Predictors of attendance at diabetic retinopathy screening among people with type 2 diabetes: Secondary analysis of data from primary care

Published:September 11, 2021DOI:https://doi.org/10.1016/j.pcd.2021.08.004

      Highlights

      • First study of uptake to examine a mix of private and public screening services.
      • Most people managed in a diabetes care programme attended retinopathy screening.
      • One third of those who attended screening attended other screening services only.
      • Attendees more likely to use oral hypoglycaemic agents or injectables.
      • Attendees more likely to have on target blood glucose and attend DNS.

      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.

      Abbreviations:

      DNS (diabetes nurse specialist), MDSCP (Midlands Diabetes Structured Care Programme), CI (confidence interval), OR (odds ratio)

      Keywords

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      References

        • Wild S.
        • Roglic G.
        • Green A.
        • Sicree R.
        • King H.
        Global prevalence of diabetes: estimates for the year 2000 and projections for 2030.
        Diabetes Care. 2004; 27: 1047-1053
        • Gregg E.W.
        • Sattar N.
        • Ali M.K.
        The changing face of diabetes complications.
        Lancet Diabetes Endocrinol. 2016; 4: 537-547
        • Zheng Y.
        • He M.
        • Congdon N.
        The worldwide epidemic of diabetic retinopathy.
        Indian J. Ophthalmol. 2012; 60: 428
        • Yau J.W.
        • Rogers S.L.
        • Kawasaki R.
        • Lamoureux E.L.
        • Kowalski J.W.
        • Bek T.
        • et al.
        Global prevalence and major risk factors of diabetic retinopathy.
        Diabetes Care. 2012; 35: 556-564
        • Olafsdottir E.
        • Andersson D.K.
        • Dedorsson I.
        • Svärdsudd K.
        • Jansson S.P.
        • Stefánsson E.
        Early detection of type 2 diabetes mellitus and screening for retinopathy are associated with reduced prevalence and severity of retinopathy.
        Acta Ophthalmol. 2016; 94: 232-239
        • Harkins V.
        Irish College of General Practitioners Health Service Executive Irish Endocrine Society A Practical Guide to Integrated Type 2 Diabetes Care. Health Service Executive, Dublin2008
        • American Diabetes Association
        11. Microvascular complications and foot care: standards of medical care in diabetes — 2020.
        Diabetes Care. 2020; 43: S135-S151
        • Pieczynski J.
        • Grzybowski A.
        Review of diabetic retinopathy screening methods and programmes adopted in different parts of the world.
        Eur. Ophthalmic Rev. 2015; 9: 49-55
        • Committee EAGNRS
        Framework for the Development of a Diabetic Retinopathy Screening Programme for Ireland.
        Naas: Health Service Executive, 2008
        • Wren M.-A.
        • Connolly S.
        A European late starter: lessons from the history of reform in Irish health care.
        Health Econ. Policy Law. 2019; 14: 355-373
        • HIA
        Annual Report and Accounts 2019.
        HIA, 2020
        • Sibal L.
        • Home P.D.
        Management of type 2 diabetes: NICE guidelines.
        Clin. Med. 2009; 9: 353-357
        • Moreton R.B.R.
        • Stratton I.M.
        • Chave S.J.
        • Lipinski H.
        • Scanlon P.H.
        Factors determining uptake of diabetic retinopathy screening in Oxfordshire.
        Diabet. Med. 2017; 34: 993-999
        • Van Eijk K.
        • Blom J.
        • Gussekloo J.
        • Polak B.
        • Groeneveld Y.
        Diabetic retinopathy screening in patients with diabetes mellitus in primary care: incentives and barriers to screening attendance.
        Diabetes Res. Clin. Pract. 2012; 96: 10-16
        • Funatsu H.
        • Hori S.
        • Shimizu E.
        • Nakamura S.
        Questionnaire survey on periodic ocular examination in Japanese diabetic patients.
        Am. J. Ophthalmol. 2003; 136: 955-957
        • Benoit S.R.
        • Swenor B.
        • Geiss L.S.
        • Gregg E.W.
        • Saaddine J.B.
        Eye care utilization among insured people with diabetes in the U.S., 2010–2014.
        Diabetes Care. 2019; 42: 427-433
        • Lawrenson J.G.
        • Bourmpaki E.
        • Bunce C.
        • Stratton I.
        • Gardner P.
        • Anderson J.
        • et al.
        Trends in diabetic retinopathy screening attendance and associations with vision impairment attributable to diabetes in a large nationwide cohort.
        Diabet. Med. 2020; : e14425
        • Kashim R.M.
        • Newton P.
        • Ojo O.
        Diabetic retinopathy screening: a systematic review on patients’ non-attendance.
        Int. J. Environ. Res. Public Health. 2018; 15
        • Bennett G.H.
        • Tuthill A.
        Investigating the barriers to the uptake of diabetic RetinaScreen.
        Ir. Med. J. 2017; 110: 628
        • Tracey MaR E.
        • Riordan F.
        • McHugh S.M.
        • Kearney P.M.
        Understanding the uptake of a national retinopathy screening programme: an audit of patients with diabetes in two large primary care centres [version 1; peer review: awaiting peer review].
        HRB Open Res. 2019; 2
        • Fowles J.B.
        • Rosheim K.
        • Fowler E.J.
        • Craft C.
        • Arrichiello L.
        The validity of self-reported diabetes quality of care measures.
        Int. J. Qual. Health Care. 1999; 11: 407-412
        • Riordan F.
        • McHugh S.
        • Marsden P.
        • Kearney P.
        • Harkins V.
        Audit Report of the HSE Midland Diabetes Structured Care Programme.
        Health Service Executive (HSE), 2017
        • Brennan C.
        • Harkins V.
        • Perry I.J.
        Management of diabetes in primary care: a structured-care approach.
        Eur. J. Gen. Pract. 2008; 14: 117-122
        • Riordan F.
        • McHugh S.M.
        • Harkins V.
        • Marsden P.
        • Kearney P.M.
        Sustaining quality in the community: trends in the performance of a structured diabetes care programme in primary care over 16 years.
        Diabet. Med. 2018; 35: 1078-1086
        • Lawrenson J.G.
        • Graham-Rowe E.
        • Lorencatto F.
        • Rice S.
        • Bunce C.
        • Francis J.J.
        • et al.
        What works to increase attendance for diabetic retinopathy screening? An evidence synthesis and economic analysis.
        Health Technol. Assess. 2018; 22: 1-160
        • Scanlon P.H.
        The english national screening programme for diabetic retinopathy 2003–2016.
        Acta Diabetol. 2017; 54: 515-525
        • Keegan D.J.
        • Acheson R.
        • Cahill M.
        • Kavanagh H.
        • Murphy C.
        • Morgan M.
        Results of the first round of screening from the Irish National Diabetic Retinopathy Screening and Treatment Programme (Diabetic RetinaScreen).
        Investig. Ophthalmol. Vis. Sci. 2016; 57
      1. Diabetic RetinaScreen, Programme Report 2013–2015.

        • Lawrenson J.G.
        • Graham-Rowe E.
        • Lorencatto F.
        • Burr J.
        • Bunce C.
        • Francis J.J.
        • et al.
        Interventions to increase attendance for diabetic retinopathy screening.
        Cochrane Database Syst. Rev. 2018; : 23-31
        • World Health Organisation
        Model of Integrated Care for Patients with Type 2 Diabetes. A Guide for Health Care Professionals (Clinical Management Guidelines).
        WHO, 2018
        • Diabetes Expert Advisory Group
        Diabetes Expert Advisory Group First Report: April 2008.
        Health Service Executive, Dublin2008
        • James M.
        • Goodchild C.
        • Bashir S.
        • Mannix M.
        Report on the creation of a diabetes register and retinopathy screening outcomes in the Mid-West of Ireland.
        Ir. J. Med. Sci. (1971-). 2016; 185: 151-159
        • Cooke M.
        Development of a Diabetes Register in Ireland: Feasibility Study for the Establishment of a Register.
        2010
        • Graham-Rowe E.
        • Lorencatto F.
        • Lawrenson J.G.
        • Burr J.M.
        • Grimshaw J.M.
        • Ivers N.M.
        • et al.
        Barriers to and enablers of diabetic retinopathy screening attendance: a systematic review of published and grey literature.
        Diabet. Med. 2018; 35: 1308-1319
        • Riordan F.
        • McHugh S.M.
        • Murphy K.
        • Barrett J.
        • Kearney P.M.
        The role of nurse specialists in the delivery of integrated diabetes care: a cross-sectional survey of diabetes nurse specialist services.
        BMJ Open. 2017; 7: e015049
        • Committee NCDMPS
        A National Chronic Disease Management Patient Support Programe for HSE.
        2012
        • Kearney H.T.
        • Smyth N.
        Overview of Activity Data from Clinical Nurse Specialist (CNSp) Diabetes Integrated Care Group Report.
        2017
        • Hurley L.
        • Campbell C.
        • Conroy A.
        • Newell E.
        • Malee K.
        • Woods S.
        • et al.
        CNS Diabetes Integrated Care Service in Community Healthcare West (CHO Area 2): Gap Analysis & Workforce Review.
        2019
        • Committee on the Future of Healthcare
        Slaintecare Report.
        Dept of Health, Ireland, 2017
        • Tracey M.
        • Racine E.
        • Riordan F.
        • McHugh S.M.
        • Kearney P.M.
        Understanding the uptake of a national retinopathy screening programme: an audit of people with diabetes in two large primary care centres.
        HRB Open Res. 2019; 2
        • Forster A.S.
        • Forbes A.
        • Dodhia H.
        • Connor C.
        • Du Chemin A.
        • Sivaprasad S.
        • et al.
        Non-attendance at diabetic eye screening and risk of sight-threatening diabetic retinopathy: a population-based cohort study.
        Diabetologia. 2013; 56: 2187-2193
        • Echouffo–Tcheugui J.
        • Ali M.
        • Roglic G.
        • Hayward R.
        • Narayan K.
        Screening intervals for diabetic retinopathy and incidence of visual loss: a systematic review.
        Diabet. Med. 2013; 30: 1272-1292
        • Taylor-Phillips S.
        • Mistry H.
        • Leslie R.
        • Todkill D.
        • Tsertsvadze A.
        • Connock M.
        • et al.
        Extending the diabetic retinopathy screening interval beyond 1 year: systematic review.
        Br. J. Ophthalmol. 2016; 100: 105-114
        • HIQA
        Scoping Report: Extended Interval Screening by the Diabetic RetinaScreen Programme in Ireland.
        2021
        • National Screening Advisory Committee
        Case for the modification of the Diabetic RetinaScreen Programme.
        NSAC, Dublin2020
        • Lian J.
        • McGhee S.M.
        • Gangwani R.A.
        • Lam C.L.K.
        • Yap M.K.H.
        • Wong D.S.H.
        Awareness of diabetic retinopathy and its association with attendance for systematic screening at the public primary care setting: a cross-sectional study in Hong Kong.
        BMJ Open. 2018; 8e019989
        • Wang S.Y.
        • Andrews C.A.
        • Gardner T.W.
        • Wood M.
        • Singer K.
        • Stein J.D.
        Ophthalmic screening patterns among youths with diabetes enrolled in a large US managed care network.
        JAMA Ophthalmol. 2017; 135: 432-438