Structured Care Programs Encourage Diabetic Retinopathy Screening

Most patients with type 2 diabetes who are managed through primary care attended diabetic retinopathy screening services, according to study findings published in Primary Care Diabetes. Factors contributing to diabetic retinopathy screening attendance included using oral hypoglycaemic agents and insulin or other injectable, visiting a Diabetes Nurse Specialist (DNS) in the previous 12 months, and an on target blood glucose level.

Regular retinopathy screening is considered an internationally accepted standard of care for persons with diabetes. However, prior studies suggest that attendance levels are inconsistent and suboptimal, ranging from approximately 50% to 81%. Research shows that factors contributing to nonattendance include limited financial resources, younger age, sex, ethnicity, type of diabetes, insulin use, educational background, and smoking.

Researchers estimated diabetic retinopathy screening attendance rates in adults with type 2 diabetes managed via primary care in Ireland. They also identified factors associated with diabetic retinopathy screening attendance. 

This observational retrospective cohort study was conducted by utilizing data obtained from a primary care audit which transpired between 2015 and 2016. Exclusion criteria consisted of patients with type 1 diabetes and patients with missing data for diabetes type. The investigators calculated attendance at any screening in the past 12 months and attendance across a variety of screening services (national programme and other screening services). They used logistic regression to assess predictors associated with attendance at any screening, and attendance at the national programme (RetinaScreen). The following factors were evaluated as predictors: socio-demographic, clinical, and lifestyle. 

The researchers collected data on 1106 adult patients with type 2 diabetes. A total of 863 (78%) patients had a record of screening attendance in the past 12 months. Among those screened, 494 (57.2%) only attended RetinaScreen, 258 (28.7%) only attended other screening services, and 111 (12.9%) attended both services. 

Multivariate logistic regression models revealed that patients receiving oral hypoglycaemic agents (OR 2.05 (95% CI 1.35–3.12) and insulin or other injectable (OR 1.94 (1.09–3.54) were more likely to attend screening vs patients managed by diet only. Likewise, patients who visited a DNS in the past 12 months (OR 2.27 (1.28-4.03) were more likely to attend screening. Further, patients with a blood glucose level on target were also more likely to attend screening (OR 0.68 (0.48-0.98). 

Gender, age, General Medical Service scheme status, duration of diabetes, hypertension and hyperlipidaemia were factors not considered statistically significant with regard to screening attendance. The investigators noted that females were less likely to attend the national screening programme compared with males. 

This study reported several limitations. The study population consisted of mostly middle-aged and older Irish individuals managed within a well-established structured diabetes care initiative, which limited the generalizability of these findings. Additionally, patients with missing data for diabetes type were not included in the analysis (N=12 <1%).  

“While this study did not examine outcomes among those who did and did not attend screening, other research suggests that those who do not attend are more likely to develop sight-threatening retinopathy,” according to the researchers. 

Reference

O’Keeffe D, Riordan F, Harkins V, Kearney P, Mc Hugh S. Predictors of attendance at diabetic retinopathy screening among people with type 2 diabetes: secondary analysis of data from primary care. PCDE. Published online September 11, 2021. doi:10.1016/j.pcd.2021.08.004