@article{7a88e3d5ced741fda26de0d5ba3b9134,
title = "Associations with sight-threatening diabetic macular oedema among Indigenous adults with type 2 diabetes attending an Indigenous primary care clinic in remote Australia: A Centre of Research Excellence in Diabetic Retinopathy and Telehealth Eye and Associated Medical Services Network study",
abstract = "Objective To identify factors associated with sight-threatening diabetic macular oedema (STDM) in Indigenous Australians attending an Indigenous primary care clinic in remote Australia. Methods and analysis A cross-sectional study design of retinopathy screening data and routinely-collected clinical data among 236 adult Indigenous participants with type 2 diabetes (35.6% men) set in one Indigenous primary care clinic in remote Australia. The primary outcome variable was STDM assessed from retinal images. Results Age (median (range)) was 48 (21-86) years, and known diabetes duration (median (range)) was 8.0 (0-24) years. Prevalence of STDM was high (14.8%) and similar in men and women. STDM was associated with longer diabetes duration (11.7 vs 7.9 years, respectively; p<0.001) and markers of renal impairment: abnormal estimated Glomerular Filtration Rate (eGFR) (62.9 vs 38.3%, respectively; p=0.007), severe macroalbuminuria (>300 mg/mmol) (20.6 vs 5.7%, respectively; p=0.014) and chronic kidney disease (25.7 vs 12.2%, respectively; p=0.035). Some clinical factors differed by sex: anaemia was more prevalent in women. A higher proportion of men were smokers, prescribed statins and had increased albuminuria. Men had higher blood pressure, but lower glycated Haemoglobin A1c (HbA1c) levels and body mass index, than women. Conclusion STDM prevalence was high and similar in men and women. Markers of renal impairment and longer diabetes duration were associated with STDM in this Indigenous primary care population. Embedded teleretinal screening, known diabetes duration-based risk stratification and targeted interventions may lower the prevalence of STDM in remote Indigenous primary care services. ",
keywords = "epidemiology, imaging, macula, pathology, public health, retina, telemedicine, vision",
author = "Laima Brazionis and Anthony Keech and Christopher Ryan and Alex Brown and David O'Neal and John Boffa and Bursell, {Sven Erik} and Alicia Jenkins",
note = "Funding Information: Funding This study was funded by the National Health and Medical Research Council of Australia [NHMRC] Centre for Research Excellence in Diabetic Retinopathy grant, an NHMRC Partnership Project grant and a Fred Hollows Foundation Global Partnership grant. Funding bodies had no input into the design or conduct of the study or the interpretation of results. Funding Information: We acknowledge both study strengths and limitations: importantly, this is the first study to examine STDM, the main cause of vision loss in diabetes globally, among Indigenous Australians. Furthermore, we shed light on modifiable clinical factors associated with the disproportionately high and increasing prevalence of STDM among Indigenous Australians with diabetes. We expect these findings to influence care provision of any person with diabetes who has any markers of renal dysfunction or duration of diabetes of at least 10 years by raising the treating doctor{\textquoteright}s index of suspicion for STDM and awareness of the need for more frequent retinal screening. Importantly, the infrastructure and training for image-based diabetic eye screening in Indigenous primary care clinics has been largely funded by the Australian Government, and the screening is a reimbursable service under the national Medicare Health Benefits Scheme. Consequently, the clinical and cost effectiveness of the retinal screening model has already been established, and the granularity our findings provide will improve risk management of sight-threatening diabetic eye disease and lead to earlier detection and timelier treatment, thereby further improving clinical and cost effectiveness of this screening model.",
year = "2021",
month = jul,
day = "1",
doi = "10.1136/bmjophth-2020-000559",
language = "English",
volume = "6",
journal = "BMJ Open Ophthalmology",
issn = "2397-3269",
publisher = "BMJ Publishing Group",
number = "1",
}