Patterns of adherence to diabetes vision care guidelines - Baseline findings from the diabetic retinopathy awareness program

Objectives: (1) To describe baseline patterns of adherence to American Diab etes Association and American Academy of Ophthalmology vision care guidelin es for diabetes in the Diabetic Retinopathy Awareness Program, and (2) to e valuate factors associated with nonadherence. This paper describes the base line characteristics of a population enrolled in a prospective, randomized clinical trial. Design: Cross-sectional study. Participants: Between October 1993 and May 1994, the study identified 2308 persons with diabetes, 18 years of age or older, who were residents of Suff olk County, New York, via a multimedia community-wide recruitment campaign. Intervention and Methods: Eligibility for the trial was determined during a 20-minute phone interview, which included questions about vision care prac tices; diabetes management; and knowledge, attitudes, and beliefs about dia betes, vision, and diabetic retinopathy. This paper describes these patient characteristics at baseline. Eligible patients would be randomized subsequ ently to a 2-year diabetes educational intervention arm, which included mai led packets and newsletters focused on vision care, or to a control noninte rvention arm. Main Outcome Measure: Nonadherence to guidelines at baseline was defined as the absence of a dilated eye examination during the year before recruitmen t into the study. Results: Of the 2308 persons interviewed, 813 (35%) did not follow the visi on care guidelines; two thirds of this group reported no eye examination in the year before the interview, and one third had an undilated examination. Ophthalmologists performed 49% of the examinations in the nonadherent grou p, versus 86% in the adherent group. In logistic regression analyses, facto rs related to nonadherence were: younger age (odds ratio [OR] = 0.97), type 2 diabetes with or without insulin use (OR = 1.62 and 1.99, respectively), shorter diabetes duration (OR = 0.97), last eye examination performed by a n optometrist (OR = 5.32) or other nonophthalmologist (OR = 4.29), less pra ctical knowledge about diabetes (OR = 1.57), and no prior formal diabetes e ducation (OR = 1.30). Conclusions: Within this population, more than one third of participants ha d not been following vision care guidelines. Nonadherence was linked to sev eral potentially modifiable factors; changes in these factors could enhance the early detection of diabetic retinopathy.