FROM BMJ DIABETES RESEARCH AND CARE
The prevalence of undiagnosed diabetic retinopathy was 25% and that of sight-threatening diabetic retinopathy was 19% of an inpatient population of patients with diabetes, compared with the general population; researchers identified several barriers to ophthalmic care.
Diabetic retinopathy and sight-threatening diabetic retinopathy are estimated at a prevalence of 28.5% and 4.4%, respectively. In contrast, there is little research in to the prevalence of undiagnosed diabetic retinopathy or sight-threatening diabetic retinopathy in higher risk inpatients.
Dr. Jessica Kovarik, who at the time of this research was with the UPMC Eye Center at the University of Pittsburgh, and her associates sought to identify the prevalence of undiagnosed diabetic retinopathy among inpatients with established diabetes as well as barriers to diabetic retinopathy examinations and treatment.
They conducted a cross-sectional analysis of diabetic patients admitted to an urban teaching hospital in Pittsburgh. Digital funduscopic images were obtained to determine the presence and severity of diabetic retinopathy and macular edema. Questionnaires assessed barriers to ophthalmic examinations and demographics (BMJ Open Diab Res Care. 2016;4:e000164 [doi: 10.1136/bmjdrc-2015-000164 ]).
In total, 113 patients were eligible and 5 were excluded from analysis of diabetic retinopathy prevalence due to an inability to take images or poor-quality images.
Among the patients, 61 were women, 83 were white, and 34 were aged 50-60 years. Most had health insurance (89%) and an ophthalmologist (64%), and most understood that diabetic retinopathy affects vision (91%). Further, patients reported a history of type 2 diabetes (96%), hypertension (85%), hyperlipidemia (68%), renal disease (25%), peripheral vascular disease (55%), and coronary artery disease (52%).
Among those who had not had a dilated funduscopic examination within a year, barriers to screening examination included transportation issues, physical disability, too many appointments or being too sick, cost, lack of time or priority, or no visual impairment. Forty percent reported having an eye examination within the year and 5% reported never having an eye examination.
The investigators identified 7 patients with clinically significant macular edema (6%), 13 with proliferative diabetic retinopathy (12%), and 1 with severe (1%), 14 with moderate (13%), and 16 with mild nonproliferative diabetic retinopathy (15%). Overall, 44% of the patients had diabetic retinopathy, with 25% previously undiagnosed. Further, sight-threatening diabetic retinopathy was found in 19%, with 3.7% previously undiagnosed.
Finally, after multivariable analysis, a longer duration of diabetes (odds ratio, 1.08 per year; 95% confidence interval, 1.014-1.147; P =.017) and renal disease (OR, 3.86; 95% CI, 1.22-12.27; P =.022) was associated with diabetic retinopathy. Further, of the 17 patients admitted with osteomyelitis or a nonhealing diabetic ulcer, 15 (88.2%) had diabetic retinopathy.
“Curiously, most inpatients in our population (91%) are aware of the ocular complications of diabetes, and many (64%) do have ophthalmologists (more than any other subspecialty listed), yet only a minority (40%) of patients are getting the recommended standard of care screening examinations. Barriers that are unique to this high-risk population may explain this disparity,” the authors wrote.
The study was funded by the National Institutes of Health, Eye and Ear Foundation of Pittsburgh, Clinical and Translational Science Institute, the University of Pittsburgh, and a grant from Research to Prevent Blindness. One of the researchers, Dr. Jann Johnston, reported speaking for Medtronic, Lilly, and Sanofi.
