Skip to main content

Advertisement

SpringerLink
Log in

Declined incidence of patients treated for vision-threatening diabetic retinopathy in South Korea: a 12-year nationwide population-based study

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To determine the age- and sex-specific annual incidence rates of patients treated for VTDR and the factors associated with increased treatment rates in patients with type 2 diabetes mellitus (T2DM) in South Korea.

Methods

This was a nationwide, retrospective, 12-year, population-based study. Patients aged over 30 years who were diagnosed with T2DM between 2006 and 2017 were included in this study. We evaluated the national health claims data acquired from the Korean National Health Insurance Service database. Main outcome measures were the annual incidence rates of patients treated for VTDR and the associated risk factors.

Results

The age-adjusted annual incidence rate of patients treated for VTDR significantly decreased from 10.05 per 1000 T2DM patients in 2006 to 6.11 in 2017 (β =  − 0.3192, P < 0.0001). The sex-adjusted annual incidence rate also significantly decreased in both men (β =  − 0.2861, P < 0.0001) and women (β =  − 0.3666, P < 0.0001). Cox hazard analysis showed that factors such as insulin use, young age, chronic kidney disease and male sex were significantly associated with increased rate of treatments for VTDR. In addition, the risk was lower for rural than for metropolitan residents.

Conclusions

Despite the increase in the number of T2DM patients in South Korea, the incidence rate of patients treated for VTDR decreases with early diagnosis and appropriate treatment. Therefore, it is important to detect and manage high-risk groups early to prevent visual impairment due to VTDR.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from National Health Insurance Service in South Korea but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available.

Code availability

Not Applicable.

References

  1. Kempen JH OCB, Leske MC, Haffner SM, Klein R, Moss SE, Taylor HR, Hamman RF, Eye Diseases Prevalence Research G (2004) The prevalence of diabetic retinopathy among adults in the United States. Archives of ophthalmology 122:552–563

  2. Bourne RR, Stevens GA, White RA, Smith JL, Flaxman SR, Price H, Jonas JB, Keeffe J, Leasher J, Naidoo K, Pesudovs K, Resnikoff S, Taylor HR, Vision Loss Expert G (2013) Causes of vision loss worldwide, 1990–2010: a systematic analysis. Lancet Glob Health 1:e339-349

    Article  Google Scholar 

  3. Yau JW, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, Chen SJ, Dekker JM, Fletcher A, Grauslund J, Haffner S, Hamman RF, Ikram MK, Kayama T, Klein BE, Klein R, Krishnaiah S, Mayurasakorn K, O'Hare JP, Orchard TJ, Porta M, Rema M, Roy MS, Sharma T, Shaw J, Taylor H, Tielsch JM, Varma R, Wang JJ, Wang N, West S, Xu L, Yasuda M, Zhang X, Mitchell P, Wong TY, Meta-Analysis for Eye Disease Study G (2012) Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care 35:556–564

  4. Knudsen LL, Lervang HH, Lundbye-Christensen S, Gorst-Rasmussen A (2006) The North Jutland County Diabetic Retinopathy Study: population characteristics. Br J Ophthalmol 90:1404–1409

    Article  CAS  Google Scholar 

  5. Liu L WX, Liu L, Geng J, Yuan Z, Shan Z, Chen L (2012) Prevalence of diabetic retinopathy in mainland China a meta-analysis. PLoS One 7:e45264

  6. Kung K CK, Hui EM, Leung M, Leung SY, Szeto CC, Lam A, Li PK ( 2014) Prevalence of complications among Chinese diabetic patients in urban primary care clinics a cross-sectional study. BMC Fam Pract 15

  7. Roy MSKR, O’Colmain BJ, Klein BE, Moss SE, Kempen JH (2004) The prevalence of diabetic retinopathy among adult type 1 diabetic persons in the United States. Arch Ophthalmol 122:546–551

    Article  Google Scholar 

  8. Tapp RJ SJ, Harper CA, de Courten MP, Balkau B, McCarty DJ, Taylor HR, Welborn TA, Zimmet PZ, AusDiab Study G (2003) The prevalence of and factors associated with diabetic retinopathy in the Australian population. Diabetes care 26:1731–1737

  9. Lin JC, Shau WY, Lai MS (2014) Sex- and age-specific prevalence and incidence rates of sight-threatening diabetic retinopathy in Taiwan. JAMA Ophthalmol 132:922–928

    Article  Google Scholar 

  10. Martin-Merino E, Fortuny J, Rivero-Ferrer E, Garcia-Rodriguez LA (2014) Incidence of retinal complications in a cohort of newly diagnosed diabetic patients. PLoS One 9:e100283

  11. Thomas RL, Dunstan F, Luzio SD, Roy Chowdury S, Hale SL, North RV, Gibbins RL, Owens DR (2012) Incidence of diabetic retinopathy in people with type 2 diabetes mellitus attending the Diabetic Retinopathy Screening Service for Wales: retrospective analysis. BMJ 344:e874

  12. Jones CD, Greenwood RH, Misra A, Bachmann MO (2012) Incidence and progression of diabetic retinopathy during 17 years of a population-based screening program in England. Diabetes Care 35:592–596

    Article  Google Scholar 

  13. Salinero-Fort MA, San Andres-Rebollo FJ, de Burgos-Lunar C, Arrieta-Blanco FJ, Gomez-Campelo P, Group M (2013) Four-year incidence of diabetic retinopathy in a Spanish cohort: the MADIABETES study. PLoS One 8:e76417

  14. Jin P, Peng J, Zou H, Wang W, Fu J, Shen B, Bai X, Xu X, Zhang X (2014) The 5-year onset and regression of diabetic retinopathy in Chinese type 2 diabetes patients. PLoS One 9:e113359

  15. Hovind P, Tarnow L, Rossing K, Rossing P, Eising S, Larsen N, Binder C, Parving HH (2003) Decreasing incidence of severe diabetic microangiopathy in type 1 diabetes. Diabetes Care 26:1258–1264

    Article  Google Scholar 

  16. Sloan FA, Belsky D, Ruiz D Jr, Lee P (2008) Changes in incidence of diabetes mellitus-related eye disease among US elderly persons, 1994–2005. Arch Ophthalmol 126:1548–1553

    Article  Google Scholar 

  17. Lee R, Wong TY, Sabanayagam C (2015) Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss. Eye Vis (Lond) 2:17

    Article  Google Scholar 

  18. Yang JY, Kim NK, Lee YJ, Noh JH, Kim DJ, Ko KS, Rhee BD, Kim DJ (2013) Prevalence and factors associated with diabetic retinopathy in a Korean adult population: the 2008–2009 Korea National Health and Nutrition Examination Survey. Diabetes Res Clin Pract 102:218–224

    Article  Google Scholar 

  19. Jee D, Lee WK, Kang S (2013) Prevalence and risk factors for diabetic retinopathy: the Korea National Health and Nutrition Examination Survey 2008–2011. Invest Ophthalmol Vis Sci 54:6827–6833

    Article  Google Scholar 

  20. Song SJ, Han K, Choi KS, Ko SH, Rhee EJ, Park CY, Park JY, Lee KU, Ko KS, Task Force Team for Diabetes Fact Sheet of the Korean Diabetes A (2018) Trends in diabetic retinopathy and related medical practices among type 2 diabetes patients: results from the National Insurance Service Survey 2006–2013. J Diabetes Investig 9:173–178

    Article  CAS  Google Scholar 

  21. Ting DS, Cheung GC, Wong TY (2016) Diabetic retinopathy: global prevalence, major risk factors, screening practices and public health challenges: a review. Clin Exp Ophthalmol 44:260–277

    Article  Google Scholar 

  22. Cheung N, Mitchell P, Wong TY (2010) Diabetic retinopathy. The Lancet 376:124–136

    Article  Google Scholar 

  23. Klein BE (2007) Overview of epidemiologic studies of diabetic retinopathy. Ophthalmic Epidemiol 14:179–183

    Article  Google Scholar 

  24. Lee YH, Han K, Ko SH, Ko KS, Lee KU, Taskforce Team of Diabetes Fact Sheet of the Korean Diabetes A (2016) Data analytic process of a nationwide population-based study using National Health Information Database established by National Health Insurance Service. Diabetes Metab J 40:79–82

    Article  Google Scholar 

  25. Nordwall M, Bojestig M, Arnqvist HJ, Ludvigsson J (2004) Declining incidence of severe retinopathy and persisting decrease of nephropathy in an unselected population of Type 1 diabetes-the Linkoping Diabetes Complications Study. Diabetologia 47:1266–1272

    Article  CAS  Google Scholar 

  26. Wong TY, Mwamburi M, Klein R, Larsen M, Flynn H, Hernandez-Medina M, Ranganathan G, Wirostko B, Pleil A, Mitchell P (2009) Rates of progression in diabetic retinopathy during different time periods: a systematic review and meta-analysis. Diabetes Care 32:2307–2313

    Article  Google Scholar 

  27. Hoerger TJ, Segel JE, Gregg EW, Saaddine JB (2008) Is glycemic control improving in U.S. adults? Diabetes Care 31:81–86

    Article  Google Scholar 

  28. Jeon JY, Kim DJ, Ko SH, Kwon HS, Lim S, Choi SH, Kim CS, An JH, Kim NH, Won JC, Kim JH, Cha BY, Song KH, Taskforce Team of Diabetes Fact Sheet of the Korean Diabetes A (2014) Current status of glycemic control of patients with diabetes in Korea: the fifth Korea national health and nutrition examination survey. Diabetes Metab J 38:197–203

    Article  Google Scholar 

  29. Bailey RN, Indian RW, Zhang X, Geiss LS, Duenas MR, Saaddine JB, Centers for Disease C, Prevention, (2006) Visual impairment and eye care among older adults - five states, 2005. MMWR Morb Mortal Wkly Rep 55:1321–1325

    PubMed  CAS  Google Scholar 

  30. Lee DJ, Lam BL, Arora S, Arheart KL, McCollister KE, Zheng DD, Christ SL, Davila EP (2009) Reported eye care utilization and health insurance status among US adults. Arch Ophthalmol 127:303–310

    Article  Google Scholar 

  31. Kramer HU, Ruter G, Schottker B, Rothenbacher D, Rosemann T, Szecsenyi J, Brenner H, Raum E (2012) Gender differences in healthcare utilization of patients with diabetes. Am J Manag Care 18:362–369

    PubMed  Google Scholar 

  32. Collaboration NCDRF (2016) Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet 387:1513–1530

    Article  Google Scholar 

  33. Zhang X, Saaddine JB, Chou CF, Cotch MF, Cheng YJ, Geiss LS, Gregg EW, Albright AL, Klein BE, Klein R (2010) Prevalence of diabetic retinopathy in the United States, 2005–2008. JAMA 304:649–656

    Article  CAS  Google Scholar 

  34. Varma R, Macias GL, Torres M, Klein R, Pena FY, Azen SP, Los Angeles Latino Eye Study G (2007) Biologic risk factors associated with diabetic retinopathy: the Los Angeles Latino Eye Study. Ophthalmology 114:1332–1340

  35. Stratton IM, Kohner EM, Aldington SJ, Turner RC, Holman RR, Manley SE, Matthews DR (2001) UKPDS 50: risk factors for incidence and progression of retinopathy in type II diabetes over 6 years from diagnosis. Diabetologia 44:156–163

    Article  CAS  Google Scholar 

  36. van Leiden HA, Dekker JM, Moll AC, Nijpels G, Heine RJ, Bouter LM, Stehouwer CDA, Polak BCP (2003) Risk factors for incident retinopathy in a diabetic and nondiabetic population: the Hoorn study. Arch Ophthalmol 121:245–251

    Article  Google Scholar 

  37. De Block CEM, De Leeuw IH, Van Gaal LF (2005) Impact of overweight on chronic microvascular complications in type 1 diabetic patients. Diabetes Care 28:1649–1655

    Article  Google Scholar 

  38. Liu Y, Yang J, Tao L, Lv H, Jiang X, Zhang M, Li X (2017) Risk factors of diabetic retinopathy and sight-threatening diabetic retinopathy: a cross-sectional study of 13 473 patients with type 2 diabetes mellitus in mainland China. BMJ Open 7:e016280

  39. Zoungas S, Woodward M, Li Q, Cooper ME, Hamet P, Harrap S, Heller S, Marre M, Patel A, Poulter N, Williams B, Chalmers J, group AC, (2014) Impact of age, age at diagnosis and duration of diabetes on the risk of macrovascular and microvascular complications and death in type 2 diabetes. Diabetologia 57:2465–2474

    Article  Google Scholar 

  40. Wong TY, Cheung N, Tay WT, Wang JJ, Aung T, Saw SM, Lim SC, Tai ES, Mitchell P (2008) Prevalence and risk factors for diabetic retinopathy: the Singapore Malay Eye Study. Ophthalmology 115:1869–1875

    Article  Google Scholar 

  41. Zheng Y, Lamoureux EL, Lavanya R, Wu R, Ikram MK, Wang JJ, Mitchell P, Cheung N, Aung T, Saw SM, Wong TY (2012) Prevalence and risk factors of diabetic retinopathy in migrant Indians in an urbanized society in Asia: the Singapore Indian eye study. Ophthalmology 119:2119–2124

    Article  Google Scholar 

  42. Tokuyama Y, Ishizuka T, Matsui K, Egashira T, Kanatsuka A (2008) Predictors of glycemic control in Japanese subjects with type 2 diabetes mellitus. Metabolism 57:453–457

    Article  CAS  Google Scholar 

  43. Hillier TAPK (2001) Characteristics of an adult population with newly diagnosed type 2 diabetes the relation of obesity and age of onset. Diabetes Care 24:1522–1527

    Article  CAS  Google Scholar 

  44. Hatunic M, Burns N, Finucane F, Mannion C, Nolan JJ (2005) Contrasting clinical and cardiovascular risk status between early and later onset type 2 diabetes. Diab Vasc Dis Res 2:73–75

    Article  Google Scholar 

  45. Lim A, Stewart J, Chui TY, Lin M, Ray K, Lietman T, Porco T, Jung L, Seiff S, Lin S (2008) Prevalence and risk factors of diabetic retinopathy in a multi-racial underserved population. Ophthalmic Epidemiol 15:402–409

    Article  Google Scholar 

  46. Wat N, Wong RL, Wong IY (2016) Associations between diabetic retinopathy and systemic risk factors. Hong Kong Med J 22:589–599

    PubMed  CAS  Google Scholar 

  47. Park YH, Shin JA, Han JH, Park YM, Yim HW (2015) The association between chronic kidney disease and diabetic retinopathy: the Korea National Health and Nutrition Examination Survey 2008–2010. PLoS One 10:e0125338

  48. Cheng Y, Zhang H, Chen R, Yang F, Li W, Chen L, Lin S, Liang G, Cai D, Chen H (2014) Cardiometabolic risk profiles associated with chronic complications in overweight and obese type 2 diabetes patients in South China. PLoS One 9:e101289

  49. Gholamhossein Y, Behrouz H, Asghar Z (2014) Diabetic retinopathy risk factors: plasma erythropoietin as a risk factor for proliferative diabetic retinopathy. Korean J Ophthalmol 28:373–378

    Article  Google Scholar 

  50. Tomic M, Ljubic S, Kastelan S, Gverovic Antunica A, Jazbec A, Poljicanin T (2013) Inflammation, haemostatic disturbance, and obesity: possible link to pathogenesis of diabetic retinopathy in type 2 diabetes. Mediators Inflamm 2013:818671

  51. Krishnaiah S, Das T, Nirmalan PK, Shamanna BR, Nutheti R, Rao GN, Thomas R (2007) Risk factors for diabetic retinopathy: findings from the Andhra Pradesh Eye Disease Study. Clin Ophthalmol 1:475–482

    PubMed  PubMed Central  Google Scholar 

  52. Liu Y, Zupan NJ, Shiyanbola OO, Swearingen R, Carlson JN, Jacobson NA, Mahoney JE, Klein R, Bjelland TD, Smith MA (2018) Factors influencing patient adherence with diabetic eye screening in rural communities: a qualitative study. PLoS One 13:e0206742

  53. Wsmbk R (2002) Risk factors for type II diabetes and diabetic retinopathy in a Mexican-American population: Proyecto VER. Am J Ophthalmol 134:390–398

    Article  Google Scholar 

  54. Hu Y, Teng W, Liu L, Chen K, Liu L, Hua R, Chen J, Zhou Y, Chen L (2015) Prevalence and risk factors of diabetes and diabetic retinopathy in Liaoning province, China: a population-based cross-sectional study. PLoS One 10:e0121477

  55. Klein R, Klein BE, Moss SE, Cruickshanks KJ (1994) The Wisconsin Epidemiologic Study of diabetic retinopathy. XIV. Ten-year incidence and progression of diabetic retinopathy. Arch Ophthalmol 112:1217–1228

    Article  CAS  Google Scholar 

  56. Klein R, Klein BE, Jensen SC, Moss SE (1994) The relation of socioeconomic factors to the incidence of proliferative diabetic retinopathy and loss of vision. Ophthalmology 101:68–76

    Article  CAS  Google Scholar 

Download references

Funding

This work was supported by a National Health Insurance Ilsan Hospital grant (NHIS-2019–1-231). This study used data from the NHIS-NCS 2003–2017, which was released by the Korean National Health Insurance System.

Author information

Author notes

  1. Jiwon Kim and Hyojin Seong contributed equally

Authors and Affiliations

  1. Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, #100 Ilsan-ro, Ilsandong-gu, Gyeonggi-do, 410-719, Goyang, Korea

    Jiwon Kim, Hyojin Seong & Eun Jee Chung

  2. Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

    Hyojin Seong

  3. Department of Research and Analysis, National Health Insurance Service Ilsan Hospital, Goyang, Korea

    Kang Ju Son

Authors
  1. Jiwon Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hyojin Seong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kang Ju Son
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eun Jee Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Ji Won Kim: substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content.

Hyojin Seong: drafting the work or revising it critically for important intellectual content.

Kang Ju Son: substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of data for the work.

Eun Jee Chung: substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Eun Jee Chung.

Ethics declarations

Ethics approval

Approval was granted by the Institutional Review Board of the National Health Insurance Service Ilsan Hospital, Gyeonggi-do, Korea (NHIMC 2019–01-017). The study adhered to the tenets of the Declaration of Helsinki.

Consent to participate

The need for written informed consent to participate was waived because of the retrospective design of the study.

Consent for publication

The need for written informed consent to publish was waived because of the retrospective design of the study.

Competing interests

The authors declare no competing interests.

Disclaimer

The authors alone are responsible for the content and writing of this article.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, J., Seong, H., Son, K.J. et al. Declined incidence of patients treated for vision-threatening diabetic retinopathy in South Korea: a 12-year nationwide population-based study. Graefes Arch Clin Exp Ophthalmol 260, 101–111 (2022). https://doi.org/10.1007/s00417-021-05365-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-021-05365-z

Keywords

Search

Navigation