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Prevalence, incidence and future projection of diabetic eye disease in Europe: a systematic review and meta-analysis

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Abstract

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.

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Funding

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.

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Authors and Affiliations

  1. Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany

    Jeany Q. Li, Julia Letow, Caroline Wolpers, Frank G. Holz & Robert P. Finger

  2. Department of Medical Biometry, Informatics and Epidemiology, University of Bonn, Venusberg Campus 1, 53127, Bonn, Germany

    Thomas Welchowski & Matthias Schmid

  3. Department of Ophthalmology, Hospital Universitario y Politécnico La Fe, 46026, Valencia, Spain

    Isabel Pascual-Camps

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Contributions

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.

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Correspondence to Robert P. Finger.

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Li, J.Q., Welchowski, T., Schmid, M. et al. Prevalence, incidence and future projection of diabetic eye disease in Europe: a systematic review and meta-analysis. Eur J Epidemiol 35, 11–23 (2020). https://doi.org/10.1007/s10654-019-00560-z

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