Diabetic Retinopathy in the Tomsk Region Among Adult Patients With Type 1 and Type 2 Diabetes From 2013 to 2022

Significance. The primary cause of disability among patients with diabetes mellitus is its micro- and macrovascular complications, particularly diabetic retinopathy. It has been calculated that blindness develops in patients with diabetes mellitus 25 times more frequently than on average in the population. According to the data from federal statistical reports, the prevalence of diabetic retinopathy varies significantly across regions of the Russian Federation, ranging from 2.6% to 66.1% in individuals with type 1 diabetes mellitus, and from 1.1% to 46.4% in individuals with type 2 diabetes mellitus. The reason for this variation in data may be due to the absence of an approved form of federal statistical observation for patients with diabetic retinopathy in certain regions of the Russian Federation, as well as the need to develop proposals for further improvement of medical care in the field of ophthalmology. In this regard, studying the overall incidence of diabetic retinopathy at the regional level is of particular interest. Purpose. To study the overall incidence of diabetic retinopathy in the Tomsk region from 2013 to 2022. Materials and methods. The object of the study is the regional segment of the Tomsk region "Databases of clinical and epidemiological monitoring of diabetes mellitus in the territory of the Russian Federation". An analysis of the depersonalized data extract as of January 1, 2023, has been performed. The overall incidence rates of diabetic retinopathy were assessed per 10,000 adult patients with diabetes mellitus (>18 years) over the period from 2013 to 2022, the rates of blindness due to diabetic retinopathy, age of onset, and duration of diabetic retinopathy until complications appeared. The analysis of the research results was conducted using descriptive statistical methods. Data processing was carried out using electronic spreadsheets "MS Office Excel 2010" and the "Statistica" software package for Windows 10.0. Results. The total number of patients with diabetic retinopathy in the Tomsk region increased by 23.51% over 10 years, from 4,714 to 5,822 individuals, of which 84.75% were patients with type 2 diabetes. The average proportion of patients with diabetic retinopathy was 19.37%. In 90.18% of cases (in this period), early non-proliferative diabetic retinopathy was registered. However, the blindness rate in type 1 diabetes (per 10,000 adult patients) increased from 63.76 to 122.13 over the period from 2013 to 2022. The duration of type 1 diabetes until the onset of diabetic retinopathy increased by 8.06 years, while for type 2 diabetes, it increased by 2.27 years. The age of onset of diabetic retinopathy decreased from 35.38 to 32.90 years for type 1 diabetes, while it increased from 62.34 to 64.33 years for type 2 diabetes. The overall incidence of diabetic retinopathy per 10,000 diabetes patients in 2022 was 1867.82, with an average of 1937.13 over 10 years. During this period, there was an increase in laser interventions, the use of antiangiogenic therapy and performed vitrectomies, especially in type 1 diabetes. The intervention rates for type 1 diabetes, calculated per 10,000 adults over 10 years, changed as follows: the number of laser photocoagulations of the retina increased by 164.70% - from 70.13 to 185.64, antiangiogenic therapy increased by 972.74% - from 3.19 to 34.20, and vitrectomies increased by 140.82% - from 22.31 to 53.74. In type 2 diabetes, the number of laser photocoagulations of the retina increased by 26.53%, the use of antiangiogenic therapy increased by 186.81%, while the number of vitrectomies decreased by 15.65%. Conclusion. The overall incidence of diabetic retinopathy in the Tomsk region is characterized by stable growth, primarily due to patients with type 2 diabetes. Among the total number of examined patients with diabetic retinopathy in the Tomsk region, patients with non-proliferative stages prevail. During this period, there was an increase in laser interventions, the use of antiangiogenic therapy, and the number of vitrectomies in the region, especially in type 1 diabetes. Application area of the results. The results of the study may be of interest to healthcare organizers, practicing doctors, residents and graduate students of medical universities.