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Barriers to care increase rate of retinopathy among inpatients with diabetes
Inpatients with diabetes are nearly twice as likely to have diabetic retinopathy when compared with nonhospitalized patients with diabetes, likely due to increased physical disability and illnesses related to other comorbidities and other barriers to care, according to recent findings.
Jessica J. Kovarik, MD, of the department of ophthalmology of the University of Pittsburgh School of Medicine in Pennsylvania, and colleagues analyzed data from 108 inpatients with diabetes admitted to UPMC Mercy Hospital, a teaching hospital in Pittsburgh, between September 2011 and August 2012 (61 women; 83 white; 30% between age 50 to 60 years). All participants completed a questionnaire; questions included whether they had an ophthalmologist, when they last had a dilated fundus examination, whether they had been diagnosed with diabetic retinopathy in the past and whether or not they knew diabetes could affect vision. All participants underwent digital fundus photographs of the posterior pole of each eye after pharmacologic dilation; researchers graded presence, absence and severity of diabetic retinopathy and macular edema and analyzed medical records to obtain data on secondary risk factors for retinopathy.
Within the cohort, 44% had diabetic retinopathy (95% CI, 34% to 53%). Previously undiagnosed retinopathy was found in 25% of participants (95% CI, 17% to 33%), and 19% of cases were sight-threatening (95% CI, 11% to 26%).
Renal disease was independently associated with the presence of diabetic retinopathy (OR, 3.86; 95% CI, 1.22–2.27), as well as a longer duration of diabetes (OR, 1.08 per year; 95% CI, 1.01–1.15). Diabetic retinopathy was seen in 15 of 17 patients admitted with diabetic foot ulcers or osteomyelitis. Frequently reported barriers to ophthalmic examinations included lack of transportation and physical disability.
“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 recommended standard of care screening examinations,” the researchers wrote. “Frequently reported barriers [to care] included transportation and physical disability, as well as being too sick or having too many other medical appointments.” – by Regina Schaffer
Disclosure: One of the study authors reports receiving speaker’s fees from Eli Lilly, Medtronic and Sanofi.