Prevalence of undiagnosed diabetic retinopathy among inpatients with diabetes: the diabetic retinopathy inpatient study (DRIPS)

Abstract

Objective To determine the prevalence and risk factors of diabetic retinopathy in the inpatient diabetic population in the USA and to determine the barriers to ophthalmic examinations and treatment among this population. Research design and methods A cross-sectional analysis of 113 inpatients with diabetes mellitus admitted to an inner city community teaching hospital in Pittsburgh. Digital fundus photographs of the posterior pole were taken of each eye after pharmacological dilation. Presence, absence and severity of diabetic retinopathy and macular edema were graded on the basis of internationally accepted criteria. An investigator-administered questionnaire and review of the medical record were used to obtain data about patient demographics, clinical characteristics and barriers to ophthalmic care. The association between these data and the presence of diabetic retinopathy was tested. Results The estimated prevalence of diabetic retinopathy in the inpatient population was 44% (95% CI 34% to 53%). The prevalence of previously undiagnosed diabetic retinopathy and sight-threatening retinopathy was 25% (95% CI 17% to 33%) and 19% (95% CI 11% to 26%), respectively. Renal disease was independently associated with the presence of diabetic retinopathy (OR, 3.86; 95% CI 1.22 to 12.27), as well as a longer duration of diabetes (OR, 1.08 per year; 95% CI 1.014 to 1.147). 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. Conclusions The prevalence of diabetic retinopathy and sight-threatening diabetic retinopathy in the inpatient population is likely significantly higher than in the general diabetic population in the USA. These patients have barriers to care that need to be addressed to make standard of care ophthalmic examinations and treatment possible in this population.

What works to increase attendance for diabetic retinopathy screening? An evidence synthesis and economic analysis

“…Report Supplementary Material 2 [see Characteristics of the 65 included studies (phase 2 review)] shows the characteristics of the 65 included studies. Forty-one (63%) 147,148,150,151,153,156,[162][163][164][165][166]171,[175][176][177][178][179][180]182,[184][185][186][187]190,192,[194][195][196][197][198][199][201][202][203][204][205][206][207][208][209][210] used quantitative methods only (e.g. questionnaires, surveys), 18 (28%) 149,152,154,155,[157][158][159][160]...…”

“…The quality appraisals of the included studies (n = 53 24,[147][148][149][150][151][152][153][154][155][156][157][158][159][160][161][163][164][165][166][167][168][169][170][172][173][174][175][177][178][179][180]182,184,185,187,[190][191][192]194,195,197,199,[201][202][203][204][205][206][207][208]…”

“…On the basis of expressed importance, domains judged to be important in the included studies were 'environmental context and resources' (19 studies 148,152,154,155,158,160,161,166,170,179,[185][186][187]189,191,194,199,201,207 ), 'knowledge' (19 studies 152,[158][159][160][161]165,[167][168][169][173][174][175]181,190,191,193,195,200,205 ), 'memory, attention and decision processes' (11 studies 156,166,170,[179][180][181][182]187,189,193,…”

“…Both people with diabetes and HCPs suggested that some people did not have the physical capability to attend screening because of a physical disability. 167,194,195 Some had limited personal mobility because of poor overall health or were housebound. 157,180 Additionally, if a person required physical assistance to attend but none was available this was also noted as being a barrier.…”

Ocular screening adherence across Hispanic/Latino heritage groups with diabetes: results from the Ocular SOL ancillary to the Miami site of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

“…The need for dilated eye examinations in those newly diagnosed is paramount and should be immediately recommended by the healthcare provider because it is not possible to determine how many years a participant was living with undiagnosed diabetes, and the risk of diabetic retinopathy and increasingly severe, related complications increases with length of time living with diabetes 2. Kovarik et al 36 found that although hospitalized patients (inpatients) had a higher prevalence of diabetic retinopathy than outpatients and that transportation and physical disability were barriers to eye care, they were more aware of ocular complications from having diabetes.…”