Barriers to annual diabetic retinopathy screening and subsequent recommended follow-up adherence among Chinese diabetics: a cross-sectional and longitudinal study

Abstract

Objectives: Adherence to routine annual eye evaluations for diabetes is frequently insufficient on a global scale. We evaluated the adherence to annual diabetic retinopathy screening (DRS) and recommended follow-up among Chinese patients with diabetes, and we also identified the associated risk variables.

Design: This was a cross-sectional and longitudinal study.

Setting: Patients with diabetes were inquired about their completion of DRS within the preceding year. All participants were required to complete the Compliance with Annual Diabetic Eye Exams Survey.

Participants: Participants with diabetes who initially sought eye examination from November 2021 to October 2023 at He Eye Specialist Hospital, Shenyang, China.

Outcome measures: Logistic regression analyses defined the risk factors associated with poor compliance with the annual DRS and recommended follow-up.

Results: There were 468 patients registered, with a mean age of 67.42±10.66 years. A total of 308 (65.8%) participants had DRS in the previous year. Rural residents (OR 1.704, 95% CI 1.019 to 2.850, p=0.042), vision-threatening diabetic retinopathy (VTDR) (OR 1.948, 95% CI 1.145 to 3.313, p=0.014), item 7 (over the past 4 weeks, I have felt blue, downhearted or depressed) (OR 0.624, 95% CI 0.401 to 0.971, p=0.037) and item 42 (I receive a reminder from my eye doctor's office when it is time to schedule an exam) (OR 0.618, 95% CI 0.387 to 0.989, p=0.045) were associated with non-adherence to annual DRS. The compliance with DRS improved to 80.9% in the second year after health education and reminders of follow-up. VTDR (OR 3.063, 95% CI 1.852 to 5.066, p<0.01) was found to be the risk factor for poor compliance with scheduled follow-up.

Conclusions: About one-third of diabetics did not complete annual DRS; that rate decreased to one-fifth after health education and follow-up reminders.

Keywords: Diabetes Mellitus, Type 2; Diabetic retinopathy; Risk Factors.

Figure 1. Diagram illustrating the inclusion and exclusion of study participants. CADEES, Compliance with Annual Diabetic Eye Exams Survey; DM, diabetes mellitus; DR, diabetes retinopathy; OCT, optical coherence tomography; SLO, scanning laser ophthalmoscope.