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Diabetic retinopathy screening in a Canadian community pediatric diabetes clinic
Kedija Abdella1, Kylen D McReelis2, M Hermina Strungaru3
1Trent University, Peterborough, Ont.
Insights
Pediatric diabetes patients showed low adherence to eye screening guidelines, often receiving excessive exams. Despite this, no diabetic retinopathy was detected, suggesting a need to reassess current screening protocols.
Area of Science:
- Ophthalmology
- Pediatrics
- Endocrinology
Background:
- Diabetic retinopathy is a leading cause of vision loss.
- Regular eye screenings are crucial for early detection and management in pediatric diabetes patients.
- Canadian Diabetes Association guidelines recommend specific screening intervals.
Purpose of the Study:
- To assess adherence to diabetic retinopathy screening guidelines in pediatric patients.
- To identify factors associated with noncompliance to screening recommendations.
- To evaluate the incidence of diabetic retinopathy in this population.
Main Methods:
- Retrospective review of medical records for 82 pediatric diabetes patients.
- Survey of parents and children regarding ocular examination history.
- Logistic regression analysis to determine predictors of noncompliance.
Main Results:
- Only 19.5% of patients adhered to screening guidelines.
- Most noncompliant patients (98.5%) underwent excessive eye examinations.
- Diabetic retinopathy was not detected in any patient.
- Longer diabetes duration was associated with noncompliance.
Conclusions:
- Low compliance with diabetic retinopathy screening guidelines exists in pediatric diabetes patients.
- Noncompliance was primarily due to over-screening, not under-screening.
- The low incidence of retinopathy warrants further investigation into screening protocol efficacy.
Objective:
To evaluate the screening rates for diabetic pediatric patients in a regional center according to the Canadian Diabetes Association guidelines.
Design:
Retrospective study.
Participants:
The study consisted of 82 patients seen in the pediatric diabetes clinic at Peterborough Regional Health Center.
Methods:
Medical records for all pediatric patients with diabetes were reviewed between July 2016 and February 2017. Parents and children were surveyed on details of their ocular examination history. Logistic regression analysis was conducted to evaluate if any characteristics were associated with noncompliance to Canadian Diabetes Association guidelines.
Results:
The average age of the patients in our study was 12 years old with a mean duration of diabetes of 4 years. The majority of patients had type 1 diabetes (n = 79/82, 96.3%) and the mean HbA1c level was 9.1. Only 16 patients (19.5%) adhered to the Canadian Diabetes Association guidelines for diabetic retinopathy screening. Of the 66 patients who did not comply with the guidelines, 65 (98.5%) had received more exams than recommended under their respective screening guidelines. All dilated eye examinations were normal, and no diabetic retinopathy was found. Statistical analysis revealed that the duration of diabetes may be a predicting factor of noncompliance to the guidelines (-0.2488, 95% CI -0.505, -0.042).
Conclusions:
This study shows a low compliance rate with screening guidelines in our diabetic pediatric population. Of interest, the low compliance in this cohort was related to excessive eye exams. This study also found a low incidence rate of diabetic retinopathy despite poor management of diabetes, similar to previous studies of pediatric diabetic eye disease.
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