Screening Results for Diabetic Retinopathy in Germany in a Real-world Cohort in a Metropolitan Diabetes Care Center

Abstract

Background Retinal screening is mandatory to prevent vision loss and blindness due to diabetic retinopathy (DR). The aim of the study was to determine retinopathy screening rates and potential barriers in a German metropolitan diabetes care center.

Methods Between May and October 2019, 265 patients with diabetes mellitus (95% type 2 diabetes; age 62±13.2 years; diabetes duration 11.1±8.5 years, HbA1c 7.4±1.0%) were referred to an ophthalmologist (referral form with order “Fundoscopy in diabetes mellitus, findings requested,” completed documentation form “General practitioner’s/diabetologist’s report to the ophthalmologist” and prepared documentation form “Ophthalmologist’s report”). A structured interview was used to assess the level of compliance with the guidelines and to identify potential barriers to retinopathy screening in a real-world setting, including the quantification of extra payments.

Results All patients were interviewed at 7.9±2.5 months after the referral for retinopathy screening had been issued. According to patient reporting, fundoscopy was performed in 191 (75%) patients. Ophthalmological reports were obtained from 119/191 (62%) patients (46% of the entire cohort). 10/119 (8%) patients had been previously diagnosed with DR and 6/119 (5%) with new-onset DR. In 158/191 (83%) of patients, the referral had been accepted by the ophthalmology practice, of which 25,1% made a co-payment of 36.2±37.6 €.

Discussion Despite a high screening performance in a real-world setting, complete screening in compliance with German guidelines, including written reporting, was found in less than half of the cohort. The prevalence and incidence of DR are high. Even when referred according to the regulations, one-quarter of patients made a co-payment. Efficient solutions to current barriers can emerge with mutual time-saving information prior to examination and feedback about the implementation of findings into treatment.

Keywords

diabetic retinopathy - dysfunctional screening - diabetes mellitus - screening

Publication History

Received: 23 February 2022

Accepted: 13 December 2022

Article published online:
13 April 2023

• References

• 1 Stitt AW, Curtis TM, Chen M. et al. The progress in understanding and treatment of diabetic retinopathy. Prog Retin Eye Res 2016; 51: 156-186
• 2 Hammes HP. Diabetic retinopathy: Hyperglycaemia, oxidative stress and beyond. Diabetologia 2018; 61: 29-38
• 3 Cavan D, Makaroff LE, da Rocha Fernandes J. et al. Global perspectives on the provision of diabetic retinopathy screening and treatment: Survey of health care professionals in 41 countries. Diabetes Res Clin Pract 2018; 143: 170-178
• 4 Javitt JC, Aiello LP. Cost-effectiveness of detecting and treating diabetic retinopathy. Ann Intern Med 1996; 124: 164-169
• 5 Vujosevic S, Aldington SJ, Silva P. et al. Screening for diabetic retinopathy: New perspectives and challenges. Lancet Diabetes Endocrinol 2020; 8: 337-347
• 6 Scanlon PH, Aldington SJ, Leal J. et al. Development of a cost-effectiveness model for optimisation of the screening interval in diabetic retinopathy screening. Health Technol Assess 2015; 19: 1-116
• 7 Schorr SG, Hammes HP, Muller UA. et al. The prevention and treatment of retinal complications in diabetes. Dtsch Arztebl Int 2016; 113: 816-823
• 8 Stock L, Roeck D, Fritsche A. et al. Interdisciplinary communication: Ophthalmologists’ letters to practices specializing in diabetic patients. Ophthalmologe 2021; 118: 374-382
• 9 Kellner C, Kuniss N, Kloos C. et al. No selection, but higher satisfaction of people participating in the disease management programme diabetes type 2 in Germany. Acta Diabetol 2018; 55: 363-367
• 10 Cavan D, Makaroff L, da Rocha Fernandes J. et al. The Diabetic Retinopathy Barometer Study: Global perspectives on access to and experiences of diabetic retinopathy screening and treatment. Diabetes Res Clin Pract 2017; 129: 16-24
• 11 Yau JW, Rogers SL, Kawasaki R. et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care 2012; 35: 556-564
• 12 Ponto KA, Koenig J, Peto T. et al. Prevalence of diabetic retinopathy in screening-detected diabetes mellitus: Results from the Gutenberg Health Study (GHS. Diabetologia 2016; 59: 1913-1919
• 13 Voigt M, Schmidt S, Lehmann T. et al. Prevalence and progression rate of diabetic retinopathy in type 2 diabetes patients in correlation with the duration of diabetes. Exp Clin Endocrinol Diabetes 2018; 126: 570-576
• 14 Cosentino F, Grant PJ, Aboyans V. et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J 2020; 41: 255-323
• 15 Kramer CK, Rodrigues TC, Canani LH. et al. Diabetic retinopathy predicts all-cause mortality and cardiovascular events in both type 1 and 2 diabetes: Meta-analysis of observational studies. Diabetes Care 2011; 34: 1238-1244
• 16 Xu XH, Sun B, Zhong S. et al. Diabetic retinopathy predicts cardiovascular mortality in diabetes: A meta-analysis. BMC Cardiovasc Disord 2020; 20: 478
• 17 Kohner EM, Stratton IM, Aldington SJ. et al. Microaneurysms in the development of diabetic retinopathy (UKPDS 42). UK Prospective Diabetes Study Group. Diabetologia 1999; 42: 1107-1112