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Diabetes and endocrinology
Protocol
Prevalence of retinopathy in prediabetes: protocol for a systematic review and meta-analysis
  1. Varo Kirthi1,2,
  2. Paul Nderitu1,2,
  3. Uazman Alam3,4,5,
  4. Jennifer Evans6,
  5. Sarah Nevitt7,
  6. Rayaz A Malik8,
  7. Timothy L Jackson1,2
  1. 1Faculty of Life Sciences and Medicine, King’s College London, London, UK
  2. 2Ophthalmology Research Unit, King’s College Hospital NHS Foundation Trust, London, UK
  3. 3Division of Diabetes, Endocrinology and Gastroenterology, Institute of Human Development, University of Manchester, Manchester, UK
  4. 4Pain Research Institute and Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool and Aintree University Hospital NHS Foundation Trust, Liverpool, UK
  5. 5Department of Diabetes and Endocrinology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
  6. 6International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
  7. 7Department of Health Data Science, University of Liverpool, Liverpool, UK
  8. 8Research Division, Weill Cornell Medicine-Qatar, Doha, Qatar
  1. Correspondence to Dr Varo Kirthi; v.kirthi{at}nhs.net

Abstract

Introduction There is growing evidence of a higher than expected prevalence of retinopathy in prediabetes. This paper presents the protocol of a systematic review and meta-analysis of retinopathy in prediabetes. The aim of the review is to estimate the prevalence of retinopathy in prediabetes and to summarise the current data.

Methods and analysis This protocol is developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. A comprehensive electronic bibliographic search will be conducted in MEDLINE, EMBASE, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google Scholar and the Cochrane Library. Eligible studies will report prevalence data for retinopathy on fundus photography in adults with prediabetes. No time restrictions will be placed on the date of publication. Screening for eligible studies and data extraction will be conducted by two reviewers independently, using predefined inclusion criteria and prepiloted data extraction forms. Disagreements between the reviewers will be resolved by discussion, and if required, a third (senior) reviewer will arbitrate.

The primary outcome is the prevalence of any standard features of diabetic retinopathy (DR) on fundus photography, as per International Clinical Diabetic Retinopathy Severity Scale (ICDRSS) classification. Secondary outcomes are the prevalence of (1) any retinal microvascular abnormalities on fundus photography that are not standard features of DR as per ICDRSS classification and (2) any macular microvascular abnormalities on fundus photography, including but not limited to the presence of macular exudates, microaneurysms and haemorrhages. Risk of bias for included studies will be assessed using a validated risk of bias tool for prevalence studies. Pooled estimates for the prespecified outcomes of interest will be calculated using random effects meta-analytic techniques. Heterogeneity will be assessed using the I2 statistic.

Ethics and dissemination Ethical approval is not required as this is a protocol for a systematic review and no primary data are to be collected. Findings will be disseminated through peer-reviewed publications and presentations at national and international meetings including Diabetes UK, European Association for the Study of Diabetes, American Diabetes Association and International Diabetes Federation conferences.

PROSPERO registration number CRD42020184820.

  • diabetic retinopathy
  • general diabetes
  • medical retina
  • epidemiology
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2020-040997

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    Footnotes

    • Twitter @jevans7, @sjn_16

    • Contributors VK, UA and TLJ conceived the review topic. VK performed background exploratory searches and drafted the initial search strategy. VK, JE and PN co-wrote the initial protocol. UA, SN, RAM and TLJ provided critical appraisal and senior oversight of the protocol. For the systematic review, VK and PN will perform the searches, data extraction and analysis. JE will provide oversight of the searches, data analysis and extraction. SN will provide statistical input for data analysis. UA, RAM and TLJ will provide critical appraisal and senior oversight of the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.