Barriers to retinopathy screening in youth and young adults with type 1 diabetes
Open accessAbstract
Early detection of diabetic retinopathy (DR) is imperative; however, adherence to screening guidelines is poor. We hypothesized that youth and young adults with type 1 diabetes (T1D) who met American Diabetes Association criteria for recommended DR screening at the time of the study (10 years old or greater with diabetes duration of 5 years or more) would report multiple barriers to screening and that targeted barriers and subpopulations could be identified to improve access to care. 271 youth aged 10 to 26 years with T1D of at least 5 years duration were recruited from clinic, diabetes camp, and a diabetes conference and completed a patient-reported questionnaire. 113 (41.7%) reported at least one barrier to DR screening, with missed school and work being the most common (20.7%). Older participants (P = 0.007) and those with a longer diabetes duration (P = 0.018) were more likely to report barriers to screening. Recruitment location, sex, race and ethnicity, HbA1c, insulin regimen, and clinic visit frequency were not associated with reporting at least one barrier. Slightly less than two-thirds (62.1%) of participants who responded (n = 235 out of 271) adhered to recommended screening guidelines of the time and reported having an eye exam within the past year, 24.7% 12-23 months ago, 9.8% 2 years ago or more, and 3.4% had never had a DR exam. As older patients and those with longer duration of diabetes are more likely to have DR, targeted interventions to address barriers to care, such as, missed school and work should be implemented in these groups.
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Commonly reported barriers to screening include miscommunication regarding the need for a diabetic eye exam, time for an additional doctor's visit, and transportation barriers.
“Commonly reported barriers to screening include miscommunication regarding the need for a diabetic eye exam, time for an additional doctor’s visit, and transportation barriers17,18.”
From Autonomous artificial intelligence increases screening and follow-up for diabetic retinopathy in youth: the ACCESS randomized control trial (2024) · cites this paper as [18]
The Results report missed work or school (20.7%), not thinking an exam was necessary (7.7%), lack of time among other barriers (1.8%), and transportation difficulties (2.2%). The Discussion says lack of a provider recommendation was not common in this population. The paper therefore supports time-related and transportation barriers, but does not establish miscommunication about the need for an exam as a commonly reported barrier. (LLM, conf=0.88)
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Wolf, R. M., Channa, R., Liu, T. Y. A., Zehra, A., Bromberger, L., Patel, D., Ananthakrishnan, A., Brown, E. A., Prichett, L., Lehmann, H. P., et al. (2024) · Nature Communications · doi:10.1038/s41467-023-44676-z · Cited by 116 · see citing works
- Authors
- Bruggeman, B., Zimmerman, C., LaPorte, A., Stalvey, M., Filipp, S. L., Gurka, M. J., Silverstein, J. H., & Jacobsen, L. M.
- Affiliations
- University of Florida Health (US)
- University of Florida (US)
- University of Alabama at Birmingham (US)
- Corresponding author
- Jacobsen, Laura M.
- ORCID
- Venue
- Pediatric Diabetes
- Publisher
- Wiley
- Published
- 2020-12-19
- Volume
- 22
- Issue
- 3
- Pages
- 469-473
- ISSN
- 1399-543X (ISSN-L)
- 1399-5448
- OpenAlex
- W3111430485
- Cited by
- 10
- References
- 0
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 3 · 2023: 2 · 2021: 1
- FWCI
- 0.57
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Pediatric Diabetes (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of South Florida
- Children's Miracle Network Hospitals
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- diabetic retinopathy, type 1 diabetes, youth and young adults, retinopathy screening, barriers to care, screening adherence, diabetes duration, access to eye care, patient-reported barriers
- MeSH terms
- Absenteeism, Adolescent, Adult, Age Factors, Child, Diabetes Mellitus, Type 1, Diabetic Retinopathy, Female, Health Services Accessibility, Humans, Male, Patient Compliance, Surveys and Questionnaires, Young Adult
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