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Rahmati M, Smith L, Boyer L, Fond G, Yon DK, Lee H, Soysal P, Piyasena MP, Pardhan S. Factors affecting global adherence for the uptake of diabetic retinopathy screening: A systematic review and meta-analysis. Am J Ophthalmol 2024:S0002-9394(24)00335-0. [PMID: 39094991 DOI: 10.1016/j.ajo.2024.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 07/16/2024] [Accepted: 07/21/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE To evaluate diabetic retinopathy (DR) screening global adherence rate and the association between sociodemographic and clinical variables and adherence rates to DR screening in individuals with diabetes. DESIGN Systematic Review and Meta-Analysis METHODS: : This systematic review was registered with International Prospective Register of Systematic Reviews (ID: CRD42024507035). We conducted a systematic review of relevant literature from inception of databases to February 24, 2024 using electronic databases searches including PubMed, MEDLINE (Ovid), EMBASE, Web of Science, Cochrane CENTRAL, and CDSR and national level DR screening databases through Google searches following PRISMA guidelines. The articles were screened for title and abstract and then for the full-text reports by two independent reviewers and study quality was appraised. Meta-analysis was performed using random effects model to calculate the pooled effects size and 95% confidence interval (CI) of each finding. RESULTS Data from a total of 11,383,715 participants from 77 studies and two national websites from 28 countries over five continents were included. Global DR screening adherence rate was 66.9% in high-income countries and 39.3% in low-and-middle-income countries. DR screening adherence rate was lowest in Africa (36.1%) and was highest in Europe (81.3%). Older age (odds ratio [OR] 1.45, 95% CI 1.30-1.62), higher education level (OR1.65, 95% CI 1.45-1.78), marriage (OR 1.42, 95% CI 1.14-1.77), living in an urban area (OR 1.57, 95% CI 1.08-2.29), higher family income (OR 1.29, 95% CI 1.24-1.35), having any health insurance (OR 1.90, 95% CI 1.56-2.31), longer duration of diabetes (OR 1.57, 95% CI 1.27-1.94), type 2 diabetes (OR 1.68, 95% CI 1.34-2.10), family history of diabetes (OR 2.25, 95% CI 1.56-3.25), vision impairment (OR 2.07, 95% CI 1.43-2.98), history of eye diseases (OR 1.99, 95% CI 1.36-2.90), insulin treatment (OR 1.38, 95% CI 1.37-1.39), and good mental health (OR 1.14, 95% CI 1.04-1.24) were associated with DR screening adherence. CONCLUSION This meta-analysis provides key information about which population subgroups may require more targeted intervention and highlights the urgent need to identify ways to improve adherence to DR screening.
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Affiliation(s)
- Masoud Rahmati
- Research Centre on Health Services and Quality of Life, Aix Marseille University, Marseille, France; Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran; Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran.
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK.
| | - Laurent Boyer
- Research Centre on Health Services and Quality of Life, Aix Marseille University, Marseille, France.
| | - Guillaume Fond
- Research Centre on Health Services and Quality of Life, Aix Marseille University, Marseille, France.
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea; Department of Pediatrics, Kyung Hee University College of Medicine, Seoul, Republic of Korea.
| | - Hayeon Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea.
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.
| | - Mapa Prabhath Piyasena
- Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University, Young Street, Cambridge, United Kingdom.
| | - Shahina Pardhan
- Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University, Young Street, Cambridge, United Kingdom; Centre for Inclusive Community Eye Health, Anglia Ruskin University, Cambridge UK.
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2
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Huang JJ, Channa R, Wolf RM, Dong Y, Liang M, Wang J, Abramoff MD, Liu TYA. Autonomous artificial intelligence for diabetic eye disease increases access and health equity in underserved populations. NPJ Digit Med 2024; 7:196. [PMID: 39039218 PMCID: PMC11263546 DOI: 10.1038/s41746-024-01197-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 07/12/2024] [Indexed: 07/24/2024] Open
Abstract
Diabetic eye disease (DED) is a leading cause of blindness in the world. Annual DED testing is recommended for adults with diabetes, but adherence to this guideline has historically been low. In 2020, Johns Hopkins Medicine (JHM) began deploying autonomous AI for DED testing. In this study, we aimed to determine whether autonomous AI implementation was associated with increased adherence to annual DED testing, and how this differed across patient populations. JHM primary care sites were categorized as "non-AI" (no autonomous AI deployment) or "AI-switched" (autonomous AI deployment by 2021). We conducted a propensity score weighting analysis to compare change in adherence rates from 2019 to 2021 between non-AI and AI-switched sites. Our study included all adult patients with diabetes (>17,000) managed within JHM and has three major findings. First, AI-switched sites experienced a 7.6 percentage point greater increase in DED testing than non-AI sites from 2019 to 2021 (p < 0.001). Second, the adherence rate for Black/African Americans increased by 12.2 percentage points within AI-switched sites but decreased by 0.6% points within non-AI sites (p < 0.001), suggesting that autonomous AI deployment improved access to retinal evaluation for historically disadvantaged populations. Third, autonomous AI is associated with improved health equity, e.g. the adherence rate gap between Asian Americans and Black/African Americans shrank from 15.6% in 2019 to 3.5% in 2021. In summary, our results from real-world deployment in a large integrated healthcare system suggest that autonomous AI is associated with improvement in overall DED testing adherence, patient access, and health equity.
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Affiliation(s)
- Jane J Huang
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Roomasa Channa
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Risa M Wolf
- Johns Hopkins Pediatric Diabetes Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yiwen Dong
- Department of Biostatistics, Johns Hopkins University, Baltimore, MD, USA
| | - Mavis Liang
- Department of Biostatistics, Johns Hopkins University, Baltimore, MD, USA
| | - Jiangxia Wang
- Department of Biostatistics, Johns Hopkins University, Baltimore, MD, USA
| | - Michael D Abramoff
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, USA
| | - T Y Alvin Liu
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Toprak A, Koc H, Alpay A, Ugurbas SH. The effect of intravitreal anti-VEGF injections on choroidal vascular index in patients with diabetic macular edema. Cutan Ocul Toxicol 2024:1-7. [PMID: 39028139 DOI: 10.1080/15569527.2024.2380325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 07/10/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE This study aims to examine and compare the effects of intravitreal bevacizumab injection (IVB) at subfoveal 1500 micron (μm) and submacular 6000 μm in patients with diabetic macular edema (DME). METHODS Fifty eyes of 45 patients with DME who completed six doses of IVB were included in the study group, and 50 eyes of 42 patients who had diabetic retinopathy (DR) but did not receive any treatment were included in the control group. Central macular thickness (CMT), central choroidal thickness (CCT), subfoveal and total choroidal area (TCA), and choroidal vascular index (CVI) were calculated and their changes at zero, three and six months were evaluated. RESULTS At baseline, CVI was significantly lower in both the subfoveal and total macular areas in the study group (p = 0.004, p = 0.003). In the study group, a significant decrease was observed in CVI between zero and six months in the subfoveal area (p = 0.001). In the submacular area, the decrease in CVI in the study group was significant between zero to three months and zero to six months. There was moderate correlation between measurements of CVI in the subfoveal and total macular areas (r = 0.66, p < 0.001). CONCLUSION These findings indicate that intravitreal bevacizumab injection reduces the CVI and the effects of intravitreal anti-VEGF on CVI emerge earlier and more prominently in the submacular 6000 µm area.
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Affiliation(s)
- Aydin Toprak
- Kırıkhan State Hospital, Kırıkhan, Hatay, Turkey
| | - Hakan Koc
- Faculty of Medicine, Department of Ophthalmology, Giresun University, Giresun, Turkey
| | - Atilla Alpay
- Faculty of Medicine, Department of Ophthalmology, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Suat Hayri Ugurbas
- Faculty of Medicine, Department of Ophthalmology, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
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Radgoudarzi N, Gregg C, Quackenbush Q, Yiu G, Freeby M, Su G, Baxter S, Thorne C, Willard-Grace R. Implementation Mapping of the Collaborative University of California Teleophthalmology Initiative (CUTI): A Qualitative Study Using the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework. Cureus 2024; 16:e64179. [PMID: 39119397 PMCID: PMC11309586 DOI: 10.7759/cureus.64179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2024] [Indexed: 08/10/2024] Open
Abstract
Background This study aimed to investigate the rationale, barriers, and facilitators of teleretinal camera implementation in primary care and endocrinology clinics for diabetic retinopathy (DR) screening across University of California (UC) health systems utilizing the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Methodology Institutional representatives from UC Los Angeles, San Diego, San Francisco, and Davis participated in a series of focus group meetings to elicit implementation facilitators and barriers for teleophthalmology programs within their campuses. Site representatives also completed a survey regarding their program's performance over the calendar year 2022 in the following areas: DR screening camera sites, payment sources and coding, screening workflows including clinical, information technology (IT), reading, results, pathologic findings, and follow-up, including patient outreach for abnormal results. Focus group and survey results were mapped to the EPIS framework to gain insights into the implementation process of these programs and identify areas for optimization. Results Four UC campuses with 20 active camera sites screened 7,450 patients in the calendar year 2022. The average DR screening rate across the four campuses was 55%. Variations between sources of payment, turn-around time, image-grading structure, image-report characteristics, IT infrastructure, and patient outreach strategies were identified between sites. Closing gaps in IT integration between data systems, ensuring the financial sustainability of the program, and optimizing patient outreach remain primary challenges across sites and serve as good opportunities for cross-institutional learning. Conclusions Despite the potential for long-term cost savings and improving access to care, numerous obstacles continue to hinder the widespread implementation of teleretinal DR screening. Implementation science approaches can identify strategies for addressing these challenges and optimizing implementation.
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Affiliation(s)
| | - Chhavi Gregg
- Informatics Services, University of California San Diego Health, San Diego, USA
| | - Quinn Quackenbush
- Family and Community Medicine, University of California San Diego Health, San Diego, USA
| | - Glenn Yiu
- Ophthalmology, University of California Davis Health, Sacramento, USA
| | - Matthew Freeby
- Endocrinology, University of California Los Angeles Health Systems, Los Angeles, USA
| | - George Su
- Pulmonary and Critical Care Medicine, University of California San Francisco Health Systems, San Francisco, USA
| | - Sally Baxter
- Ophthalmology, University of California San Diego Health, San Diego, USA
| | - Christine Thorne
- Primary Care, University of California San Diego Health, San Diego, USA
| | - Rachel Willard-Grace
- Primary Care, University of California San Francisco Health Systems, San Francisco, USA
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Salavatian F, Hashemi-Madani N, Emami Z, Hosseini Z, Falavarjani KG, Khamseh ME. Improving diabetic retinopathy screening at the point of care: integrating telemedicine to overcome current challenges. BMC Ophthalmol 2024; 24:256. [PMID: 38877501 PMCID: PMC11177507 DOI: 10.1186/s12886-024-03508-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/03/2024] [Indexed: 06/16/2024] Open
Abstract
OBJECTIVE To investigate the utility of point of care screening of diabetic retinopathy (DR) and the impact of a telemedicine program to overcome current challenges. METHODS This was a retrospective study on people with type 2 diabetes mellitus (T2DM) who were screened for DR using the single-field non-mydriatic fundus photography at the point of care during routine follow-up visits at endocrinology clinic. Retinal images were uploaded and sent to a retina specialist for review. Reports indicating retinopathy status and the need for direct retinal examination were transmitted back to the endocrinology clinic. All patients were informed about DR status and, if needed, referred to the retina specialist for direct retinal examination. RESULTS Of the 1159 individuals screened for DR, 417 persons (35.98%) were screen-positive and referred to the retina specialist for direct retinal examination. A total of 121 individuals (29.01%) underwent direct retinal examination by the specialist. Diabetes macular edema (DME) was detected in 12.1%. In addition, non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) were detected in 53.4% and 2.6% of the patients, respectively. CONCLUSION Integrating DR screening program at the point of care at the secondary care services improves the rate of DR screening as well as detection of sight threatening retinopathy and provides the opportunity for timely intervention in order to prevent advanced retinopathy in people with T2DM.
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Affiliation(s)
| | - Nahid Hashemi-Madani
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran, No. 10, Firoozeh St., Vali-asr Ave., Vali-asr Sq, Tehran, Iran
| | - Zahra Emami
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran, No. 10, Firoozeh St., Vali-asr Ave., Vali-asr Sq, Tehran, Iran
| | - Zahra Hosseini
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Khalil Ghasemi Falavarjani
- Eye Research Centre, Five Senses Health Institute, School of Medicine, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran, Sattarkhan St., Niayesh St, Tehran, 14455-364, Iran.
| | - Mohammad E Khamseh
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran, No. 10, Firoozeh St., Vali-asr Ave., Vali-asr Sq, Tehran, Iran.
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6
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Donaghue KC, Liew G. Measuring Outcomes of Diabetic Retinopathy Screening: What Is Important? Diabetes Care 2024; 47:930-932. [PMID: 38768335 DOI: 10.2337/dci24-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- Kim C Donaghue
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Child and Adolescent Health, The University of Sydney School of Medicine, Faculty of Medicine and Health, Camperdown, New South Wales, Australia
| | - Gerald Liew
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- Clinical Ophthalmology and Eye Health, The University of Sydney School of Medicine, Faculty of Medicine and Health, Camperdown, New South Wales, Australia
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Wijewickrama P, Onyema M, Eid H, Phare N, Dick J, Moutzouris D, Lambie M, Vas P, Williams J, Karalliedde J. Standards of diabetes care and burden of hypoglycaemia in people with diabetes on peritoneal dialysis: Results from a real-world clinical audit. Perit Dial Int 2024; 44:216-220. [PMID: 37702352 DOI: 10.1177/08968608231195492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
There is limited data on the standards of diabetes care in people on peritoneal dialysis (PD). Our aim was to assess the standards of diabetes care and the burden of hypoglycaemia in people with diabetes on PD. We performed a retrospective study at three university hospitals from December 2021 to January 2022. Clinical data were extracted from electronic health records. Diabetes care of people on PD was compared against recommended standards for people with diabetes on haemodialysis (as there are no agreed standards for PD). The degree of hypoglycaemia awareness was assessed by validated questionnaires. A total of 65 adults (15 type 1, 49 type 2 and 1 monogenic-diabetes) with a mean age of 63 (range 29-88) years were evaluated. Of them, 92% had diabetes retinal screening with annual review. In contrast, in this high-risk group for foot disease, only 77% had annual foot reviews. The rates of diabetes specialist reviews were variable between hospitals at 63-94% and 10 (15%) had impaired hypoglycaemia awareness. Of the cohort, 32% had HbA1c within the acceptable range of 58-80 mmol/mol (7.5-8.5%), 21% had HbA1c below 58 mmol/mol (7.5%) and 21% (n = 14) reported at least one hypoglycaemic event per month. Our results indicate variation of care within and between different centres, and the need for improved diabetes care in people on PD. Further work is required to establish agreed standards/recommendations of diabetes care in this population. Our findings highlight the necessity of an integrated multidisciplinary approach to improve the standard of diabetes care for people on PD.
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Affiliation(s)
| | | | - Hatem Eid
- King's College Hospital London, UK
- Guy's & St Thomas' Hospital, London, UK
| | | | | | | | | | | | | | - Janaka Karalliedde
- King's College Hospital London, UK
- Guy's & St Thomas' Hospital, London, UK
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Liu TYA, Huang J, Channa R, Wolf R, Dong Y, Liang M, Wang J, Abramoff M. Autonomous Artificial Intelligence Increases Access and Health Equity in Underserved Populations with Diabetes. RESEARCH SQUARE 2024:rs.3.rs-3979992. [PMID: 38559222 PMCID: PMC10980149 DOI: 10.21203/rs.3.rs-3979992/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Diabetic eye disease (DED) is a leading cause of blindness in the world. Early detection and treatment of DED have been shown to be both sight-saving and cost-effective. As such, annual testing for DED is recommended for adults with diabetes and is a Healthcare Effectiveness Data and Information Set (HEDIS) measure. However, adherence to this guideline has historically been low, and access to this sight-saving intervention has particularly been limited for specific populations, such as Black or African American patients. In 2018, the US Food and Drug Agency (FDA) De Novo cleared autonomous artificial intelligence (AI) for diagnosing DED in a primary care setting. In 2020, Johns Hopkins Medicine (JHM), an integrated healthcare system with over 30 primary care sites, began deploying autonomous AI for DED testing in some of its primary care clinics. In this retrospective study, we aimed to determine whether autonomous AI implementation was associated with increased adherence to annual DED testing, and whether this was different for specific populations. JHM primary care sites were categorized as "non-AI" sites (sites with no autonomous AI deployment over the study period and where patients are referred to eyecare for DED testing) or "AI-switched" sites (sites that did not have autonomous AI testing in 2019 but did by 2021). We conducted a difference-in-difference analysis using a logistic regression model to compare change in adherence rates from 2019 to 2021 between non-AI and AI-switched sites. Our study included all adult patients with diabetes managed within our health system (17,674 patients for the 2019 cohort and 17,590 patients for the 2021 cohort) and has three major findings. First, after controlling for a wide range of potential confounders, our regression analysis demonstrated that the odds ratio of adherence at AI-switched sites was 36% higher than that of non-AI sites, suggesting that there was a higher increase in DED testing between 2019 and 2021 at AI-switched sites than at non-AI sites. Second, our data suggested autonomous AI improved access for historically disadvantaged populations. The adherence rate for Black/African Americans increased by 11.9% within AI-switched sites whereas it decreased by 1.2% within non-AI sites over the same time frame. Third, the data suggest that autonomous AI improved health equity by closing care gaps. For example, in 2019, a large adherence rate gap existed between Asian Americans and Black/African Americans (61.1% vs. 45.5%). This 15.6% gap shrank to 3.5% by 2021. In summary, our real-world deployment results in a large integrated healthcare system suggest that autonomous AI improves adherence to a HEDIS measure, patient access, and health equity for patients with diabetes - particularly in historically disadvantaged patient groups. While our findings are encouraging, they will need to be replicated and validated in a prospective manner across more diverse settings.
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Affiliation(s)
| | | | | | - Risa Wolf
- Johns Hopkins University School of Medicine
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Kaur A, Kumar R, Sharma A. Diabetic Retinopathy Leading to Blindness- A Review. Curr Diabetes Rev 2024; 20:e240124225997. [PMID: 38275038 DOI: 10.2174/0115733998274599231109034741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/28/2023] [Accepted: 10/18/2023] [Indexed: 01/27/2024]
Abstract
Diabetic retinopathy (DR) is the most common microvascular complication of diabetes that damages the retina, leading to blindness. People with type 1 diabetes are at greater risk of developing DR than people with type 2 diabetes. Diabetic retinopathy may be divided into two primary categories: Proliferative diabetic retinopathy (PDR) and non-proliferative diabetic retinopathy (NPDR). There are multiple risk factors for the onset and progression of diabetic retinopathy, such as hypertension, obesity, smoking, duration of diabetes, and genetics. Numerous investigations have evaluated the levels of a wide range of inflammatory chemokines within DR patients' serum, vitreous, and aqueous fluids. In diabetic retinopathy, the vitreous fluid exhibited rises in angiogenic factors like platelet-derived growth factor (PDGF) or vascular endothelial growth factor (VEGF) or declines in antiangiogenic factors like pigment epithelium-derived factor (PEDF). For prevention of diabetic retinopathy, more physical activity as well as less sedentary behavior were linked to a reduced likelihood of DR. Supplementing with nutraceuticals containing vitamins (B1, B2, B6, B12, C, D, E, and l-methyl folate) and mineral (zinc) can help decrease or avoid an outbreak of DR. Only laser photocoagulation and Anti-vascular endothelial growth factor (Anti-VEGF) injections are advised as favorable therapies in severe retinopathy. When it comes to treating DR's VEGF levels, inflammation, oxidative stress, apoptosis, and angiogenesis, Traditional Chinese medicine (TCM) has an excellent future.
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Affiliation(s)
- Amandeep Kaur
- Department of Pharmacy Practice, ISF College of Pharmacy, Moga, Punjab, India
| | - Ranjeet Kumar
- Department of Pharmacy Practice, ISF College of Pharmacy, Moga, Punjab, India
| | - Amit Sharma
- Department of Pharmacy Practice, ISF College of Pharmacy, Moga, Punjab, India
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Nissen TPH, Vestergaard P, Vorum H, Torp-Pedersen C, Aasbjerg K. A cohort follow-up study for diabetic retinopathy screening incidence in the North Denmark Region. Acta Diabetol 2023; 60:1581-1590. [PMID: 37436529 PMCID: PMC10520120 DOI: 10.1007/s00592-023-02146-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/19/2023] [Indexed: 07/13/2023]
Abstract
AIMS To evaluate diabetic retinopathy (DR) screening incidence in a universal healthcare system. METHODS Registry-based cohort study based on a Danish regional population from 2009 to 2018. Individuals with diabetes were identified by medication. Screening attendance was estimated by surrogate measures using local and nationwide databases reported by cumulative incidence. RESULTS 18,832 patients were included. By the end of the first year, the cumulative incidence of screening for DR was 60.2% and by the end of the second year 74.2%. The cumulative incidence was 93.9% overall, 97.7% for patients with type 1 diabetes (T1D) and 93.4% for patients with type 2 diabetes. Screening proportions per 1, 2 and 5 years were calculated. Females, patients with T1D, and patients attending screening at hospitals had a higher Hazard Ratio of 1.084, 1.157, and 1.573, respectively. The Cochran-Armitage trend test indicated increased screening frequency from 2009 to 2018. Validation of DR screening was done at hospitals with a mean positive predictive value of 86.78%. Cumulative incidence curves showed a small right shift when censoring the first, second and third screening visits. CONCLUSIONS Nearly all patients were screened for DR over a 5-year timespan. Female patients with T1D who attended screening at hospitals were significantly more likely to be screened. Validation of screening visits at hospitals was reported with a high mean positive predictive value. Most other studies, to the best of our knowledge, only report screening attendance for patients already enrolled in a DR screening programme. This study describes the overall screening attendance for the total eligible diabetes population.
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Affiliation(s)
- Tobias P H Nissen
- Department of Ophthalmology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark.
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Hobrovej 18-22, 9000, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Henrik Vorum
- Department of Ophthalmology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands University Hospital, Hillerød, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Fu XL, He FT, Li MH, Fu CY, Chen JZ. Up-regulation of miR-192-5p inhibits the ELAVL1/PI3Kδ axis and attenuates microvascular endothelial cell proliferation, migration and angiogenesis in diabetic retinopathy. Diabet Med 2023; 40:e15077. [PMID: 36861382 DOI: 10.1111/dme.15077] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/07/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Diabetic retinopathy (DR) is a common complication of diabetes mellitus that poses a threat to adults. MicroRNAs (miRNAs) play a key role in DR progression. However, the role and mechanism of miR-192-5p in DR remain unclear. We aimed to investigate the effect of miR-192-5p on cell proliferation, migration and angiogenesis in DR. METHODS Expression of miR-192-5p, ELAV-like RNA binding protein 1 (ELAVL1) and phosphoinositide 3-kinase delta (PI3Kδ) in human retinal fibrovascular membrane (FVM) samples and human retinal microvascular endothelial cells (HRMECs) was assessed using RT-qPCR. ELAVL1 and PI3Kδ protein levels were evaluated by Western blot. RIP and dual luciferase reporter assays were performed to confirm the miR-192-5p/ELAVL1/PI3Kδ regulatory networks. Cell proliferation, migration and angiogenesis were assessed by CCK8, transwell and tube formation assays. RESULTS MiR-192-5p was decreased in FVM samples from DR patients and high glucose (HG)-treated HRMECs. Functionally, overexpressed miR-192-5p inhibited cell proliferation, migration and angiogenesis in HG-treated HRMECs. Mechanically, miR-192-5p directly targeted ELAVL1 and decreased its expression. We further verified that ELAVL1 bound to PI3Kδ and maintained PI3Kδ mRNA stability. Rescue analysis demonstrated that the suppressive effects of HG-treated HRMECs caused by miR-192-5p up-regulation were overturned by overexpressed ELAVL1 or PI3Kδ. CONCLUSION MiR-192-5p attenuates DR progression by targeting ELAVL1 and reducing PI3Kδ expression, suggesting a biomarker for the treatment of DR.
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Affiliation(s)
- Xiao-Lin Fu
- Department of Ophthalmology, Hainan West Central Hospital, Danzhou, Hainan Province, P.R. China
| | - Fu-Tao He
- Department of Ophthalmology, Hainan West Central Hospital, Danzhou, Hainan Province, P.R. China
| | - Mo-Han Li
- Department of Ophthalmology, Hainan West Central Hospital, Danzhou, Hainan Province, P.R. China
| | - Chun-Yan Fu
- Department of Ophthalmology, Hainan West Central Hospital, Danzhou, Hainan Province, P.R. China
| | - Jian-Zhi Chen
- Department of Ophthalmology, Hainan West Central Hospital, Danzhou, Hainan Province, P.R. China
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12
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Trott M, Driscoll R, Bourne R, Slade J, Ingleton H, Farrell S, Bowen M, Lovell-Patel R, Kidd J, Pardhan S. Mental health support across the sight loss pathway: a qualitative exploration of eye care patients, optometrists, and ECLOs. Eye (Lond) 2023; 37:2554-2558. [PMID: 36627444 PMCID: PMC10397192 DOI: 10.1038/s41433-022-02373-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 11/29/2022] [Accepted: 12/16/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The process of becoming visually impaired or blind is undoubtedly a highly emotional experience, requiring practical and psychological support. Information on mental health support provision in the UK across the sight-loss pathway, however, is largely unknown, especially amongst healthcare practitioners that are often sought after for advice: the referring optometrist and eye clinic liaison officer (ECLO). This study aims to ascertain the perceived accessibility and quality of mental health support across the sight-loss pathway. METHODS Semi-structured individual interviews were conducted with patients with a diagnosed eye condition who had received care from a hospital eye service, referring optometrists, and ECLOs. Following interview transcription, results were synthesised in a narrative analysis. RESULTS A total of 28 participants were included in the analysis, of which 17 were participants with various eye conditions, five were referring optometrists, and five were ECLOs. After analysis, three broad themes emerged: (1) The emotional trauma of diagnosis (2) Availability of mental health support; (3) The point where mental health support is most needed across the sight-loss pathway. Several patients reporting that they had received no offer of support nor were they signposted to any possible sources. Referring optometrists and ECLO's agreed. CONCLUSION It is important that referring optometrists are aware of the need for mental health support services and can signpost to local support services including the third sector anytime during the referral process. Future large-scale, UK-wide research into referral practice and signposting for mental health support for patients is warranted, to identify how services can be improved in order to ensure that the wellbeing of patients is maintained.
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Affiliation(s)
- M Trott
- Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK.
- Centre for Public Health, Queen's University Belfast, Belfast, UK.
| | - R Driscoll
- Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK
| | - R Bourne
- Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK
| | - J Slade
- Royal National Institute of Blind People, London, UK
| | - H Ingleton
- Royal National Institute of Blind People, London, UK
| | - S Farrell
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - M Bowen
- College of Optometrists, London, UK
| | | | - J Kidd
- Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK
| | - S Pardhan
- Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK
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13
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Kumar S, Mohanraj R, Raman R, Kumar G, Luvies S, Machhi SS, Chakrabarty S, Surya J, Ramakrishnan R, Conroy D, Sivaprasad S. 'I don`t need an eye check-up'. A qualitative study using a behavioural model to understand treatment-seeking behaviour of patients with sight threatening diabetic retinopathy (STDR) in India. PLoS One 2023; 18:e0270562. [PMID: 37319187 PMCID: PMC10270603 DOI: 10.1371/journal.pone.0270562] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 05/30/2023] [Indexed: 06/17/2023] Open
Abstract
Diabetic Retinopathy (DR) affects about 27% of patients with diabetes globally. According to the World Health Organization (WHO), DR is responsible for37 million cases of blindness worldwide. The SMART India study (October 2020-August 2021) documented the prevalence of diabetes, and DR in people40 years and above across ten Indian states and one Union Territory by conducting community screening. About 90% of people with sight threatening diabetic retinopathy (STDR) were referred from this screening study to eye hospitals for management, but failed to attend. This qualitative study, a component of the SMART India study, explored perceptions of referred patients regarding their susceptibility to eye related problems in diabetes and the benefits/barriers to seeking care. Perceived barriers from the viewpoint of ophthalmologists were also explored. Guided by the Health Beliefs Model (HBM), 20 semi structured interviews were carried out with consenting patients diagnosed with STDR. They included nine patients who had sought care recruited from eight eye hospitals across different states in India and eleven patients who did not seek care. Eleven ophthalmologists also participated. Four themes of analysis based on the HBM were, understanding of DR and its treatment, perceptions about susceptibility and severity, perceived barriers, perceived benefits and cues to action. Findings revealed poor understanding of the effects of diabetes on the eye contributing to low risk perception. Prohibitive costs of treatment, difficulties in accessing care services and poor social support were major barriers to seeking care. Ophthalmologists acknowledged that the absence of symptoms and the slow progressive nature of the disease deluded patients into thinking that they were fine. The study attests to the need for greater health literacy around diabetes, DR and STDR; for making treatment more affordable and accessible and for the development of effective patient education and communication strategies towards increasing compliance.
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Affiliation(s)
- Shuba Kumar
- Social Science Department, Samarth, Chennai, Tamil Nadu, India
| | - Rani Mohanraj
- Social Science Department, Samarth, Chennai, Tamil Nadu, India
| | - Rajiv Raman
- Department of Ophthalmology, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Geetha Kumar
- Department of Ophthalmology, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Sanjay Luvies
- Department of Ophthalmology, Giridhar Eye Institute, Cochin, Kerala, India
| | - Shivani Sunil Machhi
- Department of Ophthalmology, Aditya Jyot Foundation for Twinkling Little Eyes, Mumbai, Maharashtra, India
| | | | - Janani Surya
- Department of Ophthalmology, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Radha Ramakrishnan
- Department of Ophthalmology-NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Dolores Conroy
- Department of Ophthalmology-NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Sobha Sivaprasad
- Department of Ophthalmology-NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
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14
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Joseph S, Rajan RP, Sundar B, Venkatachalam S, Kempen JH, Kim R. Validation of diagnostic accuracy of retinal image grading by trained non-ophthalmologist grader for detecting diabetic retinopathy and diabetic macular edema. Eye (Lond) 2023; 37:1577-1582. [PMID: 35906419 PMCID: PMC10220051 DOI: 10.1038/s41433-022-02190-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 06/22/2022] [Accepted: 07/15/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To validate the fundus image grading results by a trained grader (Non-ophthalmologist) and an ophthalmologist grader for detecting diabetic retinopathy (DR) and diabetic macular oedema (DMO) against fundus examination by a retina specialist (gold standard). METHODS A prospective diagnostic accuracy study was conducted using 2002 non-mydriatic colour fundus images from 1001 patients aged ≥40 years. Using the Aravind Diabetic Retinopathy Evaluation Software (ADRES) images were graded by both a trained non-ophthalmologist grader (grader-1) and an ophthalmologist (grader-2). Sensitivity, specificity, positive predictive value and negative predictive value were calculated for grader-1 and grader-2 against the grading results by an independent retina specialist who performed dilated fundus examination for every study participant. RESULTS Out of 1001 patients included, 42% were women and the mean ± (SD) age was 55.8 (8.39) years. For moderate or worse DR, the sensitivity and specificity for grading by grader-1 with respect to the gold standard was 66.9% and 91.0% respectively and the same for the ophthalmologist was 83.6% and 80.3% respectively. For referable DMO, grader-1 and grader-2 had a sensitivity of 74.6% and 85.6% respectively and a specificity of 83.7% and 79.8% respectively. CONCLUSIONS Our results demonstrate good level of accuracy for the fundus image grading performed by a trained non-ophthalmologist which was comparable with the grading by an ophthalmologist. Engaging trained non-ophthalmologists potentially can enhance the efficiency of DR diagnosis using fundus images. Further study with multiple non-ophthalmologist graders is needed to verify the results and strategies to improve agreement for DMO diagnosis are needed.
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Affiliation(s)
- Sanil Joseph
- Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, India
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Vic, Australia
- Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Vic, Australia
| | - Renu P Rajan
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, India
| | - Balagiri Sundar
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, India
| | | | - John H Kempen
- Department of Ophthalmology, , Massachusetts Eye and Ear and Harvard Medical School; Schepens Eye Research Institute, Boston, MA, USA
- MCM Eye Unit, MyungSung Christian Medical Center (MCM) Multispecialty Hospital and MyungSung Medical School, Addis Ababa, Ethiopia
- Department of Ophthalmology, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ramasamy Kim
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, India.
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15
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Bajka A, Bacci T, Wiest MRJ, Brinkmann M, Hamann T, Toro M, Zweifel SA. Feasibility and Clinical Utility of Wide-Field Optical Coherence Tomography Angiography Compared to Ultrawide-Field Fluorescein Angiography in Patients with Diabetic Retinopathy. Klin Monbl Augenheilkd 2023; 240:490-495. [PMID: 37164407 DOI: 10.1055/a-2031-2657] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE To test the diagnostic performance of a novel wide-field swept-source optical coherence tomography angiography (WF-OCTA) device in detecting retinal non-perfusion (NP) and neovascularization (NV) in eyes with diabetic retinopathy (DR) and to compare this with the standard-of-care imaging method, ultrawide-field fluorescein angiography (UWFFA). METHODS Prospective, observational, cross-sectional single-center study evaluating patients with DR imaged with WF-OCTA (Xephilio OCT-S1; Canon Inc., Tokyo, Japan) and UWFFA (Optos California; Optos plc, Dunfermline, United Kingdom). WF-OCTA images of the superficial capillary plexus (SCP) consisted of single capture 23 × 20 mm scans centered on the fovea. In UWFFA and WF-OCTA, qualitative and quantitative measurements were assessed to analyze retinal NP and NV. Vessel density (VD) in WF-OCTA and ischemic index (ISI) in UWFFA were calculated. Qualitatively, the presence of NV and NP was assessed in both WF-OCTA (posterior pole/midperipheral retina) and UWFFA (posterior pole/midperipheral retina/far peripheral retina). RESULTS Ten consecutive patients with variable DR severity stages (17 eyes) were evaluated. Two eyes had to be excluded due to low quality of the WF-OCTA images. Therefore, 15 eyes were included for final analysis. Mean age was 57 years (± SD: 15.2) and the male : female ratio was 4 : 6. UWFFA identified retinal NP in 11 eyes (73%). Posterior pole NP was present in eight eyes, midperiphery NP was present in eight eyes, and far periphery NP was present in seven eyes. Retinal NV was detected in four eyes using UWFFA (two eyes with only midperiphery NV). WF-OCTA detected retinal NP in 11 eyes (9 cases with both posterior pole and midperiphery NP). NV was detected in three eyes (two with posterior pole and midperipheral NV, four with only midperipheral NV). Mean VD evaluated using WF-OCTA of the SCP was 0.40 (± SD: 0.1), and mean ISI in UWFFA was 0.09 (± SD: 1.3). Spearman's test did not show a significant correlation between the ISI in UWFFA and VD in WF-OCTA (p = 0.803). CONCLUSIONS Noninvasive WF-OCTA has great potential for the management of patients with DR. This new imaging modality might be useful in daily clinical routine in order to lower the number of invasive examinations. However, in a small percentage of patients, OCTA images cannot be reliably graded for the presence of NP and NV. In these cases, conventional FA needs to be performed.
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Affiliation(s)
- Anahita Bajka
- Department of Ophthalmology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Tommaso Bacci
- Ophthalmology Unit of the Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | | | - Max Brinkmann
- Department of Ophthalmology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Timothy Hamann
- Department of Ophthalmology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Mario Toro
- Ophthalmology, University of Naples Federico II, Napoli, Italy
| | - Sandrine Anne Zweifel
- Department of Ophthalmology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
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16
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Liu W, Luo Z, Zhang L, Wang Y, Yang J, You D, Cao X, Yang W. hsa-mir-(4328, 4422, 548z and -628-5p) in diabetic retinopathy: diagnosis, prediction and linking a new therapeutic target. Acta Diabetol 2023; 60:929-942. [PMID: 37002321 DOI: 10.1007/s00592-023-02077-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/11/2023] [Indexed: 04/03/2023]
Abstract
AIMS Growing evidence suggests that microRNAs (miRNAs) are crucial in controlling how diabetic retinopathy (DR) develops. We intend to mine miRNAs with diagnostic and predictive value for DR and to investigate new drug therapeutic targets. METHODS After performing a differential analysis on the miRNA and mRNA datasets for DR and neovascularization (NEO), miRNA-mRNA networks were created. Combine the results of enrichment analysis, Protein-Protein Interaction Networks (PPI), and Cytoscape to identify key miRNAs. DrugBank was used to find drugs that interacted with transcription factors (TF) predicted by TransmiR. Finally, whole blood and clinical data were collected from 58 patients with type 2 diabetes mellitus (T2DM), and RT-qPCR, logistic analysis, and ROC were used to verify the value of key miRNAs. RESULTS Differential analysis indicated the presence of genes and miRNAs that co-regulate DR and NEO. Enrichment analysis showed that key genes are inextricably linked to neovascularization. Combining the results of PPI and Cytoscape identified four key miRNAs, namely hsa-mir-(4328, 4422, 548z and -628-5p). RT-qPCR, logistic, and ROC results showed that decreased expression levels of hsa-mir-(4328, 4422, 548z and -628-5p) signal the risk of evolution to DR in T2DM patients. Finally, we constructed a TF-miRNA network to find the 15 TFs and the 35 drugs that interact with these TFs. CONCLUSION hsa-mir-(4328, 4422, 548z and -628-5p) in whole blood are protective factors for DR as novel biomarkers for diagnosis and prediction. In addition, our research provides new drug directions for the treatment of DR, such as Diosmin, Atorvastatin, and so on.
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Affiliation(s)
- Weijun Liu
- Department of Laboratory Animal Science, Kunming Medical University, No. 1168, Chunrong West Road, Yuhua Street, Chenggong District, Kunming, 650500, Yunnan, China
- School of Pharmaceutical Science and Yunnan Key Laboratory of Pharmacology for Natural Products, Kunming Medical University, No. 1168, Chunrong West Road, Yuhua Street, Chenggong District, Kunming, 650500, Yunnan, China
- The First Affiliated Hospital of Kunming Medical University, No.295 Xichang Road, Wuhua Districte, Kunming, 650500, Yunnan, China
| | - Zhanqing Luo
- Department of Laboratory Animal Science, Kunming Medical University, No. 1168, Chunrong West Road, Yuhua Street, Chenggong District, Kunming, 650500, Yunnan, China
| | - Lihuan Zhang
- Department of Laboratory Animal Science, Kunming Medical University, No. 1168, Chunrong West Road, Yuhua Street, Chenggong District, Kunming, 650500, Yunnan, China
| | - Yutao Wang
- Department of Laboratory Animal Science, Kunming Medical University, No. 1168, Chunrong West Road, Yuhua Street, Chenggong District, Kunming, 650500, Yunnan, China
| | - Jiamei Yang
- School of Rehabilitation, Kunming Medical University, No. 1168, Chunrong West Road, Yuhua Street, Chenggong District, Kunming, 650500, Yunnan, China
| | - Dingyun You
- Department of Epidemiology, School of Public Health, Kunming Medical University, No. 1168, Chunrong West Road, Yuhua Street, Chenggong District, Kunming, 650500, Yunnan, China.
| | - Xue Cao
- Department of Laboratory Animal Science, Kunming Medical University, No. 1168, Chunrong West Road, Yuhua Street, Chenggong District, Kunming, 650500, Yunnan, China.
| | - Weimin Yang
- School of Pharmaceutical Science and Yunnan Key Laboratory of Pharmacology for Natural Products, Kunming Medical University, No. 1168, Chunrong West Road, Yuhua Street, Chenggong District, Kunming, 650500, Yunnan, China.
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17
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Kropp M, Golubnitschaja O, Mazurakova A, Koklesova L, Sargheini N, Vo TTKS, de Clerck E, Polivka J, Potuznik P, Polivka J, Stetkarova I, Kubatka P, Thumann G. Diabetic retinopathy as the leading cause of blindness and early predictor of cascading complications-risks and mitigation. EPMA J 2023; 14:21-42. [PMID: 36866156 PMCID: PMC9971534 DOI: 10.1007/s13167-023-00314-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/15/2023] [Indexed: 02/17/2023]
Abstract
Proliferative diabetic retinopathy (PDR) the sequel of diabetic retinopathy (DR), a frequent complication of diabetes mellitus (DM), is the leading cause of blindness in the working-age population. The current screening process for the DR risk is not sufficiently effective such that often the disease is undetected until irreversible damage occurs. Diabetes-associated small vessel disease and neuroretinal changes create a vicious cycle resulting in the conversion of DR into PDR with characteristic ocular attributes including excessive mitochondrial and retinal cell damage, chronic inflammation, neovascularisation, and reduced visual field. PDR is considered an independent predictor of other severe diabetic complications such as ischemic stroke. A "domino effect" is highly characteristic for the cascading DM complications in which DR is an early indicator of impaired molecular and visual signaling. Mitochondrial health control is clinically relevant in DR management, and multi-omic tear fluid analysis can be instrumental for DR prognosis and PDR prediction. Altered metabolic pathways and bioenergetics, microvascular deficits and small vessel disease, chronic inflammation, and excessive tissue remodelling are in focus of this article as evidence-based targets for a predictive approach to develop diagnosis and treatment algorithms tailored to the individual for a cost-effective early prevention by implementing the paradigm shift from reactive medicine to predictive, preventive, and personalized medicine (PPPM) in primary and secondary DR care management.
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Affiliation(s)
- Martina Kropp
- Division of Experimental Ophthalmology, Department of Clinical Neurosciences, University of Geneva University Hospitals, 1205 Geneva, Switzerland ,Ophthalmology Department, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | - Olga Golubnitschaja
- Predictive, Preventive and Personalised (3P) Medicine, Department of Radiation Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
| | - Alena Mazurakova
- Clinic of Obstetrics and Gynecology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 036 01 Martin, Slovakia
| | - Lenka Koklesova
- Clinic of Obstetrics and Gynecology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 036 01 Martin, Slovakia
| | - Nafiseh Sargheini
- Max Planck Institute for Plant Breeding Research, Carl-Von-Linne-Weg 10, 50829 Cologne, Germany
| | - Trong-Tin Kevin Steve Vo
- Division of Experimental Ophthalmology, Department of Clinical Neurosciences, University of Geneva University Hospitals, 1205 Geneva, Switzerland ,Ophthalmology Department, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | - Eline de Clerck
- Division of Experimental Ophthalmology, Department of Clinical Neurosciences, University of Geneva University Hospitals, 1205 Geneva, Switzerland ,Ophthalmology Department, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | - Jiri Polivka
- Department of Histology and Embryology, and Biomedical Centre, Faculty of Medicine in Plzen, Charles University, Prague, Czech Republic
| | - Pavel Potuznik
- Department of Neurology, University Hospital Plzen, and Faculty of Medicine in Plzen, Charles University, 100 34 Prague, Czech Republic
| | - Jiri Polivka
- Department of Neurology, University Hospital Plzen, and Faculty of Medicine in Plzen, Charles University, 100 34 Prague, Czech Republic
| | - Ivana Stetkarova
- Department of Neurology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Peter Kubatka
- Department of Medical Biology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 036 01 Martin, Slovakia
| | - Gabriele Thumann
- Division of Experimental Ophthalmology, Department of Clinical Neurosciences, University of Geneva University Hospitals, 1205 Geneva, Switzerland ,Ophthalmology Department, University Hospitals of Geneva, 1205 Geneva, Switzerland
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Muacevic A, Adler JR, Xie SJ, Muro-Fuentes EA, Rodrigues EB. Evaluating Adherence to Diabetic Retinopathy Care in an Urban Ophthalmology Clinic Utilizing the Compliance With Annual Diabetic Eye Exams Survey. Cureus 2023; 15:e34083. [PMID: 36843721 PMCID: PMC9946894 DOI: 10.7759/cureus.34083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 01/25/2023] Open
Abstract
Introduction The objective of this study was to identify barriers that affect adherence to the management of diabetic retinopathy (DR) in an urban ophthalmology clinic. Patient beliefs regarding diabetic eye care, transportation to the eye clinic, the COVID-19 pandemic, and treatment with panretinal photocoagulation (PRP) or anti-vascular endothelial growth factor (anti-VEGF) injections were investigated. Materials and methods The original Compliance with Annual Diabetic Eye Exams Survey (CADEES) included 44 statements designed with a 5-point Likert scale to assess patients' beliefs and understanding of their eye health and the importance of diabetic eye examinations. This survey was modified to include additional statements regarding the COVID-19 pandemic and free-response questions about transportation barriers and patients' subjective experiences with PRP or anti-VEGF injections. A total of 365 patients with a diagnosis of any stage of DR from SLUCare Ophthalmology were identified as potential participants to complete the telephone survey. Patients were classified as non-adherent if they did not have a dilated eye examination within the past year, missed a scheduled follow-up appointment for DR care within the past year, or missed an appointment for anti-VEGF injections or PRP. The mean Likert scores for each CADEES statement were compared between the adherent and non-adherent groups using independent samples t-tests. Demographics and clinical indicators were also reported and compared between the two groups. Results Out of 365 patients, 68 completed the modified CADEES. Twenty-nine patients were adherent, and 39 patients were non-adherent. Results from six of the 54 CADEES statements were significantly different between the adherent and non-adherent groups. These statements addressed patients' perception of their eye health, self-confidence in making an eye appointment, knowing someone with diabetic eye complications, self-confidence in controlling blood sugar, ability to use public transportation during the COVID-19 pandemic, and prioritizing eye health during the pandemic. There were no significant differences in clinical indicators or demographics between the adherent and non-adherent groups. Of the participants, 39.7% offered reasons for why transportation to the eye clinic was difficult. Patients suggested three novel reasons for missing eye appointments that were not specifically addressed in the CADEES. Fourteen unique barriers were reported for non-adherence with PRP or anti-VEGF injections. Conclusions The CADEES is a thorough tool for evaluating social barriers impacting adherence with DR appointments in an urban ophthalmology clinic. The survey did not identify any clinical or demographic risk factors for non-adherence in this patient population. Decreased patient self-efficacy may lead to non-adherence with the management of DR. The COVID-19 pandemic impacted the adherence of a small percentage of patients.
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19
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Mehra AA, Softing A, Guner MK, Hodge DO, Barkmeier AJ. Diabetic Retinopathy Telemedicine Outcomes With Artificial Intelligence-Based Image Analysis, Reflex Dilation, and Image Overread. Am J Ophthalmol 2022; 244:125-132. [PMID: 35970206 DOI: 10.1016/j.ajo.2022.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/03/2022] [Accepted: 08/03/2022] [Indexed: 01/30/2023]
Abstract
PURPOSE To examine real-world telemedicine outcomes of diabetic retinopathy (DR) screening with artificial intelligence (AI)-based image analysis, reflex dilation, and secondary image overread in a primary care setting. DESIGN Validity and reliability analysis. METHODS Single institution review of 1052 consecutive adult patients who received diabetic retinopathy photoscreening in the primary care setting over an 18-month period. Nonmydriatic fundus photographs were acquired and analyzed by the IDx-DR AI-based system. When nonmydriatic images were ungradable, reflex dilation (1% tropicamide) and mydriatic photography were performed for repeat AI-based analysis. Manual overread was performed on all images. Patient demographics, clinical characteristics, and screening outcomes were recorded. RESULTS A total of 965 of 1052 patients (91.7%) had AI-gradable fundus photographs: 580 had gradable nonmydriatic imaging (55.1%) and 440 of 472 patients with ungradable nonmydriatic photographs had reflex dilation (93.2%). One hundred thirty-eight of 965 patients (14.3%) were AI-graded as "positive" (greater than mild NPDR) and 827 of 965 were "negative" (85.7%), with 100% sensitivity (95% CI 90.8-100%), 89.2% specificity (95% CI 87.0-91.1%), 27.5% positive predictive value (95% CI 24.0-31.4%), and 100% negative predictive value (95% CI 99.6-100%) compared with manual overread assessment of greater than mild NPDR requiring further evaluation with a comprehensive dilated examination. Image gradeability was inversely related to patient age: 93.5% gradable (61.9% nonmydriatic) for patients aged <70 years vs 85.3% (31.0% nonmydriatic) for patients aged 70+ years (P < .001). CONCLUSION Incorporation of AI-based image analysis into real-world primary care diabetic retinopathy screening yielded no false negative results and offered excellent image gradeability within a protocol combining nonmydriatic fundus photography and pharmacologic dilation, as needed. Image gradeability was lower with increasing patient age.
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Affiliation(s)
- Ankur A Mehra
- From Department of Ophthalmology, Mayo Clinic, Rochester, USA (A.A.M, A.S, M.K.G, A.J.B)
| | - Alaina Softing
- From Department of Ophthalmology, Mayo Clinic, Rochester, USA (A.A.M, A.S, M.K.G, A.J.B)
| | | | - David O Hodge
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, USA (D.O.H)
| | - Andrew J Barkmeier
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, USA (D.O.H).
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20
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Thykjær AS, Andersen N, Bek T, Heegaard S, Hajari J, Laugesen CS, Möller S, Pedersen FN, Rosengaard L, Schielke KC, Kawasaki R, Højlund K, Rubin KH, Stokholm L, Grauslund J. Attendance in a national screening program for diabetic retinopathy: a population-based study of 205,970 patients. Acta Diabetol 2022; 59:1493-1503. [PMID: 35953626 PMCID: PMC9519674 DOI: 10.1007/s00592-022-01946-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/16/2022] [Indexed: 11/15/2022]
Abstract
AIMS A nationwide diabetic retinopathy (DR) screening program has been established in Denmark since 2013. We aimed to perform an evaluation of adherence to DR screenings and to examine whether non-adherence was correlated to DR progression. METHODS The population consisted of a register-based cohort, who participated in the screening program from 2013 to 2018. We analyzed age, gender, marital status, DR level (International Clinical DR severity scale, none, mild-, moderate-, severe non-proliferative DR (NPDR) and proliferative DR (PDR)), comorbidities and socioeconomic factors. The attendance pattern of patients was grouped as either timely (no delays > 33%), delayed (delays > 33%) or one-time attendance (unexplained). RESULTS We included 205,970 patients with 591,136 screenings. Rates of timely, delayed and one-time attendance were 53.0%, 35.5% and 11.5%, respectively. DR level at baseline was associated with delays (mild-, moderate-, severe NPDR and PDR) and one-time attendance (moderate-, severe NPDR and PDR) with relative risk ratios (RRR) of 1.68, 2.27, 3.14, 2.44 and 1.18, 2.07, 1.26, respectively (P < 0.05). Delays at previous screenings were associated with progression to severe NPDR or PDR (hazard ratio (HR) 2.27, 6.25 and 12.84 for 1, 2 and 3+ delays, respectively). Any given delay doubled the risk of progression (HR 2.28). CONCLUSIONS In a national cohort of 205,970 patients, almost half of the patients attended DR screening later than scheduled or dropped out after first screening episode. This was, in particular, true for patients with any levels of DR at baseline. DR progression in patients with delayed attendance, increased with the number of missed appointments.
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Affiliation(s)
- Anne Suhr Thykjær
- Department of Ophthalmology, Odense University Hospital, J. B. Winsløws Vej 4, Odense C, 5000, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.
| | - N Andersen
- Organization of Danish Practicing Ophthalmologists, Copenhagen, Denmark
| | - T Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - S Heegaard
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - J Hajari
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - C S Laugesen
- Department of Ophthalmology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - S Möller
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - F N Pedersen
- Department of Ophthalmology, Odense University Hospital, J. B. Winsløws Vej 4, Odense C, 5000, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - L Rosengaard
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - K C Schielke
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
| | - R Kawasaki
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Vision Informatics, University of Osaka, Osaka, Japan
| | - K Højlund
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - K H Rubin
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - L Stokholm
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - J Grauslund
- Department of Ophthalmology, Odense University Hospital, J. B. Winsløws Vej 4, Odense C, 5000, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
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21
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Ferro Desideri L, Rutigliani C, Corazza P, Nastasi A, Roda M, Nicolo M, Traverso CE, Vagge A. The upcoming role of Artificial Intelligence (AI) for retinal and glaucomatous diseases. JOURNAL OF OPTOMETRY 2022; 15 Suppl 1:S50-S57. [PMID: 36216736 PMCID: PMC9732476 DOI: 10.1016/j.optom.2022.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 06/16/2023]
Abstract
In recent years, the role of artificial intelligence (AI) and deep learning (DL) models is attracting increasing global interest in the field of ophthalmology. DL models are considered the current state-of-art among the AI technologies. In fact, DL systems have the capability to recognize, quantify and describe pathological clinical features. Their role is currently being investigated for the early diagnosis and management of several retinal diseases and glaucoma. The application of DL models to fundus photographs, visual fields and optical coherence tomography (OCT) imaging has provided promising results in the early detection of diabetic retinopathy (DR), wet age-related macular degeneration (w-AMD), retinopathy of prematurity (ROP) and glaucoma. In this review we analyze the current evidence of AI applied to these ocular diseases, as well as discuss the possible future developments and potential clinical implications, without neglecting the present limitations and challenges in order to adopt AI and DL models as powerful tools in the everyday routine clinical practice.
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Affiliation(s)
- Lorenzo Ferro Desideri
- University Eye Clinic of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy.
| | | | - Paolo Corazza
- University Eye Clinic of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy
| | | | - Matilde Roda
- Ophthalmology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna and S.Orsola-Malpighi Teaching Hospital, Bologna, Italy
| | - Massimo Nicolo
- University Eye Clinic of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy
| | - Carlo Enrico Traverso
- University Eye Clinic of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy
| | - Aldo Vagge
- University Eye Clinic of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy
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22
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Hertzberg SNW, Jørstad ØK, Petrovski BÉ, Bragadottir R, Steffensen LA, Moe MC, Burger EA, Petrovski G. Transition from Laser to Intravitreal Injections for Diabetic Retinopathy: Hospital Utilization and Costs from an Extended Healthcare Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12603. [PMID: 36231903 PMCID: PMC9564656 DOI: 10.3390/ijerph191912603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE To describe the trends in hospital utilization and economic outcomes associated with the transition from laser to intravitreal injection (IVI) therapy for diabetic retinopathy (DR) at Oslo University Hospital (OUH), which provides the largest retina service in Norway. METHODS This descriptive study analyzed hospital administrative data and determined the average utilization and treatment proportions of laser therapy, IVIs and vitrectomy for each patient per year. The Chi-square test was used to compare resource use between treatment groups. From an extended healthcare perspective, the annual cost per patient was calculated using Norwegian tariff data from 2020 and the National Medication Price Registry for patients seen between 2010 and 2018. Bootstrapping was performed to generate 95% confidence intervals for the cost per patient per year. RESULTS Among the 1838 (41% female) patients treated for DR between 2005 and 2018, OUH provided on average 1.09 laser treatments per DR patient and 0.54 vitrectomies per DR patient in 2005, whose utilization declined to 0.54 and 0.05 treatments per DR patient, respectively, by 2018. Laser treatments declined from 64% to 10%, while vitrectomies declined from 32% to 1%. In contrast, IVI treatments increased from 4.5% to 89% of the total share, representing an average increase, from 0.08 injections per patient in 2005 to 4.73 injections per patient in 2018. Both the increasing number of DR patients and the shift in the type of treatment increased the economic costs of treating DR from a total of EUR 0.605 million (EUR 2935 per patient) in 2010 to EUR 2.240 million (EUR 3665 per patient) in 2018, with IVIs contributing considerably to these costs. CONCLUSIONS Despite the decline in the use of vitrectomies, the transition from laser to IVI therapy for DR increased the healthcare resource utilization and economic costs of its treatment over the observed time. A main cost driver was the need for long-term IVIs, in addition to the drug cost itself. Trade-offs can be achieved through effective alternative IVI delivery or appropriate drug choice that balances patient needs with the economic burden of treating DR.
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Affiliation(s)
| | - Øystein K. Jørstad
- Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
| | - Beáta Éva Petrovski
- Center for Eye Research, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, 0450 Oslo, Norway
| | - Ragnheidur Bragadottir
- Center for Eye Research, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, 0450 Oslo, Norway
- Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
| | | | - Morten Carstens Moe
- Center for Eye Research, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, 0450 Oslo, Norway
- Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
| | - Emily A. Burger
- Department of Health Management and Health Economics, University of Oslo, 0317 Oslo, Norway
- Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Goran Petrovski
- Center for Eye Research, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, 0450 Oslo, Norway
- Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
- Department of Ophthalmology, University of Split School of Medicine and University Hospital Centre, 21000 Split, Croatia
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Harbers A, Davidson S, Eggleton K. Understanding barriers to diabetes eye screening in a large rural general practice: an audit of patients not reached by screening services. J Prim Health Care 2022; 14:273-279. [PMID: 36178842 DOI: 10.1071/hc22062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/23/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Diabetes is a leading cause of blindness in New Zealanders, yet a significant proportion of patients with diabetes are not reached by diabetes eye screening. Aim Our study audited patients with diabetes in a large New Zealand rural general practice, to identify addressable barriers preventing patients from attending diabetes eye screening. Methods All patients who had missed a diabetes eye screening appointment at the Dargaville Hospital Eye Screening Clinic between 2018 and 2021 were identified. Demographic information, laboratory and disease status data were recorded and analysed. Semi-structured telephone interviews were undertaken with 66 patients exploring barriers to diabetes eye screening. Descriptive statistical analysis was performed on quantitative data and a thematic analysis on qualitative results. Results One-hundred and fifty-four (27%) of 571 patients invited to screening missed at least one appointment; of these, 66 (43%) were interviewed. Quantitative analysis suggested Māori patients were less likely to be reached, with a 20% higher number of missed appointments than European patients and a higher glycated haemoglobin (HbA1c). Māori patients reported greater barriers to attending eye screening. Common barriers identified by participants were transport, work and family commitments, financial, health and lack of appointment reminders. Discussion Increased barriers for Māori patients could explain the reduced ability of the screening service to reach Māori patients. In order to address inequity and increase overall screening rates, diabetes eye screening and primary care services need to improve the booking system, facilitate transport to screening, engage patients and their whānau and build trust.
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Affiliation(s)
- Angel Harbers
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Scott Davidson
- Department General Practice and Primary Health Care, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand; and Dargaville Medical Centre, Dargaville, Northland, New Zealand
| | - Kyle Eggleton
- Department General Practice and Primary Health Care, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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24
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Midena E, Polo C, Frizziero L, Marini MG, Lattanzio R, Vadalà M, Pilotto E, Varano M. The Narrative Medicine Approach in the Treatment of Diabetic Macular Edema: An Italian Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159367. [PMID: 35954724 PMCID: PMC9368569 DOI: 10.3390/ijerph19159367] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 12/04/2022]
Abstract
The study retraces the healthcare pathway of patients affected by diabetic macular edema (DME) through the direct voice of patients and caregivers by using a “patient journey” and narrative method approach. The mapping of the patient’s journey was developed by a multidisciplinary board of health professionals and involved four Italian retina centers. DME patients on intravitreal injection therapy and caregivers were interviewed according to the narrative medicine approach. Narratives were analyzed through a quali-quantitative tool, as set by the narrative medicine method. The study involved four specialized retina centers in Italy and collected a total of 106 narratives, 82 from DME patients and 24 from caregivers. The narratives reported their difficulty in identifying the correct pathway of care because of a limited awareness of diabetes and its complications. Patients experienced reduced autonomy due to ocular complications. In the treatment of diabetes and its complications, a multidisciplinary approach currently appears to be missing. DME reduces the quality of life of affected patients. The narrative medicine approach offers qualitative and emotional patient-guided information. The patient journey provides all of those involved in the management of DME with flowcharts to refer to, identifying the critical points in the healthcare journey of DME patients to improve the management of the disease.
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Affiliation(s)
- Edoardo Midena
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy; (C.P.); (L.F.); (E.P.)
- IRCCS—Fondazione Bietti, 00198 Rome, Italy;
- Correspondence: ; Tel.: +39-049-8212110
| | - Chiara Polo
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy; (C.P.); (L.F.); (E.P.)
| | - Luisa Frizziero
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy; (C.P.); (L.F.); (E.P.)
| | | | - Rosangela Lattanzio
- Department of Ophthalmology, Scientific Institute Ospedale San Raffaele, University Vita-Salute, 20132 Milan, Italy;
| | - Maria Vadalà
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, 90127 Palermo, Italy;
| | - Elisabetta Pilotto
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy; (C.P.); (L.F.); (E.P.)
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25
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Humphreys JD, Sivaprasad S. Living Without a Diagnosis: A Patient's Perspective on Diabetic Macular Ischemia. Ophthalmol Ther 2022; 11:1617-1628. [PMID: 35821381 PMCID: PMC9437185 DOI: 10.1007/s40123-022-00546-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/24/2022] [Indexed: 11/25/2022] Open
Abstract
Diabetic macular ischemia (DMI) is a common complication of diabetic retinopathy (DR) that can result in progressive and irreversible vision loss. DMI is associated with damage in the vessels that supply blood to the retina and the enlargement of the foveal avascular zone. Currently, there are no approved treatments specifically for DMI. Furthermore, there is limited published information about the prognosis, prevalence or outcomes of DMI, and there is no consensus regarding diagnostic criteria. It is vital to ensure that there is sufficient, accessible and accurate information available to support patients, caregivers and physicians. To lay the foundation for more research into DMI and its impact on patients, we (a patient with DMI and an expert ophthalmologist) have worked together to interweave our personal perspectives and clinical experiences with a review of currently available literature on DMI. The development of a set of confirmed diagnostic criteria for DMI would assist both patients and physicians, allowing patients to access validated information about their condition and supporting the development of clinical trials for treatments of DMI. Training for physicians must continue to emphasise the importance of treating a patient holistically, rather than only treating their symptoms. Most importantly, developing trust and a healthy rapport between a patient and their physician is important in managing health anxiety and ensuring adherence to beneficial treatments or lifestyle adjustments; physicians must cultivate an open and flexible management approach with their patients. Finally, holistic educational programmes for patients, physicians and the general public around DMI and how it can affect daily functioning would facilitate general understanding and disease awareness. Diabetic macular ischemia (DMI) is a common problem for patients with diabetic retinopathy that can lead to sight loss. There is very little information available about DMI, particularly from a patient’s point of view. To address the lack of information about DMI, we (a person with DMI and her eye doctor) have worked together to examine what it is like to live with DMI.
It is important to provide clear and accessible information about diseases to patients and carers. The lack of information about DMI may be upsetting for some people, and should be addressed with more research. Developing of a set of confirmed signs and symptoms for the diagnosis of DMI would allow people to be more confident in the information that they receive about their disease, and support the development of treatments for DMI.
The support of others is central to the wellbeing of people with vision loss. Although people with vision loss may also lose independence, care from loved ones can help to improve quality of life. Most importantly, developing trust between a patient and their doctor is central to managing people’s fears about their eyesight, and making sure that they follow helpful advice. Doctors must use an open and flexible approach with their patients, providing information in an honest and understandable way. Living Without a Diagnosis: A Patient’s Perspective on Diabetic Macular Ischemia; Audioslides. (MP4 23566 kb)
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Affiliation(s)
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, 162 City Rd, London, EC1V 2PD, UK.
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Anderson MJ, Chinn DJ, Styles CJ. Long-term trends in incidence and prevalence of severe sight impairment due to diabetes in South East Scotland before and after implementation of diabetic retinopathy screening. BRITISH JOURNAL OF VISUAL IMPAIRMENT 2022. [DOI: 10.1177/02646196221099147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The study set out to examine the impact of the introduction of a national diabetic retinopathy screening programme in Scotland in 2006 on incidence and trends in severe sight impairment (SSI) certification due to diabetes over three decades. We analysed SSI certification due to diabetic eye disease in Fife, Scotland, between 2010 and 2019 and compared it to previously published estimates from 1990 onwards. Population estimates of the general population and those with diabetes were obtained from the National Records of Scotland and the National Diabetes Register, NHS SCI Diabetes, respectively. Mean annual incidence of SSI in the population with diabetes, 1990–2019, before and after the introduction of diabetic retinopathy screening was compared using a Mann–Whitney U Test. Mean incidence in 2007–2019 was 19.8/100,000 and was significantly less than the period before the systematic screening, 1990–2006 (57.5/100,000, p < .001). Mean SSI incidence due to diabetes in Fife between 2010 and 2019 was significantly lower than in the previous decades ( p < .001) at 16.4 per 100,000 for the population with diabetes, per year ( SD 10.0; 95% confidence interval: [9.2, 23.5]) compared to 42.7 per 100,000 in 2000–2009 and 64.3 per 100,000 in 1990–1999. This study demonstrates a significant reduction in the annual incidence of SSI due to diabetes before and after the introduction of the screening programme provides evidence for the benefit of systematic diabetic retinopathy screening programmes. Other factors including improved management of diabetes and risk factors will have also had an impact emphasizing the importance of a multidisciplinary approach to the prevention of sight loss in diabetes.
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27
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Scanlon PH. Improving the screening of risk factors in diabetic retinopathy. Expert Rev Endocrinol Metab 2022; 17:235-243. [PMID: 35730170 DOI: 10.1080/17446651.2022.2078305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/12/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION In 2002, Diabetic Retinopathy was reported as the leading cause of blindness in the working age group. The introduction of systematic screening programs in the UK has reduced visual loss and blindness due to diabetic retinopathy, but it does still occur with catastrophic consequences for the individual. AREAS COVERED The author conducted an ongoing search for articles relating to diabetic retinopathy since 2000 utilizing Zetoc Alert with keywords and contents page lists from relevant journals. This review covers the risk factors for loss of vision due to diabetic retinopathy and discusses ways in which the awareness of these risk factors can be used to further reduce visual loss. Some risk factors such as glycemic and B/P control are well known from landmark trials. This review has included these factors but concentrated more on the evidence behind those risk factors that are not so clearly defined or so well known. EXPERT OPINION The major risk factors are well known, but one continues to find that people with diabetes lose vision in situations in which a better awareness of the risks by both the individual with diabetes and the health workers involved may have prevented the visual loss.
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Affiliation(s)
- Peter H Scanlon
- Consultant Ophthalmologist, Department of Ophthalmologist, Gloucestershire Hospitals NHS Foundation Trust Cheltenham, UK
- National Clinical Lead, NHS Diabetic Eye Screening Programme (Ophthalmology), Public Health Commissioning and Operations, England
- Associate Professor, Nuffield Department of Clinical Neuroscience, University of Oxford, UK
- Visiting Professor, School of Health and Social Care, University of Gloucestershire, UK
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28
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Hudson SM, Modjtahedi BS, Altman D, Jimenez JJ, Luong TQ, Fong DS. Factors Affecting Compliance with Diabetic Retinopathy Screening: A Qualitative Study Comparing English and Spanish Speakers. Clin Ophthalmol 2022; 16:1009-1018. [PMID: 35400992 PMCID: PMC8992739 DOI: 10.2147/opth.s342965] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/20/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Sharon M Hudson
- Keck School of Medicine of USC/Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA
| | - Bobeck S Modjtahedi
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA
- Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, CA, USA
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
- Correspondence: Bobeck S Modjtahedi, Eye Monitoring Center, Kaiser Permanente Baldwin Park Medical Center, 1011 Baldwin Park Blvd, Baldwin Park, CA, 91706, USA, Email
| | - Danielle Altman
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA
| | - Jennifer J Jimenez
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA
| | - Tiffany Q Luong
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA
| | - Donald S Fong
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA
- Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, CA, USA
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29
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Huang XM, Yang BF, Zheng WL, Liu Q, Xiao F, Ouyang PW, Li MJ, Li XY, Meng J, Zhang TT, Cui YH, Pan HW. Cost-effectiveness of artificial intelligence screening for diabetic retinopathy in rural China. BMC Health Serv Res 2022; 22:260. [PMID: 35216586 PMCID: PMC8881835 DOI: 10.1186/s12913-022-07655-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) has become a leading cause of global blindness as a microvascular complication of diabetes. Regular screening of diabetic retinopathy is strongly recommended for people with diabetes so that timely treatment can be provided to reduce the incidence of visual impairment. However, DR screening is not well carried out due to lack of eye care facilities, especially in the rural areas of China. Artificial intelligence (AI) based DR screening has emerged as a novel strategy and show promising diagnostic performance in sensitivity and specificity, relieving the pressure of the shortage of facilities and ophthalmologists because of its quick and accurate diagnosis. In this study, we estimated the cost-effectiveness of AI screening for DR in rural China based on Markov model, providing evidence for extending use of AI screening for DR. METHODS We estimated the cost-effectiveness of AI screening and compared it with ophthalmologist screening in which fundus images are evaluated by ophthalmologists. We developed a Markov model-based hybrid decision tree to analyze the costs, effectiveness and incremental cost-effectiveness ratio (ICER) of AI screening strategies relative to no screening strategies and ophthalmologist screening strategies (dominated) over 35 years (mean life expectancy of diabetes patients in rural China). The analysis was conducted from the health system perspective (included direct medical costs) and societal perspective (included medical and nonmedical costs). Effectiveness was analyzed with quality-adjusted life years (QALYs). The robustness of results was estimated by performing one-way sensitivity analysis and probabilistic analysis. RESULTS From the health system perspective, AI screening and ophthalmologist screening had incremental costs of $180.19 and $215.05 but more quality-adjusted life years (QALYs) compared with no screening. AI screening had an ICER of $1,107.63. From the societal perspective which considers all direct and indirect costs, AI screening had an ICER of $10,347.12 compared with no screening, below the cost-effective threshold (1-3 times per capita GDP of Chinese in 2019). CONCLUSIONS Our analysis demonstrates that AI-based screening is more cost-effective compared with conventional ophthalmologist screening and holds great promise to be an alternative approach for DR screening in the rural area of China.
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Affiliation(s)
- Xiao-Mei Huang
- Department of Ophthalmology, the First Affiliated Hospital, Jinan University, Guangzhou, China.,Institute of Ophthalmology, School of Medicine, Jinan University, Guangzhou, China
| | - Bo-Fan Yang
- Institute of Ophthalmology, School of Medicine, Jinan University, Guangzhou, China
| | - Wen-Lin Zheng
- Institute of Ophthalmology, School of Medicine, Jinan University, Guangzhou, China.,Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Qun Liu
- Institute of Ophthalmology, School of Medicine, Jinan University, Guangzhou, China
| | - Fan Xiao
- Institute of Ophthalmology, School of Medicine, Jinan University, Guangzhou, China.,Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Pei-Wen Ouyang
- Department of Ophthalmology, the First Affiliated Hospital, Jinan University, Guangzhou, China.,Institute of Ophthalmology, School of Medicine, Jinan University, Guangzhou, China
| | - Mei-Jun Li
- Department of Ophthalmology, the First Affiliated Hospital, Jinan University, Guangzhou, China.,Institute of Ophthalmology, School of Medicine, Jinan University, Guangzhou, China
| | - Xiu-Yun Li
- Department of Ophthalmology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Jing Meng
- Department of Ophthalmology, the First Affiliated Hospital, Jinan University, Guangzhou, China
| | | | - Yu-Hong Cui
- School of Basic Medical Sciences, The Guangzhou Institute of Cardiovascular Disease, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.,Department of Histology and Embryology, School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, China
| | - Hong-Wei Pan
- Department of Ophthalmology, the First Affiliated Hospital, Jinan University, Guangzhou, China. .,Institute of Ophthalmology, School of Medicine, Jinan University, Guangzhou, China.
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Xiao B, Mercer GD, Jin L, Lee HL, Chen T, Wang Y, Liu Y, Denniston AK, Egan CA, Li J, Lu Q, Xu P, Congdon N. Outreach screening to address demographic and economic barriers to diabetic retinopathy care in rural China. PLoS One 2022; 17:e0266380. [PMID: 35442967 PMCID: PMC9020743 DOI: 10.1371/journal.pone.0266380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 03/04/2022] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE Poor access to existing care for diabetic retinopathy (DR) limits effectiveness of proven treatments. OBJECTIVES We examined whether outreach screening in rural China improves equity of access. DESIGN, SETTING AND PARTICIPANTS We compared prevalence of female sex, age > = 65 years, primary education or below, and requiring referral care for DR between three cohorts with diabetes examined for DR in neighboring areas of Guangdong, China: passive case detection at secondary-level hospitals (n = 193); persons screened during primary-level DR outreach (n = 182); and individuals with newly- or previously-diagnosed diabetes in a population survey (n = 579). The latter reflected the "ideal" reach of a screening program. RESULTS Compared to the population cohort, passive case detection reached fewer women (50·8% vs. 62·3%, p = 0·006), older adults (37·8% vs. 51·3%, p < 0·001), and less-educated persons (39·9% vs. 89·6%, p < 0·001). Outreach screening, compared to passive case detection, improved representation of the elderly (49·5% vs. 37·8%, p = 0·03) and less-educated (70·3% vs. 39·9%, p<0·001). The proportion of women (59.8% vs 62.3%, P>0.300) and persons aged > = 65 years (49.5% vs 51.3%, p = 0.723) in the outreach screening and population cohorts did not differ significantly. Prevalence of requiring referral care for DR was significantly higher in the outreach screening cohort (28·0%) than the population (14·0%) and passive case detection cohorts (7·3%, p<0·001 for both). CONCLUSIONS AND RELEVANCE Primary-level outreach screening improves access for the poorly-educated and elderly, and removes gender inequity in access to DR care in this setting, while also identifying more severely-affected patients than case finding in hospital.
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Affiliation(s)
- Baixiang Xiao
- Affiliated Eye Hospital of Nanchang University, Nanchang City, China
| | - Gareth D. Mercer
- Department of Ophthalmology and Visual Sciences, McGill University, Montréal, Canada
| | - Ling Jin
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou City, China
| | - Han Lin Lee
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Tingting Chen
- The Ophthalmology Department of the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanfang Wang
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou City, China
| | - Yuanping Liu
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou City, China
| | | | - Catherine A. Egan
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
| | - Jia Li
- Orbis International, New York, NY, United States of America
| | - Qing Lu
- Orbis International, New York, NY, United States of America
| | - Ping Xu
- Orbis International, New York, NY, United States of America
| | - Nathan Congdon
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou City, China
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
- Orbis International, New York, NY, United States of America
- * E-mail:
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Shehata AS, Mohamed DA, Hagras SM, El-Beah SM, Elnegris HM. The role of hesperidin in ameliorating retinal changes in rats with experimentally induced type 1 diabetes mellitus and the active role of vascular endothelial growth factor and glial fibrillary acidic protein. Anat Cell Biol 2021; 54:465-478. [PMID: 34936987 PMCID: PMC8693142 DOI: 10.5115/acb.21.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/11/2021] [Accepted: 10/02/2021] [Indexed: 01/18/2023] Open
Abstract
Patients with type 1 diabetes mellitus (T1DM) are vulnerable to developing diabetic retinopathy even under insulin therapy. Thus, this study was designed to evaluate the efficacy of hesperidin and insulin in rats with T1DM compared with insulin alone in improving diabetic retinal changes. Eighty rats were divided into four equal groups: group I, control rats without diabetes; group II, untreated rats with diabetes; group III, rats with diabetes treated daily with subcutaneous (SC) doses of long-acting insulin; and group IV, a rat with diabetes in which hesperidin was orally administered with SC insulin. The animals were assessed histologically, morphometrically, and biochemically. In group II, the thickness of all retinal layers decreased histologically. Ultrastructurally, degenerated retinal neurons and congested blood vessels were observed. Immunostaining detected elevated gene expression of advanced glycation end products. Gene expression of vascular endothelial growth factor, and glial fibrillary acidic protein were elevated. In this study, hesperidin supplementation with insulin significantly improved the retinal histological changes, supported by morphometric findings, compared with insulin alone. Moreover, treatment with hesperidin significantly reduced malondialdehyde and elevated serum antioxidant markers, including superoxide dismutase and catalase; furthermore, glutathione peroxidase decreased. Hesperidin might be an effective supplement for improving diabetic retinal complications occurring even with insulin treatment.
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Affiliation(s)
- Azza Saad Shehata
- Department of Histology and Cell Biology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | | | - Shimaa Mohsen El-Beah
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Heba Mohamed Elnegris
- Department of Histology and Cell Biology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.,Department of Histology and Cell Biology, Faculty of Medicine, Badr University in Cairo, Cairo, Egypt
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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. Prim Care Diabetes 2021; 15:1086-1094. [PMID: 34518110 DOI: 10.1016/j.pcd.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 08/06/2021] [Accepted: 08/08/2021] [Indexed: 10/20/2022]
Abstract
AIMS To estimate the uptake of diabetic retinopathy screening among adults with type 2 diabetes and to identify and compare factors associated with attendance at the national diabetic retinal screening programme, and other screening services provided by ophthalmic surgeons, community ophthalmologists and optometrists. METHODS An observational retrospective cohort study was carried out using data from the 2016 audit of care delivered by general practices (n = 30) enrolled in a structured diabetes care initiative. Attendance at any screening in the previous 12 months, and attendance across different types of service (national programme and other screening services) was calculated. Logistic regression was performed to examine predictors associated with (1) attendance at any screening and (2) attendance at the national programme (RetinaScreen). Sociodemographic, clinical, and lifestyle factors were examined as predictors. RESULTS Data were available for 1106 people with type 2 diabetes aged ≥18 years. Overall, 863 (78%) of patients had a record of screening attendance in the previous 12 months. Of those screened, 494 (57.2%) attended RetinaScreen only, 258 (28.7%) attended other screening services only, and 111 (12.9%) attended both services. Statistically significant predictors of attendance at any screening were tablet/injectable controlled diabetes, attendance at a diabetes nurse specialist (DNS) in the past 12 months and a blood glucose level which was not on target (HbA1c >7.0% or >53 mmol/mol). In addition to these factors, when examining predictors of attendance at the national screening programme specifically, females were less likely to attend. CONCLUSIONS Most patients managed in a structured diabetes care programme in primary care attended screening. Those with on target blood glucose control, those who were on oral or injectable medication or had been seen by a DNS were more likely to attend for annual screening. Of those who attended screening, almost one-third attended other screening services and so were not availing of the national programme, which is free, quality assured and has an integrated treatment arm.
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Affiliation(s)
- Dara O'Keeffe
- School of Public Health, University College Cork, Ireland.
| | - Fiona Riordan
- School of Public Health, University College Cork, Ireland
| | - Velma Harkins
- Midland Diabetes Structured Care Programme, Banagher Family Practice, Offaly, Ireland
| | | | - Sheena Mc Hugh
- School of Public Health, University College Cork, Ireland
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Tanya SM, He B, Aubrey-Bassler C. Eye-care utilization among a Canadian diabetic refugee population: retrospective cohort study of an interdisciplinary care model. INTERNATIONAL JOURNAL OF CARE COORDINATION 2021. [DOI: 10.1177/20534345211061032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Vision health is an important and underutilized health service among newly arrived refugees in Canada, yet the body of literature on eye-care delivery in this population is limited. The study objective was to identify patterns of eye-care utilization among refugee patients with type 2 diabetes mellitus (T2DM) in Newfoundland and Labrador (NL) under an interdisciplinary clinic model comprised of family physicians, eye-care providers, and settlement services. Methods This was a retrospective cohort study at the Memorial University Family Medicine clinic. All patients with a new T2DM diagnosis between 2015–2020 were included. Data were described using basic statistics and unpaired t-tests. This study received full ethics approval. Results Seventy-three (18 refugee, 55 non-refugee) patients were included. Refugees had a higher rate of referral to an eye-care provider ( p = 0.0475) and were more likely to attend their eye-care provider appointment than non-refugees ( p = 0.016). The time from diagnosis to referral was longer for refugees than non-refugees ( p = 0.0498). A trend towards longer time from referral to appointment attendance for refugees than non-refugees was noted ( p = 0.9069). Discussion Refugee patients had higher rates of referral to eye-care providers and utilization of eye-care services. However, refugees also experienced a longer time to access vision screening services suggesting possible gaps in accessible care delivery. This suggests that the interdisciplinary model of care may be effective in referring refugee patients for vision screening and there may be a role for increased collaboration across family physicians, eye-care providers, and settlement services to improve accessibility of vision screening services.
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Affiliation(s)
- Stuti M Tanya
- Faculty of Medicine, Memorial University of Newfoundland, St John's, Canada
| | - Bonnie He
- The University of British Columbia, Vancouver, Canada
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Wentzel A, Mchiza ZJR. Exploring Factors Associated with Diabetic Retinopathy Treatment Compliance Behaviour in Cape Town, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212209. [PMID: 34831965 PMCID: PMC8617604 DOI: 10.3390/ijerph182212209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/12/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022]
Abstract
Complete patient adherence to treatment for diabetic retinopathy (DR) is critical to limit vision loss. There is a dearth of evidence regarding the reasons why South African patients referred for suspected vision-threatening DR stay compliant to or default their treatment. The current study sought to explore factors associated with treatment compliance among patients living with diabetes who have been referred for suspected vision-threatening DR in the Northern/Tygerberg sub-Structure (NTSS) public health care system of Cape Town, South Africa. A qualitative research approach was used where semi-structured in-depth interviews were conducted with 13 adult patients living with DR, and 2 key informants who are primary eye care providers. Thematic data analysis was conducted using taguette.org. Fear of going blind was the most notable patient-related factor associated with compliance. Notable patient-related barriers reported were forgetfulness and a poor state of health. Notable institution-related barriers included suboptimal information received from health care service providers, poor referral management by the organisation delivering retinal screening services, as well as the inaccessibility of the main NTSS hospital via telephone calls. All these factors were confirmed by the key informants of the current study. Finally, all patients and key informants agreed that SARS-CoV-2 negatively affected patients’ adherence to their DR treatment. Hence, scaling up of health care, referral, and appointment setting services could increase the uptake of treatment and retinal screenings among patients attending the Cape Town, NTSS public health care system.
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Affiliation(s)
- Annalie Wentzel
- School of Public Health, University of the Western Cape, Bellville, Cape Town 7535, South Africa;
- Correspondence:
| | - Zandile June-Rose Mchiza
- School of Public Health, University of the Western Cape, Bellville, Cape Town 7535, South Africa;
- Non-Communicable Disease Research Unit, South African Medical Research Council, Parow Valley, Cape Town 7501, South Africa
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Kaushik M, Nawaz S, Qureshi TS. Profile of sight-threatening diabetic retinopathy and its awareness among patients with diabetes mellitus attending a tertiary care center in Kashmir, India. Indian J Ophthalmol 2021; 69:3123-3130. [PMID: 34708753 PMCID: PMC8725088 DOI: 10.4103/ijo.ijo_831_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: To study the profile of sight-threatening diabetic retinopathy (STDR), its association with various factors affecting it, and awareness of diabetic retinopathy (DR) among patients with diabetes mellitus (DM) attending a tertiary care center in Kashmir. Methods: In this prospective cross-sectional study, 625 consecutive patients with DM were assessed for STDR. Demographic/clinical data were obtained. Early treatment diabetic retinopathy study (ETDRS) criteria were used to grade fundus photographs. Severe nonproliferative DR, proliferative DR, and/or macular edema were classified as STDR. Optical coherence tomography was used to confirm the diagnosis of macular edema. Results: The mean age of patients was 56.36 ± 9.29 years. The male-to-female ratio was 0.92:1. The majority (99.36%) of patients had type 2 DM. STDR was seen in 208 (33.28%) patients. Non-sight-threatening diabetic retinopathy (NSTDR) was seen in 173 (27.68%) patients. Eye care was sought by 313 (50.08%) patients for the first time. STDR had a significant association with difficulty in accessing the health care facilities, duration of diabetes, uncontrolled diabetes, presence of other diabetes complications, use of insulin, and hypertension (P < 0.05 for all). Awareness that diabetes can affect eyes showed a significant association with age, gender, educational status, duration of diabetes, glycemic status, DR, and STDR (P < 0.001 for all). Conclusion: STDR is a common complication in diabetes and is duration- and glycemic control-dependent. Understanding the factors associated with STDR can help in making strategies for its prevention. Spreading awareness regarding STDR at the community level in the Kashmir valley is crucial in this regard.
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Affiliation(s)
- Madhurima Kaushik
- Department of Ophthalmology, Govt. Medical College, Srinagar, Jammu and Kashmir, India
| | - Shah Nawaz
- Department of Ophthalmology, Govt. Medical College, Srinagar, Jammu and Kashmir, India
| | - Tariq Syed Qureshi
- Department of Ophthalmology, Govt. Medical College, Srinagar, Jammu and Kashmir, India
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Ashour DM, El-Shazly AAEF, Abdelgawad RHA, Saleh MI. Choroidal thickness in relation to urinary albumin excretion rate in type 2 diabetes mellitus without retinopathy. Int J Retina Vitreous 2021; 7:61. [PMID: 34656175 PMCID: PMC8520201 DOI: 10.1186/s40942-021-00332-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/03/2021] [Indexed: 11/17/2022] Open
Abstract
Background To evaluate choroidal thickness (CT) in diabetic patients without diabetic retinopathy (DR) in relation to the urinary albumin excretion rate (UAER). Methods This is a prospective case-control study that included a consecutive sample of 120 patients with type 2 diabetes without clinically evident DR and a group of 60 matched healthy controls. Diabetic patients were included in two groups according to their UAER (normoalbuminuria and microalbuminuria). Complete ophthalmological examination was performed followed by optical coherence tomography (SD-OCT) for retinal and choroidal assessment. Twenty-four-hour urine samples were collected for UAER and blood samples for HbA1c and serum creatinine were obtained. Results The study included 180 eyes from 180 subjects in three groups. Patients with higher levels of albuminuria had a thinner choroid than normal controls, with decremental thinning as albuminuria progressed. Diabetics with normoalbuminuria showed no significant differences from controls. Choroidal thickness showed a significant moderate negative correlation with UAER (r = − 0.58, p < 0.001). Multiple regression analyses for diabetic patients with microalbuminuria demonstrated that UAER is the most important determinant of subfoveal choroidal thickness (SFCT) (p < 0.001). Conclusions Decreased CT was significantly correlated with UAER in diabetic patients without retinopathy and otherwise normal kidney functions. This decrease in thickness might be a predictor of DR.
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Affiliation(s)
- Doaa Maamoun Ashour
- Ophthalmology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
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Fei Z, Gao W, Xu X, Sheng H, Qu S, Cui R. Serum superoxide dismutase activity: a sensitive, convenient, and economical indicator associated with the prevalence of chronic type 2 diabetic complications, especially in men. Free Radic Res 2021; 55:275-281. [PMID: 34082660 DOI: 10.1080/10715762.2021.1937146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
To investigate the relationship between serum superoxide dismutase (SOD) activity and the presence of chronic complications in patients with type 2 diabetes mellitus (T2DM). We conducted a retrospective cross-sectional study in patients with T2DM. They were assigned to three groups (Q1, Q2, and Q3) by SOD levels in both sexes. Clinical characteristics, cardiovascular disease, diabetic retinopathy, nephropathy, and peripheral neuropathy were compared. The relationship between the SOD and the prevalence of chronic complications was analyzed by binary logistic regression. Statistical analysis was performed in SPSS 26.0 (SPSS Inc., Chicago, IL). A total of 645 T2DM patients (401 men and 244 women) with complete data for SOD and medical records of complications were included. In men, patients in the Q1 group (lowest serum SOD activity) had the highest prevalence of diabetes with atherosclerosis (AS) (p<.001), DN (p=.029), and DPN (p=.001). In comparison, only DN was found to have the highest prevalence in the Q1 group in women (p=.010). In the multivariate analysis, patients in the Q1 group had a 3.0-, 1.6-, 1.9-, and 2.4-fold risk for the prevalence of AS, DR, DN, and DPN, respectively, compared with the Q3 group. In women, a 7.0-fold risk for the prevalence of DN in the Q1 group was found compared with the Q3 group. After adjusting for the age, duration of T2DM, body mass index, pulse pressure, alanine transaminase, clearance of creatinine, triglyceride, glycosylated hemoglobin, and fasting C-peptide in the models, the differences found in both men and women persisted. SOD activity is related to cardiovascular and microvascular diseases in men and the prevalence of diabetic nephropathy in women in T2DM.
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Affiliation(s)
- Zhaoliang Fei
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wenxue Gao
- Medical Services Section, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaojuan Xu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hui Sheng
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shen Qu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ran Cui
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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Watane A, Kalavar M, Vanner EA, Cavuoto K, Sridhar J. FOLLOW-UP ADHERENCE IN PATIENTS WITH NONPROLIFERATIVE DIABETIC RETINOPATHY PRESENTING TO AN OPHTHALMIC EMERGENCY DEPARTMENT. Retina 2021; 41:1293-1301. [PMID: 33252579 DOI: 10.1097/iae.0000000000003037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the rate of follow-up after emergent encounters for nonproliferative diabetic retinopathy and to identify patient or visit characteristics associated with follow-up adherence. METHODS A retrospective cohort study of patients presenting to an ophthalmic emergency department with nonproliferative diabetic retinopathy between May 2014 and December 2018 was conducted. Demographic and encounter data were gathered. Adherence to follow-up was defined as a completed encounter within 5 weeks of the recommended follow-up. RESULTS A total of 1,248 patients were included. The overall follow-up rate was 53%. Significantly decreased odds of follow-up adherence were associated with longer physician recommended follow-up intervals (odds ratio: 0.81, P < 0.001), longer interval to scheduled appointment (OR: 0.98, P < 0.001), commercial insurance (OR: 0.76, P = 0.01), and lack of any insurance (OR: 0.57, P < 0.01). Significantly increased odds were associated with a longer emergency department visit duration (OR: 1.002, P = 0.001), farther home distance (1.02, P < 0.01), increased likelihood of living in a higher income area (OR: 1.07, P = 0.04), greater NPDR severity (OR: 1.23, P < 0.01), Medicare (OR: 1.38, P = 0.04), presence of macular edema (OR: 1.66, P < 0.001), and worse vision (OR: 1.73, P < 0.001). CONCLUSION Patients presenting emergently with non-proliferative diabetic retinopathy are at high risk for follow-up nonadherence. Several patient and encounter characteristics were associated with follow-up adherence.
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Affiliation(s)
- Arjun Watane
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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Sociodemographics Associated With Risk of Diabetic Retinopathy Detected by Tele-Ophthalmology: 5-Year Results of the Toronto Tele-Retinal Screening Program. Can J Diabetes 2021; 46:26-31. [PMID: 34144907 DOI: 10.1016/j.jcjd.2021.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/11/2021] [Accepted: 05/02/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Our aim in this study was to describe screening outcomes and sociodemographic characteristics of patients in an urban tele-ophthalmology screening program for diabetic retinopathy (DR). METHODS A prospective cohort study was conducted on adults with diabetes type 1 or type 2 enrolled in the Toronto Tele-Retinal Screening Program between September 2013 and March 2019. RESULTS A total of 1,374 screenings were completed, of which 344 (25%) detected DR. Of all participants, 17% did not have provincial health coverage and 21% never had an eye exam. Of the 587 patients who completed sociodemographic questionnaires, the majority (84%) were born outside of Canada, and only 62% preferred English as their spoken language. Forty percent reported a household income of <$25,000, with these participants having an increased likelihood of detectable DR (odds ratio [OR], 1.83; p<0.01). CONCLUSIONS Participants with low income are more likely to screen positive for DR. Tele-ophthalmologic screening can be effective in an urban, culturally diverse and socioeconomically disadvantaged population.
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Jiang L, Liu S, Li H, Xie L, Jiang Y. The role of health beliefs in affecting patients' chronic diabetic complication screening: a path analysis based on the health belief model. J Clin Nurs 2021; 30:2948-2959. [PMID: 33951248 PMCID: PMC8453575 DOI: 10.1111/jocn.15802] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 02/05/2023]
Abstract
AIMS AND OBJECTIVES To explore the role of health beliefs in affecting patients' chronic diabetic complication (CDC) screening. BACKGROUND Patients' adherence to the guideline-recommended CDC screening was far from optimal. While many demographic and clinical characteristics were documented to influence patients' adherence, psychological profiles, such as health beliefs, were not well studied before. It is crucial to understand how health beliefs affect patients' CDC screening behaviour and thus to provide implications for future intervention programmes. DESIGN A cross-sectional study was conducted. METHODS 785 type 2 diabetes were enrolled from the community health centre in Wuhou District, Chengdu, China. Structured questionnaires were used to collect data regarding the demographic and clinical information, knowledge about CDC, health belief model constructs and CDC screening behaviour. Mediation analysis was performed to explore the mechanisms of health belief model constructs on CDC screening behaviour. The study methods were compliant with the STROBE checklist. RESULTS Knowledge had a significant indirect effect on CDC screening behaviour through perceived susceptibility, perceived benefits, perceived barriers and self-efficiency. Cues to action exerted both significant direct and indirect effects on CDC screening behaviour. The indirect effects of cues to action were exerted through perceived susceptibility, perceived barriers and self-efficiency. CONCLUSION Health beliefs played vital roles in mediating the effects of knowledge and cues to action on patients' CDC screening behaviour. Health beliefs should be assessed and modified through creative educational methods. Strategies aimed at increasing cues to action are also expected to facilitate patients' CDC screening behaviour. RELEVANCE TO CLINICAL PRACTICES The study contributes to the exploration of how health beliefs affect patients' CDC screening behaviour. The results could be used to inspire future community-based intervention programmes.
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Affiliation(s)
- Lingjun Jiang
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China.,Department of Cardiothoracic Surgery, Yichang Central People, Hospital, Yichang, China
| | - Suzhen Liu
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Hang Li
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Linna Xie
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Jiang
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu, China
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Kelly SR, Loiselle AR, Pandey R, Combes A, Murphy C, Kavanagh H, Fitzpatrick P, Mooney T, Kearney P, Crabb DP, Keegan DJ. Factors associated with non-attendance in the Irish national diabetic retinopathy screening programme (INDEAR study report no. 2). Acta Diabetol 2021; 58:643-650. [PMID: 33483856 PMCID: PMC8076137 DOI: 10.1007/s00592-021-01671-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/04/2021] [Indexed: 01/09/2023]
Abstract
AIMS We aimed to determine the patient and screening-level factors that are associated with non-attendance in the Irish National Diabetic Retinal screening programme (Diabetic RetinaScreen). To accomplish this, we modelled a selection of predictors derived from the historical screening records of patients with diabetes. METHODS In this cohort study, appointment data from the national diabetic retinopathy screening programme (RetinaScreen) were extracted and augmented using publicly available meteorological and geospatial data. A total of 653,969 appointments from 158,655 patients were included for analysis. Mixed-effects models (univariable and multivariable) were used to estimate the influence of several variables on non-attendance to screening appointments. RESULTS All variables considered for analysis were statistically significant. Variables of note, with meaningful effect, were age (OR: 1.23 per decade away from 70; 95% CI: [1.22-1.24]), type 2 diabetes (OR: 1.10; 95% CI: [1.06-1.14]) and socio-economic deprivation (OR: 1.12; 95% CI: [1.09-1.16]). A majority (52%) of missed appointments were from patients who had missed three or more appointments. CONCLUSIONS This study is the first to outline factors that are associated with non-attendance within the Irish national diabetic retinopathy screening service. In particular, when corrected for age and other factors, patients with type 2 diabetes had higher rates of non-attendance. Additionally, this is the first study of any diabetic screening programme to demonstrate that weather may influence attendance. This research provides unique insight to guide the implementation of an optimal and cost-effective intervention strategy to improve attendance.
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Affiliation(s)
- Stephen R Kelly
- Mater Retina Research Group, Mater Misericordiae University Hospital, Dublin, Ireland.
| | - Allison R Loiselle
- Department of Ophthalmology, University Medical Centre Groningen, Groningen, Netherlands
| | - Rajiv Pandey
- Mater Retina Research Group, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Colette Murphy
- Diabetic RetinaScreen, National Screening Service, Health Service Executive, Cork, Ireland
| | - Helen Kavanagh
- Diabetic RetinaScreen, National Screening Service, Health Service Executive, Cork, Ireland
| | - Patricia Fitzpatrick
- Programme Evaluation Unit, National Screening Service, Health Service Executive, Dublin, Ireland
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Therese Mooney
- Programme Evaluation Unit, National Screening Service, Health Service Executive, Dublin, Ireland
| | - Patricia Kearney
- Department of Epidemiology, University College Cork, Cork, Ireland
| | - David P Crabb
- Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, UK
| | - David J Keegan
- Mater Retina Research Group, Mater Misericordiae University Hospital, Dublin, Ireland
- Diabetic RetinaScreen, National Screening Service, Health Service Executive, Cork, Ireland
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Clemens KK, Ouédraogo AM, Garg AX, Silver SA, Nash DM. Opportunities To Improve Diabetes Care in the Hemodialysis Unit: A Cohort Study in Ontario, Canada. KIDNEY360 2021; 2:653-665. [PMID: 35373046 PMCID: PMC8791316 DOI: 10.34067/kid.0007082020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/09/2021] [Indexed: 02/04/2023]
Abstract
Background Patients with diabetes receiving chronic, in-center hemodialysis face healthcare challenges. We examined the prevalence of gaps in their diabetes care, explored regional differences, and determined predictors of care gaps. Methods We conducted a population-based, retrospective study between January 1, 2016 and January 1, 2018 in Ontario, Canada. We included adults with prevalent diabetes mellitus receiving in-center hemodialysis as of January 1, 2018 and examined the proportion with (1) insufficient or excessive glycemic monitoring, (2) suboptimal screening for diabetes-related complications (retinopathy and cardiovascular screening), (3) hospital encounters for hypo- or hyperglycemia, and (4) hospital encounters for hypertension in the 2 years prior (January 1, 2016 to January 1, 2018). We then identified patient, provider, and health-system factors associated with more than one care gap and used multivariable logistic regression to determine predictors. Further, we used geographic information systems to explore spatial variation in gaps. Results There were 4173 patients with diabetes receiving in-center hemodialysis; the mean age was 67 years, 39% were women, and the majority were of lower socioeconomic status. Approximately 42% of patients had more than one diabetes care gap, the most common being suboptimal retinopathy screening (53%). Significant predictors of more than one gap included younger age, female sex, shorter duration of diabetes, dementia, fewer specialist visits, and not seeing a physician for diabetes. There was evidence of spatial variation in care gaps across our region. Conclusions There are opportunities to improve diabetes care in patients receiving in-center hemodialysis, particularly screening for retinopathy. Focused efforts to bring diabetes support to high-risk individuals might improve their care and outcomes.
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Affiliation(s)
- Kristin K. Clemens
- Division of Endocrinology and Metabolism, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- ICES, Ontario, Canada
- Center for Diabetes, Endocrinology and Metabolism, St. Joseph's Health Care London, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | | | - Amit X. Garg
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- ICES, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Division of Nephrology, Western University, London, Ontario, Canada
| | - Samuel A. Silver
- ICES, Ontario, Canada
- Division of Nephrology, Queen's University, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Danielle M. Nash
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- ICES, Ontario, Canada
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Hvass AMF, Norredam M, Sodemann M, Wejse C. Is there a need of health assessments for resettling refugees? A cross-sectional study of 1431 refugees who arrived in Denmark between 2014 and 2018. J Migr Health 2021; 3:100044. [PMID: 34405189 PMCID: PMC8352093 DOI: 10.1016/j.jmh.2021.100044] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/03/2020] [Accepted: 04/10/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Refugees have increased health risks due to factors related to their country of origin, the migration itself and the receiving country. Based on systematic general health assessments of newly arrived refugees, we aimed to study the characteristics with regard to background, migration and health needs. METHODS All refugees (children/adolescents and adults) arriving in Aarhus, Denmark from 1 January 2014 to 1 November 2018 were offered a general health assessment by a doctor including: medical history, a physical examination and blood samples. RESULTS A cohort of 1431 (of 1618 invited, (88.4%) participants accepted the health assessment. The most commonly found health conditions in children were vitamin D deficiency (28.3%), elevated serum-IgE (34%) and lack of immunity against vaccine-preventable diseases (measles 20.1%, polio 3.9%). In adults, vitamin D deficiency (34.6%), IgE elevation (30%), latent tuberculosis (20.3%) and symptoms of PTSD (15.9%) were most prevalent. We found participants from Southern Asia (Iran, Afghanistan and Pakistan) to be overrepresented with regard to vitamin D deficiency, vitamin B12 deficiency and symptoms of PTSD. Furthermore, we found that origin in Africa was associated with latent tuberculosis. In total, 63.8% of examined refugees had one or more health problems requiring further testing, treatment or follow-up. CONCLUSIONS A comprehensive health assessment among recently arrived refugees showed multiple health issues to address, and demonstrates the need of systematic health assessments for resettling refugees.
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Affiliation(s)
- Anne Mette F. Hvass
- Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Aarhus, Denmark
- Department of Social Medicine, Aarhus Municipality, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen K, Denmark
- Section for Immigrant Medicine, Department of Infectious Diseases, Hvidovre University Hospital, Denmark
| | - Morten Sodemann
- Migrant Health Clinic, Department of Infectious Diseases, Odense University Hospital
| | - Christian Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
- Department of Public Health, Center for Global Health, Aarhus University, Bartolins Alle 4, 8000 Aarhus C, Denmark
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Domeyer PR, Tsimtsiou Z, Gkizlis V, Gougourelas D, Papaioannou A, Birka S, Sifaki-Pistolla D, Tsiligianni I. Modeling patients' choice between a primary care physician or a diabetes specialist for the management of type-2 diabetes using a bivariate probit analysis. Prim Care Diabetes 2021; 15:150-155. [PMID: 32768282 DOI: 10.1016/j.pcd.2020.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/15/2020] [Accepted: 07/18/2020] [Indexed: 11/17/2022]
Abstract
AIMS To determine the prevalence of type-2 diabetes patients that were initially and currently being treated by primary care physicians (PCPs) or diabetes specialists and assess predictors influencing their choice. METHODS This cross-sectional study was conducted in nine Greek primary healthcare units. Patients' choices were modeled using a bivariate probit analysis. RESULTS A total of 225 patients participated (84% response rate). Only 15.9% and 11.9% of the respondents acknowledged having chosen a diabetes specialist for their initial or current treatment, respectively. The family history of diabetes in siblings and the screening for diabetic retinopathy during the past year were significantly positively associated with choosing a diabetes specialist (initially p=0.033 or currently p=0.007), and resulted in a statistically significant reduction of the joint probabilities of choosing a PCP by 15.6% and 13.6%, respectively. Younger age (p=0.040), female sex (p=0.017), higher HbA1c (p=0.004), experience of hypoglycemia (p=0.029) and low cardiovascular morbidity index (p=0.016) emerged as important predictors for choosing a diabetes specialist for their treatment. CONCLUSIONS Our findings provide a better insight in diabetes patients' choices regarding the category of their treating physicians and their predictors. More studies are required to replicate them and identify patient subpopulations that may favor diabetes specialists' guidance.
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Affiliation(s)
- Philippe-Richard Domeyer
- School of Social Sciences, Hellenic Open University, Aristotelous 18, 26335 Patra, Greece; Research Committee of Greek Association of General Practitioners, 54625 Thessaloniki, Greece.
| | - Zoi Tsimtsiou
- Research Committee of Greek Association of General Practitioners, 54625 Thessaloniki, Greece; Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece; Health Center of Evosmos, Tegopoulou 2 and Patron Street, 56226 Thessaloniki, Greece.
| | - Vasileios Gkizlis
- Research Committee of Greek Association of General Practitioners, 54625 Thessaloniki, Greece; Rural Practice of Maurommati, 43060 Mavrommati Karditsa, Greece.
| | - Dimitrios Gougourelas
- Research Committee of Greek Association of General Practitioners, 54625 Thessaloniki, Greece; Health Center of Goura, 20014 Goura Korinthia, Greece.
| | - Anastasia Papaioannou
- Research Committee of Greek Association of General Practitioners, 54625 Thessaloniki, Greece; Health Center of N. Makri, Artemidos & Marathonos Avenue, 19005 Athens, Greece.
| | - Sofia Birka
- Research Committee of Greek Association of General Practitioners, 54625 Thessaloniki, Greece; Health Center of Evosmos, Tegopoulou 2 and Patron Street, 56226 Thessaloniki, Greece.
| | - Dimitra Sifaki-Pistolla
- Department of Social Medicine, Faculty of Medicine, University of Crete, 71003 Heraklion Crete, Greece.
| | - Ioanna Tsiligianni
- Research Committee of Greek Association of General Practitioners, 54625 Thessaloniki, Greece; Department of Social Medicine, Faculty of Medicine, University of Crete, 71003 Heraklion Crete, Greece.
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Silverberg EL, Sterling TW, Williams TH, Castro G, Rodriguez de la Vega P, Barengo NC. The Association between Social Determinants of Health and Self-Reported Diabetic Retinopathy: An Exploratory Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020792. [PMID: 33477729 PMCID: PMC7832397 DOI: 10.3390/ijerph18020792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/19/2020] [Accepted: 01/14/2021] [Indexed: 11/16/2022]
Abstract
One-third of Americans with diabetes will develop diabetic retinopathy (DR), the leading cause of blindness in working-age Americans. Social determinants of health (SDOHs) are conditions in a person’s environment that may impact health. The objective of this study was to determine whether there is an association between SDOHs and DR in patients with type II diabetes. This cross-section study used data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS). This study included people with self-reported diabetes in the US in 2018 (n = 60,703). Exposure variables included homeownership, marital status, income, health care coverage, completed level of education, and urban vs. rural environment. The outcome variable was DR. Logistic regression analysis were applied to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Alaskan Native/Native American (OR 2.11; 95% CI: 1.14–3.90), out of work (OR 2.82; 95% CI: 1.62–4.92), unable to work (OR 2.14; 95% CI: 1.57–2.91), did not graduate high school (OR 1.91; 95% CI: 1.30–2.79), only graduated high school (OR 1.43; 95% CI 1.08–1.97), or only attended college or technical school without graduating (OR 1.42; 95% CI: 1.09–1.86) were SDOHs associated with DR in patients with diabetes. Health care providers should identify these possible SDOHs affecting their diabetic patients.
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Affiliation(s)
- Emily L. Silverberg
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; (E.L.S.); (T.W.S.); (T.H.W.); (G.C.); (P.R.d.l.V.)
| | - Trevor W. Sterling
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; (E.L.S.); (T.W.S.); (T.H.W.); (G.C.); (P.R.d.l.V.)
| | - Tyler H. Williams
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; (E.L.S.); (T.W.S.); (T.H.W.); (G.C.); (P.R.d.l.V.)
| | - Grettel Castro
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; (E.L.S.); (T.W.S.); (T.H.W.); (G.C.); (P.R.d.l.V.)
| | - Pura Rodriguez de la Vega
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; (E.L.S.); (T.W.S.); (T.H.W.); (G.C.); (P.R.d.l.V.)
| | - Noël C. Barengo
- Department of Translational Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; (E.L.S.); (T.W.S.); (T.H.W.); (G.C.); (P.R.d.l.V.)
- Department of Public Health, Faculty of Medicine, University of Helsinki, 00100 Helsinki, Finland
- Department of Epidemiology and Public Health, College of Medicine, Riga Stradins University, LV-1007 Riga, Latvia
- Correspondence: ; Tel.: +1-305-842-8793
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Agrawal S, Strzelec B, Poręba R, Agrawal A, Mazur G. Clinical Characteristics, Preventive Care and Attitude to Telemedicine among Patients with Diabetic Retinopathy: A Cross-Sectional Study. J Clin Med 2021; 10:jcm10020249. [PMID: 33445546 PMCID: PMC7827263 DOI: 10.3390/jcm10020249] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 11/16/2022] Open
Abstract
Diabetic retinopathy (DR) is the most frequent and one of the most severe complications of both types of diabetes. Despite the development of versatile diabetes management programs in most developed countries, many patients remain at increased risk for developing this life-limiting and life-threatening condition. This cross-sectional analysis objective was to examine and compare the prevalence of diabetic retinopathy and comorbidities, as well as the clinical characteristics, prevention patterns, and attitude to telemedicine in patients with diabetes. We found that, when compared to the non-DR group, patients with DR significantly more often utilize clinical preventive services and counseling; however, there is still a significant gap in the receipt of preventative care. Moreover, in the DR subgroup, inadequate diabetic control and the presence of various signs and symptoms of diseases were observed. Although less than a fifth of all patients use mobile applications to monitor their health status, the patients indicate their willingness to use telemedical technology, particularly if it is recommended by the physician and provided without additional costs. The evolution of telemedicine offers a possibility of inexpensive, continuous monitoring of the disease that could improve treatment outcomes. Our observations emphasize DR's perception as a complex disease in which education and continuous monitoring, particularly with telemedicine methods, are critical for further improvement in chronic care.
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Affiliation(s)
- Siddarth Agrawal
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wrocław, Poland; (R.P.); (G.M.)
- Department of Pathology, Wroclaw Medical University, 50-368 Wrocław, Poland
- Correspondence:
| | - Bartłomiej Strzelec
- Second Department and Clinic of General and Oncological Surgery, Wroclaw Medical University, 50-556 Wrocław, Poland; (B.S.); (A.A.)
| | - Rafał Poręba
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wrocław, Poland; (R.P.); (G.M.)
| | - Anil Agrawal
- Second Department and Clinic of General and Oncological Surgery, Wroclaw Medical University, 50-556 Wrocław, Poland; (B.S.); (A.A.)
| | - Grzegorz Mazur
- Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 50-556 Wrocław, Poland; (R.P.); (G.M.)
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Chariwala RA, Shukla R, Gajiwala UR, Gilbert C, Pant H, Lewis MG, Murthy GVS. Effectiveness of health education and monetary incentive on uptake of diabetic retinopathy screening at a community health center in South Gujarat, India. Indian J Ophthalmol 2020; 68:S52-S55. [PMID: 31937730 PMCID: PMC7001183 DOI: 10.4103/ijo.ijo_2118_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose: The effectiveness of Accredited Social Health Activists (ASHAs) with and without monetary incentive in uptake of diabetic retinopathy (DR) screening at community health center (CHC) was compared in South Gujarat, India. Methods: In this non-randomized controlled trial, ASHAs were incentivized to refer people with diabetes mellitus (PwDM) from their respective villages for DR screening after people were sensitized to DM and DR. The minimum sample size was 63 people in each arm. Results: Of 162, 50.6% were females, 80.2% were literate, 56.2% were >50 years, 54.3% had increased random blood sugar (RBS), and 59.9% had diabetes for 5 years. The percentage of screening was significantly higher [relative risk (RR) = 4.37, 95% confidence interval (CI) 2.79, 6.84] in ASHA incentive group and health education (HE) group (RR = 3.67, 95% CI 2.35, 5.75) compared with baseline. Providing incentive to ASHAs was not found to be of extra advantage (RR = 1.19, 95% CI 0.89, 1.57). The likelihood of uptake of screening was higher among uncontrolled PwDM, poor literacy, and higher duration of diabetes in incentive phase (P < 0.001) compared with HE. The results show that age (P = 0.017), education (P = 0.015) and level of RBS (P = 0.001) of those referred were significantly associated with incentives to ASHAs. Conclusion: ASHAs can be used effectively to refer known PwDM for DR screening especially when DR screening program is introduced in population with low awareness and poor accessibility. When incentives are planned, additional burden on resources should be kept in mind before adapting this model of care.
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Affiliation(s)
| | - Rajan Shukla
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Uday R Gajiwala
- Divyajyoti Trust, Tejas Eye Hospital, Mandvi, District-Surat, Gujarat, India
| | - Clare Gilbert
- Department of Clinical Research, International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Hira Pant
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Melissa Glenda Lewis
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India
| | - G V S Murthy
- South Asia Centre for Disability Inclusive Development Research, Indian Institute of Public Health, Public Health Foundation of India, Hyderabad, Telangana, India; Department of Clinical Research, International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Raj P, Singh S, Lewis MG, Shukla R, Murthy GVS, Gilbert C. Diabetic retinopathy screening uptake after health education with or without retinal imaging within the facility in two AYUSH hospitals in Hyderabad, India: A nonrandomized pilot study. Indian J Ophthalmol 2020; 68:S56-S58. [PMID: 31937731 PMCID: PMC7001171 DOI: 10.4103/ijo.ijo_2119_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: In India, people with diabetes (PwDM) often seek care in the government-approved alternative medicine system, AYUSH (Ayurveda, Yoga and naturopathy, Unani, Siddha and Homeopathy). The purpose of this pilot study was to assess whether health education plus retinal imaging for diabetic retinopathy (DR) within an AYUSH hospital increased the uptake of screening for DR compared with health education and referral. Methods: The study was a nonrandomized pilot conducted in two AYUSH hospitals. Both hospitals received intervention on educating the AYUSH practitioners about DR screening and distributing health education materials to diabetic patients. In one hospital in addition to education, retinal imaging by a trained technician with remote grading by an ophthalmologist was provided, while in another hospital PwDM were referred to nearby eye hospitals for screening. The uptake of screening was assessed through registers and phone calls. Results: At baseline, only 10.7% of 178 PwDM were aware of DR and only 8% had undergone DR screening. After the intervention, in the hospital where screening was provided, all (100%) eligible patients (101) underwent digital imaging, whereas in the other hospital only 25% of 77 eligible patients underwent screening in eye hospitals (P < 0.001). Conclusion: AYUSH hospitals could provide a feasible and acceptable location for providing DR screening services. Further studies are required to assess scale-up of such intervention.
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Affiliation(s)
- Pruthvi Raj
- Indian Institute of Public Health, Hyderabad, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Samiksha Singh
- Indian Institute of Public Health, Hyderabad, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Melissa G Lewis
- Indian Institute of Public Health, Hyderabad, Public Health Foundation of India, Hyderabad, Telangana, India
| | - Rajan Shukla
- Indian Institute of Public Health, Hyderabad, Public Health Foundation of India, Hyderabad, Telangana, India
| | - G V S Murthy
- Indian Institute of Public Health, Hyderabad, Public Health Foundation of India, Hyderabad, Telangana, India; International Centre for Eye Health, Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Clare Gilbert
- International Centre for Eye Health, Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Kumar S, Kumar G, Velu S, Pardhan S, Sivaprasad S, Ruamviboonsuk P, Raman R. Patient and provider perspectives on barriers to screening for diabetic retinopathy: an exploratory study from southern India. BMJ Open 2020; 10:e037277. [PMID: 33303431 PMCID: PMC7733174 DOI: 10.1136/bmjopen-2020-037277] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Diabetic retinopathy is one of the leading causes of visual impairment after cataract and uncorrected refractive error. It has major public health implications globally, especially in countries such as India where the prevalence of diabetes is high. With timely screening and intervention, the disease progression to blindness can be prevented, but several barriers exist. As compliance to diabetic retinopathy screening in people with diabetes is very poor in India, this study was conducted to explore understanding of and barriers to diabetic retinopathy screening from the perspectives of patients and healthcare providers. METHODS Using qualitative methods, 15 consenting adult patients with diabetes were selected purposively from those attending a large tertiary care private eye hospital in southern India. Eight semistructured interviews were carried out with healthcare providers working in large private hospitals. All interviews were audiotaped, transcribed verbatim and analysed using the framework analytical approach. RESULTS Four themes that best explained the data were recognising and living with diabetes, care-seeking practices, awareness about diabetic retinopathy and barriers to diabetic retinopathy screening. Findings showed that patients were aware of diabetes but understanding of diabetic retinopathy and its complications was poor. Absence of symptoms, difficulties in doctor-patient interactions and tedious nature of follow-up care were some major deterrents to care seeking reported by patients. Difficulties in communicating information about diabetic retinopathy to less literate patients, heavy work pressure and silent progression of the disease were major barriers to patients coming for follow-up care as reported by healthcare providers. CONCLUSIONS Enhancing patient understanding through friendly doctor-patient interactions will promote trust in the doctor. The use of an integrated treatment approach including education by counsellors, setting up of patient support groups, telescreening approaches and use of conversation maps may prove more effective in the long run.
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Affiliation(s)
| | - Geetha Kumar
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
| | - Saranya Velu
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
| | - Shahina Pardhan
- Vision and Eye Research Unit (VERU), School of Medicine, Anglia Ruskin University, Cambridge, UK
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
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50
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Diabetic retinopathy screening barriers among Palestinian primary health care patients: a qualitative study. J Diabetes Metab Disord 2020; 19:875-881. [PMID: 33520809 DOI: 10.1007/s40200-020-00575-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 06/19/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Diabetic Retinopathy (DR) screening among Palestinian diabetic patients is limited. To improve the care of our patients, we explored the barriers to DR screening with a qualitative study. METHODS Three focus groups were conducted in the northern West Bank. Patients noncompliant with DR screening were recruited from Primary Health Care clinics. Questions were adapted from similar published studies. Informed consent was obtained and group discussions were audio recorded, transcribed, and analyzed for themes by three researchers. RESULTS Most patients reported financial barriers including the costs of the exam and additional treatments, and transportation to the referral clinic. System related issues were the difficulty of getting appointments and long wait times due to inadequate numbers of ophthalmologists or screening facilities, and physicians failing to recommend screening. Personal concerns related to patients having other priorities, fears about the results, and the negative experiences of family members. Finally, cultural aspects included the stigma of wearing glasses and not doing a test for a condition without symptoms. CONCLUSIONS Barriers to completing retinopathy screening are multidimensional with financial, personal, educational, health system, and cultural factors. These should be taken into consideration by policy makers in order to increase the uptake and quality of service.
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