All challenges of living with diabetes are better served by diligence to medical care early in life, and that’s certainly the case for ocular involvement, too. Unfortunately, kids from minority backgrounds may be less likely to undergo recommended diabetic eye exams—yet these individuals are more likely to have diabetic retinopathy (DR) than age-matched Caucasians, new research published in JAMA Ophthalmology suggests. These findings highlight the critical need to address barriers and improve access to DR screenings, says researcher Risa Wolf, MD, of the Johns Hopkins Hospital.
The study, which included 149 participants, specifically found only 46% of minority youths had previous diabetic eye exams compared with 85% of white teens. Minority participants were more likely to have DR (15% vs. 3%, respectively) and require these screenings. Another key finding: individuals with public insurance were also less likely to undergo recommended evaluations.
Participants with type 1 or 2 diabetes were screened for DR at the Johns Hopkins Hospital Pediatric Diabetes Center from 2018 to 2019. The study considered race and ethnicity categories including Black, Hispanic, white and “other,” which was defined as those individuals who reported being mixed-race or Asian. The participants were equally divided by gender and were between the ages of five and 21.
Of the 149 subjects, 51 (34%) never had a previous diabetic eye exam. The majority were more likely to be non-white (75% vs. 32%) and have type 2 diabetes (75% vs. 10%). Additionally, individuals in the minority group more often had Medicaid or public insurance (84% vs. 32%), lower annual household incomes of $25,000 or less (41% vs. 9%) and education levels of high school or less (67% vs. 35%).
Considering barriers to care, 56% of participants said they couldn’t recall receiving a recommendation to obtain a diabetic eye exam, 29% cited difficulty finding time for an additional appointment and 20% reported transportation issues. Minority youths were also less likely to get diabetic eye exams even after adjusting for insurance, household income and parental education level.
Over the last decade, there has been a rise in the prevalence of type 2 diabetes in youths, which disproportionately affects racial/ethnic minorities and those of lower socioeconomic status, who are at higher risk of developing DR, the investigators said.
Point-of-care DR exams integrated in the diabetes clinic may help improve adherence to ADA-recommended screening guidelines, particularly in high-risk populations, the study suggested. Case in point: at Dr. Wolf’s pediatric diabetes center, she and her team increased access and screening rates from 49% to 95% using autonomous point-of-care DR screening.
Thomas CG, Channa R, Prichett L, et al. Racial/ethnic disparities and barriers to diabetic retinopathy screening in youths. JAMA Ophthalmology. May 27, 2021. [Epub ahead of print].