The Diabetes Complications in Senior Adults (DCSA) Study: A Scoping Review and a National Case Analysis from Northern Ireland, UK on Ocular Complications in Adults Aged 80 and over Living with Diabetes.

backgroundThe number of people 80 years and over with a diagnosis of diabetes is increasing. This is due to people with type 1 diabetes living longer, successful diabetes management and a growing aging population. Due to this increase, there is limited understanding of the impact of diabetes in people 80 years or over, especially in relation to diabetic retinal disease (DRD) and other ocular complications. METHODOLOGY: A scoping review was conducted using PRISMA-ScR guidelines, with two reviewers independently screening abstracts and full texts. Case study data were obtained from the Northern Ireland Diabetic Eye Screening Programme. Database searches identified 1644 references, of which seven studies met the inclusion criteria following review. Across these, 29,734 participants were included, with 14,920 (50%) aged 80 years and over. The reported prevalence of diabetic retinopathy (DR) and diabetic maculopathy (DM) varied considerably across studies, ranging from 0.8% in Australia to 9.5% and 11.6% in Thailand and Suriname, respectively. This substantial variation may be attributable to differences in participant characteristics, study populations, geographical and regional settings, diagnostic and grading criteria for DR and DM and other methodological factors. Some studies reported the incidence of DRD in people 80 years and over was higher in those with a longer duration of diabetes. However, none have provided a comprehensive understanding of the burden of both diabetes-related and other ocular diseases within this older patient cohort. This case study found that approximately 20% of individuals aged 80 years and over had a diagnosis of diabetes. Although the proportion with proliferative, sight-threatening diabetic retinopathy was small (0.6%), this rate is comparable to the general population of people with diabetes.

conclusionFew studies have examined DRD in people 80 years and over. This case study aligns with the limited available evidence and highlights the continued importance of screening in this population.