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Validation of a model to estimate personalised screening frequency to monitor diabetic retinopathy

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Abstract

Aims/hypothesis

Our study aimed to validate a model to determine a personalised screening frequency for diabetic retinopathy.

Methods

A model calculating a personalised screening interval for monitoring retinopathy based on patients’ risk profile was validated using the data of 3,319 type 2 diabetic patients in the Diabetes Care System West-Friesland, the Netherlands. Two-field fundus photographs were graded according to the EURODIAB coding system. Sight-threatening retinopathy (STR) was considered to be grades 3–5. Validity of the model was assessed using calibration and discrimination measures. We compared model-based time of screening with time of STR diagnosis and calculated the differences in the number of fundus photographs using the model compared with those in annual or biennial screening.

Results

During a mean of 53 months of follow-up, 76 patients (2.3%) developed STR. Using the model, the mean screening interval was 31 months, leading to a reduced screening frequency of 61% compared with annual screening and 23% compared with biennial screening. STR incidence occurred after a mean of 26 months after the model-based time of screening in 67 patients (88.2%). In nine patients (11.8%), STR had developed before the model-based time of screening. The discriminatory ability of the model was good (C-statistic 0.83; 95% CI 0.74, 0.92). Calibration showed that the model overestimated STR risk.

Conclusions/interpretation

A large reduction in retinopathy screening was achieved using the model in this population of patients with a very low incidence of retinopathy. Considering the number of potentially missed cases of STR, there is room for improvement in the model. Use of the model for personalised screening may eventually help to reduce healthcare use and costs of diabetes care.

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Abbreviations

DCS:

Diabetes Care System West-Friesland

STR:

Sight-threatening retinopathy

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Acknowledgements

We gratefully acknowledge M. S. A. Suttorp-Shulten (Department of Ophthalmology, OLVG, Amsterdam, the Netherlands) for grading of the fundus photographs.

Funding

This study was funded by ZonMw, the Netherlands organisation for health research.

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

Contribution statement

AAWAvdH was involved in the conception and design of the study, analysis and interpretation of the data and drafting of the manuscript. IW was involved in the analysis and interpretation of the data and drafting of the manuscript. EvtR, TA, SHL, PE, BCPP, ACM, JEEK, JMD and GN were involved in the interpretation of the data and revision of the manuscript. GN was involved in the conception of the study, interpretation of the data and revision of the manuscript. All authors approved the final version of the manuscript. AAWAvdH and IW are the guarantors of this work, had full access to the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

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Authors and Affiliations

  1. EMGO Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands

    Amber A. W. A. van der Heijden, Iris Walraven, Esther van ’t Riet, Petra Elders, Bettine C. P. Polak, Annette C. Moll, Jacqueline M. Dekker & Giel Nijpels

  2. Department of General Practice, VU University Medical Center, Amsterdam, the Netherlands

    Amber A. W. A. van der Heijden, Petra Elders & Giel Nijpels

  3. Department of Ophthalmology, VU University Medical Center, Amsterdam, the Netherlands

    Iris Walraven & Annette C. Moll

  4. Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands

    Iris Walraven, Esther van ’t Riet, Bettine C. P. Polak & Jacqueline M. Dekker

  5. Faculty of Medicine, University of Iceland, Reykjavik, Iceland

    Thor Aspelund & Sigrún H. Lund

  6. Department of Ophthalmology, University Medical Center St Radboud, Nijmegen, the Netherlands

    Jan E. E. Keunen

Authors
  1. Amber A. W. A. van der Heijden
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  2. Iris Walraven
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  3. Esther van ’t Riet
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  4. Thor Aspelund
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  5. Sigrún H. Lund
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  6. Petra Elders
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  7. Bettine C. P. Polak
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  8. Annette C. Moll
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  9. Jan E. E. Keunen
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  10. Jacqueline M. Dekker
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  11. Giel Nijpels
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Corresponding author

Correspondence to Amber A. W. A. van der Heijden.

Additional information

A. A. W. A. van der Heijden and I. Walraven contributed equally to this study.

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van der Heijden, A.A.W.A., Walraven, I., van ’t Riet, E. et al. Validation of a model to estimate personalised screening frequency to monitor diabetic retinopathy. Diabetologia 57, 1332–1338 (2014). https://doi.org/10.1007/s00125-014-3246-4

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  • DOI: https://doi.org/10.1007/s00125-014-3246-4

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