Project I See in NC: Initial results of a program to increase access to retinal examinations among diabetic individuals in North Carolina
Diabetic retinopathy is the leading cause of preventable blindness in adults. Project I See in NC was begun to determine whether access to eye screening for Medicaid recipients and uninsured patients with diabetes in North Carolina could be improved. We targeted Medicaid recipients and uninsured adults with diabetes for screening in 2 Community Care of North Carolina Networks. Screenings were performed in primary care settings throughout 6 counties in the Northwest Community Care Network and 6 counties in Access III of Community Care of the Lower Cape Fear. Patients were screened using a high-resolution digital retinal camera with images read at a centralized reading center at Wake Forest School of Medicine. A total of 1,688 patients were screened from October 2005 through September 2007. Nearly 15% (282) were found to have mild, nonproliferative-to-proliferative retinopathy, while the majority of patients had no evidence of diabetic retinopathy. Nearly 12% (196) required referral to an ophthalmologist, with 5% (86) requiring urgent referral for potentially sight-threatening retinopathy. We were not able to confirm which patients kept their ophthalmologic appointments; however, we are currently analyzing data from the Medicaid patients in our study who required ophthalmologic referral. Remote digital retinal screening for diabetic retinopathy is feasible in primary care settings in both urban and rural areas of North Carolina, and it may prove to be an effective means of reaching more patients who require annual screening examinations.
- [Show abstract] [Hide abstract] ABSTRACT: To determine the likelihood of progression from M3 grade maculopathy, and therefore the safety of these patients remaining under the care of a primary screener. Patients graded M3 at diabetic screening were selected from the Wellington screening database. Photographs for this visit and the subsequent visit were obtained, and graded by a consultant ophthalmologist. Photographs graded M3 were included and progression of maculopathy between visits, number of patients with a reduction in vision and duration between visits were determined. Mean duration between visits for all patients was 255 (plus or minus 59.5) days. Of the 54 eyes studied, 15 or 33.3% progressed to M4 maculopathy at the subsequent visit. Despite progressing from M3 to M4, none had a reduction of vision by more than one line of Snellen acuity at follow up due to diabetic maculopathy. Rates of progression of maculopathy from M3 to M4 were of clinical significance. Despite this none had worsening visual acuity due to diabetic eye disease. This suggests patients with M3 maculopathy could be maintained under a primary screening programme, as is the case in the United Kingdom.0Comments 1Citation
- [Show abstract] [Hide abstract] ABSTRACT: Objectives/hypothesis: The aim of this study was to systematically and quantitatively review the available evidence on the effects of type 2 diabetes mellitus on hearing function. Data sources and review methods: Eligible studies were identified through searches of eight different electronic databases and manual searching of references. Articles obtained were independently reviewed by two authors using predefined inclusion criteria to identify eligible studies. Meta-analysis was performed on pooled data using Cochrane's Review Manager. Results: Eighteen articles fulfilled the inclusion criteria. Hearing loss (HL) was defined by all studies as pure tone average greater than 25 dB in the worse ear. The incidence of HL ranged between 44% and 69.7% for type 2 diabetics, significantly higher than in controls (OR 1.91; 95% confidence interval 1.47-2.49). The mean PTA (pure tone audiometry) thresholds were greater in diabetics than in controls for all frequencies [test or overall effect Z = 3.68, P = 0.0002]. Auditory brainstem response (ABR) wave V latencies were also statistically significantly longer in diabetics when compared to control groups [OR 3.09, 95% CI 1.82- 4.37, P < 0.00001]. Conclusions: Type 2 diabetic patients had significantly higher incidence for at least the mild degree of HL when compared with controls. Mean PTA thresholds were greater in diabetics for all frequencies but were more clinically relevant at 6000 and 8000 Hz. Prolonged ABR wave V latencies in the diabetic group suggest retro-cochlear involvement. Age and duration of DM play important roles in the occurrence of DM-related HL.0Comments 16Citations