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Diabetes mellitus, Diabetic Retinopathy, Screening, Engagement
Objectives: Diabetic retinopathy (DR) is one of the primary causes of preventable vision loss and blindness. Diabetic retinopathy screening (DRS) is essential to detect microvascular damage to the retina; it can be performed in primary care or specialist eye health clinics. The system of referral, screening, and treatment relies on an organized primary care referral pathway, accessible services, and at least a basic level of health literacy among those living with or under threat of developing Diabetes Mellitus (DM).
Methods: Routinely collected patient data from the Pacific Eye Institute (PEI) in Fiji was analyzed to describe a) clinical and demographic DR patient characteristics and b) characteristics of patients demonstrating higher clinic engagement (using multiple logistic regression).
Results: Of 9287 patients who first attended the PEI for DRS between 2012 and 2017, 22% presented with sight-threatening diabetic retinopathy (STDR) in at least one eye. The average duration of DM was 3 years; self-reported glycaemic control was poor. Indo-Fijian or other ethnicity (both vs iTaukei, OR=2.30, 95%CI 1.96-2.70 and OR=2.18, 95% CI 1.63-2.92, respectively; p<0.001), high blood sugar (OR 1.39, 95%CI 1.10-1.75, p=0.006), longer duration of disease (OR=1.21, 95%CI 1.02-1.43, p=0.027), peripheral neuropathy (OR=1.43, 95%CI 1.24-1.65, p<0.001) and STDR (OR=3.30, 95%CI 2.78-3.92, p<0.001) were associated with greater odds of higher clinic engagement. Male gender (Odds Ratio (OR)=0.83, 95% Confidence Interval (CI) 0.72-0.95, p=0.006), younger or older age (both vs 40-70 years; <40 years, OR=0.48, 95%CI 0.37-0.63, ?70 years OR=0.61, 95%CI 0.48-0.76, p<0.001), year of first clinic visit (2013 vs 2012 OR=0.58, 95%CI 0.50-0.69, p<0.001; 2014 vs 2012 OR=0.36, 95%CI 0.30-0.43, p<0.001) and moderate visual impairment (OR=0.67 95%CI 0.56-0.80, p<0.001) were associated with lower odds of high clinic engagement.
Conclusion: Our results identify patient groups that may be more vulnerable to lower engagement with eye health services. Increasing engagement may help reduce delays in screening and treatment. Given the projected continued rise in DM in the Pacific region, investing in robust electronic data systems that collect and connect public health and clinical data is imperative. Health literacy is important for the prevention of DM, timely DM diagnosis, and screening for complications such as DR.
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