Efficacy of an endocrinologist-led specialist care clinic in minimizing burden of vision-threatening retinopathy in Chinese diabetic patients

Abstract

Purpose To assess the 1) incidence of referrals to the ophthalmology specialist outpatient clinics and 2) diabetic retinopathy grading severity in diabetic patients under the care of an endocrinologist-led specialist diabetes clinic. Furthermore, 3) to investigate potential risk factors for need for ophthalmologist referral. Methods This is a cross-sectional observational study on consecutive patients aged ≥ 18 years and had a consultation visit at the Integrated Diabetic Clinic at Queen Mary Hospital, Hong Kong SAR between 1stof March and 30thof April 2018 for management diabetes mellitus. Patient demographics and clinical data were collected from electronic patient records. All patients underwent retinal photography and DR status was graded according to the International Council of Ophthalmology Diabetic Retinopathy grading system. Patients were referred to an ophthalmologist if they had either 1) at least moderate NPDR on screening 2) or un-assessable fundus photo on screening. Descriptive data was presented as mean±standard deviation. Statistical analysis was conducted using Student’s t-test for parametric data. Results 631 consecutive patients with diabetes mellitus were included for analysis. The prevalence of diabetic retinopathy was identified at 37.8%. Stratified according to grading, 35.89% had mild NPDR, 1.59% had moderate NPDR, 1.59% had severe NPDR, and 0.16% had PDR. The rate of ophthalmologist referral was 16.1%. Comparatively, evidence from previous meta-analyses on global data quotes an overall DR prevalence of 23-35.26% and a prevalence of PDR of 2.8%. From our study, risk factors for referral to ophthalmologists included lower visual acuity, longer duration of diabetes, impaired estimated glomerular filtration rate, and presence of diabetic peripheral neuropathy (via vibration perception threshold). Conclusions Endocrinologist-led diabetic clinics may lower the overall ophthalmic burden of DM through a combination of good glycaemic control and timely referral to ophthalmologists before sight-threatening complications arise. Our study identified risk factors that may prompt earlier referral to ophthalmologists.