Transition probabilities of diabetic retinopathy and death in an Asian population with diabetes

Purpose: To evaluate the dynamic transitions in diabetic retinopathy (DR) severity over time and associated risk factors in an Asian population with diabetes. Design: Longitudinal cohort study Methods: We analyzed data from 9481 adults in the Singapore Integrated Diabetic Retinopathy Screening Progr...

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Main Authors: Seshasai, Sudarshan, He, Feng, Lam, Betty, Hamzah, Haslina, Cheng, Ching-Yu, Li, Jialiang, Wong, Tien Yin, Tan, Gavin Siew Wei, Sabanayagam, Charumathi
Other Authors: Lee Kong Chian School of Medicine (LKCMedicine)
Format: Article
Language:English
Published: 2024
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Online Access:https://hdl.handle.net/10356/179767
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spelling sg-ntu-dr.10356-1797672024-08-25T15:38:20Z Transition probabilities of diabetic retinopathy and death in an Asian population with diabetes Seshasai, Sudarshan He, Feng Lam, Betty Hamzah, Haslina Cheng, Ching-Yu Li, Jialiang Wong, Tien Yin Tan, Gavin Siew Wei Sabanayagam, Charumathi Lee Kong Chian School of Medicine (LKCMedicine) Medicine, Health and Life Sciences Multistate model Risk factors Purpose: To evaluate the dynamic transitions in diabetic retinopathy (DR) severity over time and associated risk factors in an Asian population with diabetes. Design: Longitudinal cohort study Methods: We analyzed data from 9481 adults in the Singapore Integrated Diabetic Retinopathy Screening Program (2010–2015) with linkage to death registry. A multistate Markov model adjusted for age, sex, systolic blood pressure (SBP), diabetes duration, HbA1c, and body mass index (BMI) was applied to estimate annual transition probabilities between four DR states (no, mild, moderate, and severe/proliferative) and death, and the mean sojourn time in each state. Results: The median assessment interval was 12 months, with most patients having 3 assessments. Annual probabilities for DR progression (no-to-mild, mild-to-moderate and moderate-to-severe/proliferative) were 6.1 %, 7.0 % and 19.3 %, respectively; and for regression (mild-to-no, moderate-to-mild and severe-to-moderate) were 55.4 %, 17.3 % and 4.4 %, respectively. Annual mortality rates from each DR state were 1.2 %, 2.0 %, 18.7 %, and 30.0 %. The sojourn time in each state were 8.2, 0.8, 0.8 and 2.2 years. Higher HbA1c and SBP levels were associated with progression of no-mild and mild-moderate DR, and diabetes duration with no-to-mild and moderate-to-severe/proliferative DR. Lower HbA1c levels were associated with regression from mild-to-no and moderate-to-mild, and higher BMI with mild-to-no DR. Conclusions: Our results suggest a prolonged duration (∼8 years) in developing mild DR, with faster transitions (within a year) from mild or moderate states. Moderate/above DR greatly increases the probability of progression and death as compared to mild DR/below. HbA1c was associated with both progression as well as regression. Ministry of Health (MOH) National Medical Research Council (NMRC) Published version This study was supported by the Singapore Ministry of Health’s National Medical Research Council, NMRC/OFLCG/MOH-001327-03 and NMRC/HCSAINV/MOH-001019-00. The Singapore Diabetic Retinopathy Program (SiDRP) received funding from the Singapore Ministry of Health’s (AIC/RPDD/SIDRP/SERI/FY2013/0018 & AIC/HPD/FY2016/0912). 2024-08-21T06:08:52Z 2024-08-21T06:08:52Z 2024 Journal Article Seshasai, S., He, F., Lam, B., Hamzah, H., Cheng, C., Li, J., Wong, T. Y., Tan, G. S. W. & Sabanayagam, C. (2024). Transition probabilities of diabetic retinopathy and death in an Asian population with diabetes. Asia-Pacific Journal of Ophthalmology, 13(3), 100070-. https://dx.doi.org/10.1016/j.apjo.2024.100070 2162-0989 https://hdl.handle.net/10356/179767 10.1016/j.apjo.2024.100070 38777093 2-s2.0-85193957525 3 13 100070 en NMRC/OFLCG/MOH-001327-03 NMRC/HCSAINV/MOH-001019-00 AIC/RPDD/SIDRP/SERI/FY2013/0018 AIC/HPD/FY2016/0912 Asia-Pacific Journal of Ophthalmology © 2024 The Author(s). Published by Elsevier Inc. on behalf of Asia-Pacific Academy of Ophthalmology and Academy of Asia-Pacific Professors of Ophthalmology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). application/pdf
institution Nanyang Technological University
building NTU Library
continent Asia
country Singapore
Singapore
content_provider NTU Library
collection DR-NTU
language English
topic Medicine, Health and Life Sciences
Multistate model
Risk factors
spellingShingle Medicine, Health and Life Sciences
Multistate model
Risk factors
Seshasai, Sudarshan
He, Feng
Lam, Betty
Hamzah, Haslina
Cheng, Ching-Yu
Li, Jialiang
Wong, Tien Yin
Tan, Gavin Siew Wei
Sabanayagam, Charumathi
Transition probabilities of diabetic retinopathy and death in an Asian population with diabetes
description Purpose: To evaluate the dynamic transitions in diabetic retinopathy (DR) severity over time and associated risk factors in an Asian population with diabetes. Design: Longitudinal cohort study Methods: We analyzed data from 9481 adults in the Singapore Integrated Diabetic Retinopathy Screening Program (2010–2015) with linkage to death registry. A multistate Markov model adjusted for age, sex, systolic blood pressure (SBP), diabetes duration, HbA1c, and body mass index (BMI) was applied to estimate annual transition probabilities between four DR states (no, mild, moderate, and severe/proliferative) and death, and the mean sojourn time in each state. Results: The median assessment interval was 12 months, with most patients having 3 assessments. Annual probabilities for DR progression (no-to-mild, mild-to-moderate and moderate-to-severe/proliferative) were 6.1 %, 7.0 % and 19.3 %, respectively; and for regression (mild-to-no, moderate-to-mild and severe-to-moderate) were 55.4 %, 17.3 % and 4.4 %, respectively. Annual mortality rates from each DR state were 1.2 %, 2.0 %, 18.7 %, and 30.0 %. The sojourn time in each state were 8.2, 0.8, 0.8 and 2.2 years. Higher HbA1c and SBP levels were associated with progression of no-mild and mild-moderate DR, and diabetes duration with no-to-mild and moderate-to-severe/proliferative DR. Lower HbA1c levels were associated with regression from mild-to-no and moderate-to-mild, and higher BMI with mild-to-no DR. Conclusions: Our results suggest a prolonged duration (∼8 years) in developing mild DR, with faster transitions (within a year) from mild or moderate states. Moderate/above DR greatly increases the probability of progression and death as compared to mild DR/below. HbA1c was associated with both progression as well as regression.
author2 Lee Kong Chian School of Medicine (LKCMedicine)
author_facet Lee Kong Chian School of Medicine (LKCMedicine)
Seshasai, Sudarshan
He, Feng
Lam, Betty
Hamzah, Haslina
Cheng, Ching-Yu
Li, Jialiang
Wong, Tien Yin
Tan, Gavin Siew Wei
Sabanayagam, Charumathi
format Article
author Seshasai, Sudarshan
He, Feng
Lam, Betty
Hamzah, Haslina
Cheng, Ching-Yu
Li, Jialiang
Wong, Tien Yin
Tan, Gavin Siew Wei
Sabanayagam, Charumathi
author_sort Seshasai, Sudarshan
title Transition probabilities of diabetic retinopathy and death in an Asian population with diabetes
title_short Transition probabilities of diabetic retinopathy and death in an Asian population with diabetes
title_full Transition probabilities of diabetic retinopathy and death in an Asian population with diabetes
title_fullStr Transition probabilities of diabetic retinopathy and death in an Asian population with diabetes
title_full_unstemmed Transition probabilities of diabetic retinopathy and death in an Asian population with diabetes
title_sort transition probabilities of diabetic retinopathy and death in an asian population with diabetes
publishDate 2024
url https://hdl.handle.net/10356/179767
_version_ 1814047234735472640