Vision care guidelines and diabetes - A community based intervention trial

Purpose. To assess the extent of adherence with vision care guidelines for diabetes, as determined during recruitment into a community based trial, and to evaluate factors related to non-adherence. Methods. The Diabetic Retinopathy Awareness Program (DRAP) is a four year community based trial to evaluate interventions to enhance vision care practices by persons with diabetes. Between October 1993 and April 1994, the study identified 2309 persons with diabetes ≥ 18 years who were residents of Suffolk County, NY, via a multimedia community-wide recruitment campaign. Eligibility for the intervention trial was determined during a 30 minute telephone interview, which included questions about overall diabetes management, vision care practices, knowledge, attitudes and beliefs about diabetes, vision and diabetic retinopathy. Persons eligible for the trial were those not following vision care guidelines for diabetes, i.e., those not having a comprehensive eye examination (with dilatation) in the year prior to study recruitment. Results. Of the 2309 persons interviewed, 813 (35%) did not follow vision care guidelines. Two-thirds of the non-compliant group reported no eye exam in the year prior to interview and one-third had an undilated exam. As compared to the compliant group (n=1496), the non-complaint group (n=813) had a significantly (p<0.01) younger mean age (51 vs. 58 years), more men (52 vs. 44%), higher mean body mass (29 vs. 28 kg/m²), and shorter mean duration of diabetes (4 vs. 9 years). They were more likely (p<0.01) to have NIDDM (86 vs. 80%), less likely to use eye glasses (78 vs. 89%) or be seen by an ophthalmologist (49 vs. 86%),and had fair to poor medical (35 vs. 24%) and practical knowledge (18 vs. 10%) of diabetes. In addition, this group appeared to be less informed about available treatment for diabetic retinopathy and the efficacy of regular eye examinations, and less concerned about losing their vision from diabetes (p<0.01). Conclusions, Over one-third of participants did not follow vision care guidelines. Our analyses identified several potentially modifiable factors that can be targeted to improve vision care practices among persons with diabetes. This information can be used to develop programs to prevent or control visual loss from diabetic retinopathy.