and satisfaction with treatment (rs?=?0.458. Conclusions:LTFU threatens vision in PDR patients receiving PRP and/or IVIs of anti-VEGF. Possibly, patient-specific LTFU causes should be addressed before treatment in order to minimize the risk of LTFU. The clinical trial is registered with NCT04018326 (trial registration: ClinicalTrials.gov Identifier: NCT04018326, 10th of July 2019 "Retrospectively registered").

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Proliferative diabetic retinopathy in long-term diabetic patients with and without clinical osteoarthritis.

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