***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background / aims To determine the changes in the incidence of diabetic retinopathy ( DR ) , diabetic macular oedema ( DMO ) and their risk factors in a population -based study of patients with diabetes mellitus ( DM ) referred to our 16 Primary Health Care Areas ( HCAs ) . Methods Prospect i ve population -based study of a total of 15 396 Caucasian patients with DM , who represent 86.53 % of the total patients with DM in our HCAs , were studied over an 8-year follow-up period . All patients were screened with a mean follow-up of 3.18±1.11 times for each patient over the 8 years . Results The yearly mean value of any DR was 8.37±2.19 % ( 8.09%–8.99 % ) ; of advanced DR yearly mean value of 0.46±0.22 % ( 0.03–0.78 ) ; and of DMO a yearly mean value of 2.19±0.18 % ( 2%–2.49 % ) . A clear increase was observed in the last 3 years , any DR increased from 8.09 % in 2007 to 8.99 % in 2014 , and DMO from 2 % in 2007 to 2.49 % in 2014 . These increases were more evident in some age groups . For patients with any DR aged 41–50 and 51–60 and for patients with advanced DR aged 41–50 , 51–60 and 61–70 , the increase was more marked , related to an increase in HbA1c values or to patients treated with insulin . Conclusions An increase in the incidence of DR and DMO was observed , especially in the younger patients aged between 31 and 70 years . This is linked to bad metabolic control of DM . Our results suggest a greater number of ocular complications in the near future , such as neovascular glaucoma , if these current findings are not addressed Aims To extrapolate , from the proportion of subjects with observable retinopathy at diagnosis of type 2 diabetes mellitus in routine clinical practice , the mean duration of undiagnosed diabetes . Methods On 1 October 1999 , there were 4313 patients with type 2 diabetes in the 41 participating practice s in the Tayside region ( registered with one of 166 GPs ) . 501 ( 12 % ; 95 % CI 11 to 13 % ) patients were selected using a pseudo-r and om number allocation algorithm , and practice lists checked for recently deceased , non-residents ( 45 exclusions ) . Retinopathy was grade d by vali date d slit lamp biomicroscopy and four-field stereo photography . Date of first diagnosis of diabetes was ascertained from the regional diabetes register created using multiple source data capture . Results Of living Tayside resident patients , 295 from 456 invited type 2 patients ( 65 % ) were examined . 14.68 % ( 95 % CI 12.48 to 16.88 % ) were found to have retinopathy at diagnosis . Assuming a linear model , these data suggest that the onset of detectable retinopathy occurs 5.77 years ( 95 % CI 4.6 to 7 years ) before diagnosis . Comparison using the log rank test with survival to onset of sight threatening retinopathy/maculopathy in 291 patients with type 1 diabetes mellitus also examined from the same population cohort showed the 95 % CIs of length of pre clinical diabetes to be between 3.0 and 9.4 years . Conclusion There is accumulating evidence to question the assumption of linearity as a model of choice . The authors ' underst and ing of a distinct glycaemic threshold for retinal change is also overly simplistic and consequently the bounds of uncertainty concerning the pre clinical duration of disease are considerable Objective To evaluate the incidence of diabetic retinopathy in patients with Type 2 Diabetes Mellitus , to identify the risk factors associated with the incidence of retinopathy and to develop a risk table to predict four-year retinopathy risk stratification for clinical use , from a four-year cohort study . Design The MADIABETES Study is a prospect i ve cohort study of 3,443 out patients with Type 2 Diabetes Mellitus , sample d from 56 primary health care centers ( 131 general practitioners ) in Madrid ( Spain ) . Results The cumulative incidence of retinopathy at four-year follow-up was 8.07 % ( 95 % CI = 7.04–9.22 ) and the incidence density was 2.03 ( 95 % CI = 1.75–2.33 ) cases per 1000 patient-months or 2.43 ( 95 % CI = 2.10–2.80 ) cases per 100 patient-years . The highest adjusted hazard ratios of associated risk factors for incidence of diabetic retinopathy were LDL-C > 190 mg/dl ( HR = 7.91 ; 95 % CI = 3.39–18.47 ) , duration of diabetes longer than 22 years ( HR = 2.00 ; 95 % CI = 1.18–3.39 ) , HbA1c>8 % ( HR = 1.90 ; 95 % CI = 1.30–2.77 ) , and aspirin use ( HR = 1.65 ; 95 % CI = 1.22–2.24 ) . Microalbuminuria ( HR = 1.17 ; 95 % CI = 0.75–1.82 ) and being female ( HR = 1.12 ; 95 % CI = 0.84–1.49 ) showed a non-significant increase of diabetic retinopathy . The greatest risk is observed in females who had diabetes for more than 22 years , with microalbuminuria , HbA1c>8 % , hypertension , LDL-Cholesterol > 190 mg/dl and aspirin use . Conclusions After a four-year follow-up , the cumulative incidence of retinopathy was relatively low in comparison with other studies . Higher baseline HbA1c , aspirin use , higher LDL-Cholesterol levels , and longer duration of diabetes were the only statistically significant risk factors found for diabetic retinopathy incidence . This is the first study to demonstrate an association between aspirin use and diabetic retinopathy risk in a well-defined cohort of patients with Type 2 Diabetes Mellitus at low risk of cardiovascular events . However , further studies with patients at high cardiovascular and metabolic risk are needed to clarify this issue OBJECTIVE To establish the prevalence of diabetic retinopathy ( DR ) , types and risk factors in a diabetic population in the city of Badajoz . METHODS A cross-sectional study , with prospect i ve data collection , was performed in 2002 on 762 r and omly selected diabetic patients belonging to two Primary Care Centers . We evaluated age , gender , type , treatment , duration of diabetes and blood pressure levels .  Two color fundus photographs were taken and ophthalmoscopy performed on both eyes . Data were analyzed using SPSS ( 11.5 ) . RESULTS The mean age of the patients was 66.2 ( DS 11.4 ) years , 4.7 % were type 1 diabetics , 29 % were insulin-treated and 52.8 % had elevated blood pressure . Prevalence of DR was 29.8 % , macular edema 1.4 % and proliferative DR 4.8 % . Multivariate analysis showed that patients with an evolution of between 5 and 10 years had a frequency 1.13 times higher ( ORaj 1.13 ; IC 95 % 0.68 - 1.88 ; p=0.648 ) than those of less than 5 years evolution , while those with more than 15 years evolution had a frequency 3.12 times higher ( ORaj 3.12 ; IC 95 % 1.85 - 5.26 ; p<0.001 ) . Patients receiving treatment with oral antidiabetic agents  had an RD prevalence 2.39 times higher ( ORaj 2.39 ; IC 95 % 1.21 - 4.74 ; p=0,012 ) than those treated with diet only . Patients treated with insulin had a 10.32 higher frequency ( ORaj 10.32 ; IC 95 % 5.07 - 21.00 ; p<0.001 ) than those treated with diet . CONCLUSIONS 29.8 % of the diabetic population in the city of Badajoz is affected by DR . Although this prevalence is lower than that observed in previous studies performed by the same team , further studies should be carried out to detect risk sub-groups to allow us to act to decrease such a high prevalence Purpose To investigate the prevalence and risk factors of diabetic retinopathy in subjects aged 40 years or older living in Casteldaccia , Sicily . Methods A population -based survey was performed on 1,588 subjects r and omly enrolled among people aged 40 years or older . A total of 1,068 persons could be examined and in 1,019 the fundus of the eye was adequately observed ( 64.2 % of the enrolled population ) . Diabetic retinopathy was diagnosed by ophthalmoscopy and fundus photographs ; fluorescein angiography was performed in 91 % of retinopathic subjects . In addition , a case – control study was carried out in order to demonstrate the association of diabetic retinopathy with a number of variables . Results Diabetic retinopathy was found in 4.4 % of the whole population studied and in 34.1 % of the diabetics . Nonproliferative diabetic retinopathy was found in 29.6 % and proliferative diabetic retinopathy in 4.5 % of the diabetics . Diabetic retinopathy was significantly associated with the following univariate variables : duration of diabetes , duration and type of antidiabetic treatment , and duration of alcohol intake . After multivariate logistic regression the only variable independently associated with diabetic retinopathy was duration of antidiabetic treatment . Conclusion Diabetic retinopathy affects more than one third of diabetics and represents a leading cause of retinal disease . The antidiabetic treatment is the most important risk factor for diabetic retinopathy , even stronger than the duration of diabetes OBJECTIVE To determine the prevalence of diabetic retinopathy (  DR  )  and evaluate our experience in DR screening in a study carried out between the Ophthalmology Department of the University General Hospital of Alicante and Department 19 Primary Care of Alicante by using a non-retinal mydriatic camera and telemedicine . MATERIAL AND METHODS A descriptive , cross-sectional study was conducted on 2,435 diabetic patients from 1 February 2006 to 1 February 2009 .  Three 45 ° retinographies of both eyes of each patient were obtained and sent to the Department of Ophthalmology via the hospital intranet . These were then evaluated by 2 ophthalmologists , experts in the retina , with each issuing an individualized report for each patient . RESULTS The prevalence of DR was 17.90 % , with 80.73 % of them having mild-moderate proliferative DR , 12.16 % severe non-proliferative DR , 2.29 % proliferative DR , and 4.82 % with diabetic maculopathy associated with any level of retinopathy . The retinographies were considered low quality in 41 patients ( 1.69 % ) . CONCLUSIONS We highlight the benefits of the tele-ophthalmology in screening diabetic patients to enable early diagnosis and treatment , and improving the circuit of communication between primary and specialist care OBJECTIVES To report on the prevalence of retinopathy in patients with newly diagnosed non-insulin-dependent diabetes mellitus ( NIDDM ) and to evaluate the relationship of retinopathy to clinical and biochemical variables . DESIGN A multicenter , r and omized , controlled clinical study of therapy in patients with NIDDM . SETTING AND PATIENTS Patients were part of the United Kingdom Prospect i ve Diabetes Study , a 23-center study of 2964 white patients who had both eyes photographed and assessed .  OUTCOME MEASURES The presence and severity of diabetic retinopathy were evaluated by sex , and the relationship of retinopathy to medical and biochemical parameters was assessed . RESULTS Retinopathy , defined as microaneurysms or worse lesions in at least 1 eye , was present in 39 % of men and 35 % of women . Marked retinopathy with cotton wool spots or intraretinal microvascular abnormalities was present in 8 % of men and 4 % of women . The severity of retinopathy was related in both sexes to higher fasting plasma glucose levels , higher systolic and diastolic blood pressure , lower serum insulin levels , and reduced beta-cell function . In addition , in men , increased alcohol consumption was related to increased severity of retinopathy , while leaner women had more severe eye lesions . Visual acuity was normal in most patients , but in men there was a trend for those with more severe retinal lesions to have worse visual acuity . CONCLUSIONS Diabetic retinopathy 
    Output:
    
DED is estimated to be present in more than a quarter of persons with type 2 diabetes and half of persons with type 1 diabetes underlining the importance of regular monitoring .