Oral Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

Primary care-based diabetic retinopathy screening identifies early intervention opportunities -  on behalf of the TEAMSnet Study Group and the CRE in Diabetic Retinopathy (#158)

Laima Brazionis 1 , Alicia Jenkins 2 , Tony Keech 2 , Chris Ryan 2 , Sven-Erik Bursell 3
  1. The University of Melbourne, Melbourne, VIC, Australia
  2. Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
  3. Telehealth Unit, University of Hawaii, Hawaii, USA

Background: Telehealth-based diabetic retinopathy [DR] screening was conducted in a remote Australian [Alice Springs, NT] primary care clinic of an Aboriginal community-controlled health organization [ACCHO] as part of the Telehealth Eye and Associated Medical Services Network [TEAMSnet] study. The purpose was to use a telehealth approach to determine DR prevalence and facilitate diabetes care in a remote Aboriginal community.

Methods/Design: Diabetes status was determined clinically. A flexible multi-field, image-based DR screening protocol was undertaken in 2013-2015 in Indigenous Australian adults with type 2 diabetes by trained imagers, locally, and expert graders, remotely, at the Centre for Eye Research Australia, Melbourne. TEAMSnet DR screening was a multi-purpose tool for diabetes education/patient engagement, diabetes risk stratification and detection of ‘any DR’ and ‘treatable DR’.

Results: Among the 301 Indigenous Australians aged 19-86 years (33% male) screened, diabetes duration [median (range)] was 9 (0-24) years. Gradable imaging-study rates [% (n)] were 78.7% (237) for DR and 83.4% (251) for diabetic maculopathy [DM]. The crude prevalence of any DR was 46.4% (110) and of DM was 14.4% (36).  Prevalence of sight-threatening DR [STDR] was 16.1%, of which 2.1% (5) [0.4% (1) untreated] was proliferative DR and 14.0% (35) [3.2% (8) untreated] was clinically-significant DM.

Conclusion: Any DR and STDR seem more prevalent in this Aboriginal community than reported in other Indigenous studies [21.0-39.4% and 7.0-15.2%, respectively] and in the broader Australian population [19.8-33.6% and 7.4-11.4%, respectively], but treatment coverage is comparable with recent national data [75-79%]. Importantly, TEAMSnet implemented an effective DR screening program that not only detected STDR, but also identified clinical and patient-based intervention opportunities via earlier detection of non-STDR using a primary care-centric, multi-field imaging approach. Consequently, consideration of Indigenous-specific primary care guidelines for DR management in remote settings is merited.