Vision care utilization in the diabetic retinopathy awareness program

Purpose. To examine the effect of an educational intervention to enhance vision care practices in persons with diabetes. Methods. The Diabetic Retinopathy Awareness Program (DRAP) is a five year community based intervention trial aimed at persons with diabetes ivho were not following eye examination guidelines. In 1993 - 1994, DRAP identified 2.309 residents of Suffolk County, NY, > 18 years, with diabetes. Persons eligible for the trial were those not following eye examination guidelines for diabetes, i.e., those not having a comprehensive eye exam (with dilatation) in the year prior to study recruitment. Participants in the trial were randomized to either a multiple educational intervention or a control arm and followed for two years. The effectiveness of the inlervention was evaluated by an interview a! the close of the trial. Adherence with eye examination guidelines was defined as a report of at least two eye exams with dilatation at most one year apart. Results. Of the 2,309 persons interviewed at baseline, 813 (35%) were eligible for the trial. Of these, two-thirds were eligible due to a lack of an eye exam in the year prior to interview and one-third because of an undilated exam within the past year. Median age was 51 years at baseline and median duration of diabetes was 4 years; 51% were male. 85% were white, and 89% had NIDDM. The overall follow-up rate was 88% Ai trial's end, 44% reported > 2 eye exams at most one year apart; specifically, 38% among iluise with no eye exams within the year before baseline and 55% among those with oiiK undilaled eye exams with that year. Overall, 30% (n=134) of those in the former group and 27% (n=55) of those in the latter group had at least 2 exams with dilatation. Those with previous undilated exams tended to continue having undilated exams. In those with NIDDM, 46% of the intervention group reported an annual eye exam vs. 38% of the nonintervention group. Dilated exams were less than 30% in both these groups. The intervention group reported making more changes in diabetes management as a result of the study (62 v s. 52%, p=0.02). Conclusions The trial improved obtainment of an annual exam among persons with NIDDM. The trial did not affect frequency of dilated exams. Further evaluations are needed to determine barriers to dilatation. Results can be used to develop programs to improve eye care utilization amone persons with diabetes.