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Diabetic Retinopathy Screening Frequency

Socioeconomic Differences Among Community-dwelling Diabetic Adults Screened For Diabetic Retinopathy And Nephropathy: The 2015 Korean Community Health Survey

Socioeconomic Differences Among Community-dwelling Diabetic Adults Screened For Diabetic Retinopathy And Nephropathy: The 2015 Korean Community Health Survey

Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click here . Socioeconomic differences among community-dwelling diabetic adults screened for diabetic retinopathy and nephropathy: The 2015 Korean Community Health Survey Affiliations Department of Preventive Medicine & Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Jeonbuk, Republic of Korea, Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Jeonbuk, Republic of Korea ORCID Socioeconomic differences among community-dwelling diabetic adults screened for diabetic retinopathy and nephropathy: The 2015 Korean Community Health Survey We investigated the association between socioeconomic status (SES) and screening for diabetic retinopathy (DR) and diabetic nephropathy (DN) in community-dwelling diabetics. We analyzed data from 22,134 people with diabetes aged 19 years at the time of the nationwide 2015 Korean Community Health Survey. Multiple logistic regression analysis was used to explore the relationship between SES and screening for DR and DN both before and after adjustment for health behaviors, comorbidities, and educational level. Of all diabetic subjects, 33.9% and 38.1% underwent DR and DN screening, respectively. In the fully adjusted model, the extent of the DR and DN screening trended significantly lower as the educational level fell. Monthly household income was positively associated with DR screening, but a lower odds ratio (OR) for DN screening was evident only when the lowest and highest income groups were compared. Compared with managers/professionals, agricultural/forestry/fishery workers (OR 0.81, 95% confidence interval [CI] 0.690.96) and mechanical/manual laborers (OR 0.83, 95% CI Continue reading >>

Individualised Risk Assessment For Diabetic Retinopathy And Optimisation Of Screening Intervals: A Scientific Approach To Reducing Healthcare Costs

Individualised Risk Assessment For Diabetic Retinopathy And Optimisation Of Screening Intervals: A Scientific Approach To Reducing Healthcare Costs

Individualised risk assessment for diabetic retinopathy and optimisation of screening intervals: a scientific approach to reducing healthcare costs S H Lund - University of Iceland T Aspelund - University of Iceland, Risk ehf, Reykjavik, Iceland P Kirby - Health Intelligence plc, Cambridge, UK G Russell - Health Intelligence plc, Cambridge, UK S Einarsson - Risk ehf, Reykjavik, Iceland O Palsson - Risk ehf, Reykjavik, Iceland E Stefnsson - University of Iceland, Risk ehf, Reykjavik, Iceland OBJECTIVE: To validate a mathematical algorithm that calculates risk of diabetic retinopathy progression in a diabetic population with UK staging (R0-3; M1) of diabetic retinopathy. To establish the utility of the algorithm to reduce screening frequency in this cohort, while maintaining safety standards. RESEARCH DESIGN AND METHODS: The cohort of 9690 diabetic individuals in England, followed for 2 years. The algorithms calculated individual risk for development of preproliferative retinopathy (R2), active proliferative retinopathy (R3A) and diabetic maculopathy (M1) based on clinical data. Screening intervals were determined such that the increase in risk of developing certain stages of retinopathy between screenings was the same for all patients and identical to mean risk in fixed annual screening. Receiver operating characteristic curves were drawn and area under the curve calculated to estimate the prediction capability. RESULTS: The algorithm predicts the occurrence of the given diabetic retinopathy stages with area under the curve =80% for patients with type II diabetes (CI 0.78 to 0.81). Of the cohort 64% is at less than 5% risk of progression to R2, R3A or M1 within 2 years. By applying a 2 year ceiling to the screening interval, patients with type II diabetes are screened o Continue reading >>

Screening Intervals For Diabetic Retinopathy And Incidence Of Visual Loss: Asystematic Review.

Screening Intervals For Diabetic Retinopathy And Incidence Of Visual Loss: Asystematic Review.

1. Diabet Med. 2013 Nov;30(11):1272-92. doi: 10.1111/dme.12274. Screening intervals for diabetic retinopathy and incidence of visual loss: asystematic review. Echouffo-Tcheugui JB(1), Ali MK, Roglic G, Hayward RA, Narayan KM. (1)Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA. Screening for diabetic retinopathy can help to prevent this complication, butevidence regarding frequency of screening is uncertain. This paper systematicallyreviews the published literature on the relationship between screening intervals for diabetic retinopathy and the incidence of visual loss. The PubMed and EMBASE databases were searched until December 2012. Twenty five studies fulfilled theinclusion criteria, as these assessed the incidence/prevalence ofsight-threatening diabetic retinopathy in relation to screening frequency. Theincluded studies comprised 15 evaluations of real-world screening programmes,three studies modelling the natural history of diabetic retinopathy and sevencost-effectiveness studies. In evaluations of diabetic retinopathy screeningprogrammes, the appropriate screening interval ranged from one to four years, in people with no retinopathy at baseline. Despite study heterogeneity, the overall tendency observed in these programmes was that 2-year screening intervals amongpeople with no diabetic retinopathy at diagnosis were not associated with highincidence of sight-threatening diabetic retinopathy. The modelling studies(non-economic and economic) assessed a range of screening intervals (1-5years). The aggregated evidence from both the natural history and cost-effectivenessmodels favors a screening interval >1year, but 2years. Such an interval would be appropriate, safe and cost-effective for people with no diabetic Continue reading >>

Longitudinal Commercial Claimsbased Cost Analysis Of Diabetic Retinopathy Screening Patterns

Longitudinal Commercial Claimsbased Cost Analysis Of Diabetic Retinopathy Screening Patterns

Diabetes is a complex disease associated with many potential long-term complications, such as heart disease, stroke, kidney failure, lower limb amputation, and visual impairment.1 Diabetic retinopathy (ie, damage to the small blood vessels in the retina) is one of the most common complications in patients with chronic diabetes.1-3 In fact, in an analysis of 2005-2008 data from the National Health and Nutrition Examination Survey, 28.5% of US adults aged 40 years with diabetes had diabetic retinopathy, and 4.4% of these adults had advanced diabetic retinopathy (ie, a vision-threatening condition).1,4 Notably, diabetic retinopathy is the main cause of new cases of blindness (ie, central visual acuity of <20/200) in US adults aged 20 to 74 years.2 Several factors have been linked to an increased risk for the development of diabetic retinopathy, including male sex, relatively longer duration of diabetes, and the use of insulin.4 Although many diabetic patients with diabetic retinopathy may be unaware of its presence or progression,3 the early signs of retinopathy can be detected on retinal screening examination, and the treatment of early retinopathy can prevent or delay blindness.2 Because of the high prevalence of diabetic retinopathy in the population with diabetes and the availability of effective treatment, the standards of medical care include screening diabetic patients for early signs of eye disease and implementing appropriate treatment to prevent blindness and other visual complications.3 Several professional organizations have developed clinical practice guidelines for diabetic retinopathy screening. Diabetic retinopathy screening guidelines established by the American Association of Clinical Endocrinologists (AACE), the American Diabetes Association (ADA), and Continue reading >>

New Schedule Proposed For Diabetic Retinopathy Screening

New Schedule Proposed For Diabetic Retinopathy Screening

New Schedule Proposed for Diabetic Retinopathy Screening A new model for diabetic retinopathy screening may decrease the frequency of eye examinations in patients with type 1 diabetes mellitus (T1DM), without delaying the diagnosis of clinically significant eye disease. Findings were recently published online in the New England Journal of Medicine. The personalized screening schedule was developed from the Diabetes Control and Complications Trial (DCCT) and the Epidemiology of Diabetes Intervention and Complications (EDIC) study and may substantially decrease costs by an estimated $1 billion over 20 years. The model is based on individual glycemic control and five different states determined by the degree of retinopathy at baseline: State 2: Mild nonproliferative retinopathy State 3: Moderate nonproliferative retinopathy State 4: Severe nonproliferative diabetic retinopathy State 5: Proliferative diabetic retinopathy or clinically significant macular edema Our data suggest that a practical, evidence-based schedule for time to the next examination would be 4 years, 3 years, 6 months, and 3 months for patients with states 1 through 4, respectively, for which the corresponding cumulative incidence of progression to state 5 retinopathy would be 2.9%, 3.7%, 6.6%, and 14.4%, wrote author David Nathan, MD, of Harvard Medical School in Boston, and colleagues with the DCCT/EDIC Research Group. Diabetic retinopathy represents the most common cause of blindness in American adults. Current guidelines recommend annual screening retinal examinations 3 to 5 years after the diagnosis of T1DM. Screening can contribute to earlier detection and intervention, which can greatly decrease vision loss. To develop the screening schedule, researchers evaluated retinal photographs from the DCCT Continue reading >>

Screening Intervals For Diabetic Retinopathy And Implications For Care

Screening Intervals For Diabetic Retinopathy And Implications For Care

Screening Intervals for Diabetic Retinopathy and Implications for Care 1Gloucestershire Retinal Research Group, Gloucestershire Hospitals NHS Foundation Trust, Office above Oakley Ward, Cheltenham General Hospital, Sandford Road, Cheltenham, GL53 7AN UK 2Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU UK 1Gloucestershire Retinal Research Group, Gloucestershire Hospitals NHS Foundation Trust, Office above Oakley Ward, Cheltenham General Hospital, Sandford Road, Cheltenham, GL53 7AN UK 2Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU UK Peter H. Scanlon, Email: [email protected] . Author information Copyright and License information Disclaimer Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The purpose of this study is to review the evidence that lower risk groups who could safely be screened less frequently for sight-threatening diabetic retinopathy (DR) than annually. Data have demonstrated that people with no DR in either eye are at a low risk of progression to sight-threatening DR over a 2-year period (event rate 4.8 per 1000 person years), irrespective of whether the screening method is one-field non-mydriatic or two-field mydriatic digital photography. Low risk has been defined as no retinopathy on two consecutive screening episodes or no retinopathy on one screening episode combined with risk factor data. The risk of Continue reading >>

Targeted Retinopathy Screening Proposed In Type 1 Diabetes

Targeted Retinopathy Screening Proposed In Type 1 Diabetes

Targeted Retinopathy Screening Proposed in Type 1 Diabetes A data-based model for individualizing retinopathy screening schedules for patients with type 1 diabetes could significantly reduce the frequency of eye exams without delaying the diagnosis of sight-threatening disease, potentially leading to savings of $1 billion in the US over the next 20 years, new research suggests. The findings, from 30 years of fundus photography data on 1375 participants in the Diabetes Control and Complications Trial (DCCT) and its longitudinal follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study, were published in the April 20 issue of the New England Journal of Medicine by the DCCT/EDIC Research Group. With the goal of keeping the probability of progression to proliferative diabetic retinopathy (PDR) or clinically significant macular edema (CSME) at less than 5%, David Nathan, MD, director of the Diabetes Center at Massachusetts General Hospital, Boston, and colleagues devised a screening schedule using exam intervals ranging from 4 years to 3 months, depending on the patient's current state of retinopathy and HbA1c. "We're saying what you have determines the risk going forward," Dr Nathan told Medscape Medical News. The findings suggest a departure from American Diabetes Association guidelines, with a new position statement issued earlier this year advising screening at no less than 2-year intervals for patients with type 1 or type 2 diabetes who have no retinopathy on initial exam and at least annually for those with any degree of retinopathy. "We've actually demonstrated that we can change the frequency safely," Dr Nathan said. In an accompanying editorial , Jamie B Rosenberg, MD, of the department of ophthalmology and visual sciences, Montefiore Medical Continue reading >>

My Site - Chapter 30: Retinopathy

My Site - Chapter 30: Retinopathy

Laser therapy, local intraocular pharmacological therapy and surgery reduce the risk of significant visual loss. Diabetic retinopathy is the most common cause of new cases of legal blindness in people of working age (1) . The Eye Diseases Prevalence Research Group determined the crude prevalence rate of retinopathy in the adult population with diabetes of the United States to be 40.3%; sight-threatening retinopathy occurred at a rate of 8.2% (1) . Previous data showed the prevalence rate of proliferative retinopathy to be 23% in people with type 1 diabetes, 14% in people with type 2 diabetes and on insulin therapy, and 3% in people receiving oral antihyperglycemic therapies (2) . Macular edema occurs in 11%, 15% and 4% of these groups, respectively (3) . Higher prevalence rates were noted in First Nations populations in Canada (4,5) . Visual loss is associated with significant morbidity, including increased falls, hip fracture and a 4-fold increase in mortality (6) . Among individuals with type 1 diabetes, limb amputation and visual loss due to diabetic retinopathy are the independent predictors of early death (7) . Diabetic retinopathy is clinically defined, diagnosed and treated based on the extent of retinal vascular disease exclusively. Three distinct forms of diabetic retinopathy are described: 1) macular edema, which includes diffuse or focal vascular leakage at the macula; 2) progressive accumulation of blood vessel change that includes microaneurysms, intraretinal hemorrhage, vascular tortuosity and vascular malformation (together known as nonproliferative diabetic retinopathy) that ultimately leads to abnormal vessel growth (proliferative diabetic retinopathy); and 3) retinal capillary closure, a form of vascular change detected on fluorescein angiography, whi Continue reading >>

Validation Of A Model To Estimate Personalised Screening Frequency To Monitor Diabetic Retinopathy

Validation Of A Model To Estimate Personalised Screening Frequency To Monitor Diabetic Retinopathy

Validation of a model to estimate personalised screening frequency to monitor diabetic retinopathy Amber A. W. A. van der Heijden &Iris Walraven &Esther van tRiet& Thor Aspelund &Sigrn H. Lund &Petra Elders &Bettine C. P. Polak & Annette C. Moll &Jan E. E. Keunen &Jacqueline M. Dekker &Giel Nijpels Received: 14 November 2013 /Accepted: 28 March 2014 Aims/hypothesis Our study aimed to validate a model to de- termine a personalised screening frequency for diabetic Methods A model calculating a personalised screening inter- val for monitoring retinopathy based on patientsrisk profile was validated using the data of 3,319 type 2 diabetic patients in the Diabetes Care System West-Friesland, the Netherlands. Two-field fundus photographs were graded according to the EURODIAB coding system. Sight-threatening retinopathy (STR) was considered to be grades 35. Validity of the model was assessed using calibration and discrimination measures. We compared model-based time of screening with time of STR diagnosis and calculated the differences in the number of fundus photographs using the model compared with those in Results During a mean of 53 months of follow-up, 76 patients (2.3%) developed STR. Using the model, the mean screening interval was 31 months, leading to a reduced screening frequency of 61% compared with annual screen- ing and 23% compared with biennial screening. STR incidence occurred after a mean of 26 months after the model-based time of screening in 67 patients (88.2%). In nine patients (11.8%), STR had developed before the model-based time of screening. The discriminatory ability of the model was good (C-statistic 0.83; 95% CI 0.74, 0.92). Calibration showed that the model overestimated Conclusions/interpretation A large reduction in retinopathy screening was achie Continue reading >>

Frequency Of Screening For Diabetic Retinopathy

Frequency Of Screening For Diabetic Retinopathy

Frequency of Screening for Diabetic Retinopathy This article is intended for primary care clinicians, endocrinologists, ophthalmologists, and other specialists who provide care to patients with diabetes mellitus. The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care. Upon completion of this activity, participants will be able to: Report recommendations by the American Diabetes Association for eye examinations in patients with diabetes mellitus. Evaluate a simple risk stratification for time to development of sight-threatening diabetic retinopathy. As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest. Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content. Disclosure: Miriam E. Tucker has disclosed no relevant financial relationships. Disclosure: Brande Nicole Martin, MA, has disclosed no relevant financial relationships. Disclosure: Hien T. Nghiem, MD, has disclosed no relevant financial relationships. Disclosure: Sarah Fleischman has disclosed no relevant financial relationships. Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physician Continue reading >>

Frequency Of Evidence-based Screening For Retinopathy In Type 1 Diabetes.

Frequency Of Evidence-based Screening For Retinopathy In Type 1 Diabetes.

Frequency of Evidence-Based Screening for Retinopathy in Type 1 Diabetes. Author(s): DCCT/EDIC Research Group., Nathan DM, Bebu I, Hainsworth D, Klein R, Tamborlane W, Lorenzi G, Gubitosi-Klug R, Lachin JM. Frequency of Evidence-Based Screening for Retinopathy in Type 1 Diabetes. N Engl J Med. 2017 Apr 20;376(16):1507-1516. doi: 10.1056/NEJMoa1612836. Journal: The New England Journal Of Medicine, Volume 376, Issue 16, 04 2017 BACKGROUND In patients who have had type 1 diabetes for 5 years, current recommendations regarding screening for diabetic retinopathy include annual dilated retinal examinations to detect proliferative retinopathy or clinically significant macular edema, both of which require timely intervention to preserve vision. During 30 years of the Diabetes Control and Complications Trial (DCCT) and its longitudinal follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study, retinal photography was performed at intervals of 6 months to 4 years. METHODS We used retinal photographs from the DCCT/EDIC study to develop a rational screening frequency for retinopathy. Markov modeling was used to determine the likelihood of progression to proliferative diabetic retinopathy or clinically significant macular edema in patients with various initial retinopathy levels (no retinopathy or mild, moderate, or severe nonproliferative diabetic retinopathy). The models included recognized risk factors for progression of retinopathy. RESULTS Overall, the probability of progression to proliferative diabetic retinopathy or clinically significant macular edema was limited to approximately 5% between retinal screening examinations at 4 years among patients who had no retinopathy, 3 years among those with mild retinopathy, 6 months among those with moderate reti Continue reading >>

Diabetic Retinopathy Screening Using Telemedicine Tools: Pilot Study In Hungary

Diabetic Retinopathy Screening Using Telemedicine Tools: Pilot Study In Hungary

Diabetic Retinopathy Screening Using Telemedicine Tools: Pilot Study in Hungary 1Department of Public Health, University of Szeged, Szeged, Hungary 2Department of Ophthalmology, Albert Szent-Gyrgyi Clinical Center, University of Szeged, Szeged, Hungary 3Health Intelligence, Clinical Development, Chesire, UK 4Centre of Eye Research, Department of Ophthalmology, Oslo University Hospital, University of Oslo, Oslo, Norway 5Health Services Research Centre, Akershus University Hospital, Lrenskog, Norway 6Institute of Clinical Medicine, University of Oslo, Campus Ahus, Oslo, Norway Received 9 September 2016; Revised 27 October 2016; Accepted 3 November 2016 Copyright 2016 Dra J. Eszes et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Diabetic retinopathy (DR) is a sight-threatening complication of diabetes. Telemedicine tools can prevent blindness. We aimed to investigate the patients satisfaction when using such tools (fundus camera examination) and the effect of demographic and socioeconomic factors on participation in screening. Methods. Pilot study involving fundus camera screening and self-administered questionnaire on participants experience during fundus examination (comfort, reliability, and future interest in participation), as well as demographic and socioeconomic factors was performed on 89 patients with known diabetes in Csongrd County, a southeastern region of Hungary. Results. Thirty percent of the patients had never participated in any ophthalmological screening, while 25.7% had DR of some grade based upon a standard fundus camera examination and UK-based DR grading protocol (S Continue reading >>

Do Routine Eye Exams Reduce Occurrence Of Blindness From Type 2 Diabetes?

Do Routine Eye Exams Reduce Occurrence Of Blindness From Type 2 Diabetes?

Do routine eye exams reduce occurrence of blindness from type 2 diabetes? J Fam Pract. 2004 September;53(9):732-746 University of Texas Southwestern Medical Center, Dallas 1. Younis N, Broadbent DM, Vora JP, Harding SP. Incidence of sight-threatening retinopathy in patients with type 2 diabetes in the Liverpool Diabetic Eye Study: a cohort study. Lancet 2003;361:195-200. 2. Hutchinson A, McIntosh A, Peters J, et al. Effectiveness of screening and monitoring tests for diabetic retinopa-thya systematic review. Diabet Med 2000;17:495-506. 3. The Diabetic Retinopathy Study Research Group. Preliminary report on effects of photocoagulation therapy. Am J Ophthalmol 1976;81:383-396. 4. British Multicentre Study Group. Photocoagulation from diabetic maculopathy: a randomized controlled clinical trial using the xenon arc. Diabetes 1983;32:1010-1016. 5. Fong DS, Aiello L, Gardner TW, et al. American Diabetes Association. Diabetic retinopathy. Diabetes Care 2004;26 Suppl 1:S84-S87. Screening eye exams for patients with type 2 diabetes can detect retinopathy early enough so treatment can prevent vision loss. Patients without diabetic retinopathy who are systematically screened by mydriatic retinal photography have a 95% probability of remaining free of sight-threatening retinopathy over the next 5 years. If background or preproliferative retinopathy is found at screening ( Figure ), the 95% probability interval for remaining free of sight-threatening retinopathy is reduced to 12 and 4 months, respectively (strength of recommendation [SOR]: B, based on 1 prospective cohort study). A reliably sensitive screening exam requires mydriatic retinal photography augmented by ophthalmoscopy when photographs are inconclusive (SOR: A, based on a systematic review). For patients with diabetes n Continue reading >>

Diabetic Retinopathy Management Guidelines

Diabetic Retinopathy Management Guidelines

Diabetic Retinopathy Management Guidelines Assessment of DR: Frequency of Examination While there was general consensus among published guidelines regarding the timing of the initial examination, there were differences between follow-up examination schedules ( Table 4 ). For patients without evidence of retinopathy, guidelines from South Africa, NICE, RCO, AAO and the Pacific Islands recommended annual follow-up. The AAO referenced the WESDR that demonstrated that at 1 year, 510% of patients with a normal retinal examination at baseline had progressed to some evidence of DR. The 4-year incidence of any DR was 59% in patients with Type 1 DM and 34% in Type 2 patients.[ 43 ] The NHMRC was the only publication that identified and recommended that patients at elevated risk (longer duration, poor glycemic control, hypertension, hyperlipidemia or from an indigenous background) required at minimum annual review. The necessity for greater vigilance particularly for the indigenous population is supported by recent evidence which demonstrated that indigenous people in Australia developed vision-threatening disease (particularly clinically significant macular edema [CSME]) from a normal baseline at an earlier stage than nonindigenous populations.[ 76 , 77 ] Extension of the examination schedule to 2-yearly intervals for most patients was recommended by the NHMRC, Scottish Intercollegiate Guidelines Network (SIGN), New Zealand and Malaysia. Evidence-based justification for the timing between examinations were based on findings from studies subsequent to WESDR, including the UKPDS, showed that 22% with a normal baseline examination developed DR after 6 years.[ 78 ] Comparable data showing half the incidence in the WESDR was also demonstrated in the Blue Mountains Eye Study,[ 79 ] M Continue reading >>

Equity Of Uptake Of A Diabetic Retinopathy Screening Programme In A Geographically And Socio-economically Diverse Population - Sciencedirect

Equity Of Uptake Of A Diabetic Retinopathy Screening Programme In A Geographically And Socio-economically Diverse Population - Sciencedirect

Equity of uptake of a diabetic retinopathy screening programme in a geographically and socio-economically diverse population At the time of undertaking the audit, the uptake of diabetic retinopathy screening in Derbyshire was 73%, below the national standard of 80%. To assess equity of access to diabetic retinopathy screening in a geographically and ethnically diverse population and determine predictors for poor uptake that will inform service improvements. Postal questionnaires were issued to 1000 people invited for diabetic retinopathy screening in May 2010 and telephone interviews were conducted with subsample of 32 people who had not made a screening appointment. Routine data from the screening programme was used to identify characteristics of people who did not respond to screening invitation. The adjusted odds ratios (OR) and 95% confidence intervals (95% CI) using multivariate methods were calculated in this study. The response rate to the postal questionnaire was 43%. Of these, 28% of respondents did not recall discussing the importance of diabetic retinopathy screening with their primary care team and 11% of people did not understand the term diabetic retinopathy. Non-uptake of screening was associated with deprivation (OR 1.19, 95% CI 1.101.29 for those living in the most deprived areas compared to the least deprived) and young people were over three times more likely not to participate than older people (OR 3.13, 95% CI 2.703.64 for men under 40 compared to men over 80 and OR 3.03, 95% CI 1.545.98 for people with type 1 diabetes under 40 compared to those over 80). Ensuring that primary care and other health care and third sector organisations convey the importance of diabetic retinopathy screening with patients and improving patients' understanding of the s Continue reading >>

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