DR screening occurs too late among insured diabetic youths

This retrospective, longitudinal study assessed the rate of ophthalmic examinations among youths with diabetes, specifically to monitor screening for diabetic retinopathy (DR).

Study design

Using data from a US managed care network over a period of 14 years, investigators examined 12,686 participants aged 21 years or younger, each with newly diagnosed diabetes. The cohort comprised 5,453 with type 1 diabetes and 7,233 with type 2 diabetes.

Outcomes

Of those with health insurance, only 64.9% of type 1 and 42.2% of type 2 were screened for DR within 6 years of initial diabetes diagnosis.

White (54.7%) and Asian youths (57.3%) were more likely to undergo screening compared with Latino (41.6%) and black youths (44.6%). Patients with household net worth of ≥$500,000 were also more than 50% likely to be screened than those with households worth less than $25,000.

Limitations

This is an excellent study that followed a sound methodology, but it lacks clinical data, such as visual acuity and retinal findings, which would have been useful in applying the study to clinical situations.

Clinical significance

These findings suggest that many youths with diabetes who have health insurance are not receiving timely eye examinations to monitor for DR.

The authors suggest telemedicine and nonmydriatic fundus photography may be helpful in overcoming barriers to screening, especially when used in primary care. There are several potential advantages, including:

• Increasing DR surveillance rates as patients are more likely to undergo retinal imaging in their primary care facility.
• Filtering out patients who do not require to be seen by an eye care professional, thereby easing patient burden.
• Facilitating referrals to ophthalmologists for patients at risk of vision loss and requiring treatment.
• Reducing costs to both the patient and health care system.