Abstract
BackgroundVision loss due to diabetic retinopathy can largely be prevented or delayed through treatment. Patients with vision-threatening diabetic retinopathy are typically offered laser or intravitreal injections which often require more than one treatment cycle. However, treatment is not always initiated, or it is not completed, resulting in poor visual outcomes. Interventions aimed at improving the uptake or completion of treatment for diabetic retinopathy can potentially help prevent or delay visual loss in people with diabetes.MethodsWe will search MEDLINE, Embase, Global Health and Cochrane Register of Studies for studies reporting interventions to improve the uptake of treatment for diabetic retinopathy (DR) and/or diabetic macular oedema (DMO), compared with usual care, in adults with diabetes. The review will include studies published in the last 20 years in the English language. We will include any study design that measured any of the following outcomes in relation to treatment uptake and completion for DR and/or DMO: (1) proportion of patients initiating treatment for DR and/or DMO among those to whom it is recommended, (2) proportion of patients completing treatment for DR and/or DMO among those to whom it is recommended, (3) proportion of patients completing treatment for DR and/or DMO among those initiating treatment and (4) number and proportion of DR and/or DMO rounds of treatment completed per patient, as dictated by the treatment protocol. For included studies, we will also report any measures of cost-effectiveness when available. Two reviewers will screen search results independently. Risk of bias assessment will be done by two reviewers, and data extraction will be done by one reviewer with verification of 10% of the papers by a second reviewer. The results will be synthesised narratively.DiscussionThis rapid review aims to identify and synthesise the peer-reviewed literature on the effectiveness of interventions to increase uptake and completion of treatment for DR and/or DMO in LMICs. The rapid review methodology was chosen in order to rapidly synthesise the available evidence to support programme implementers and policy-makers in designing evidence-based health programmes and public health policy and inform the allocation of resources.Systematic review registrationOSF osf.io/h5wgr
Highlights
Vision loss due to diabetic retinopathy can largely be prevented or delayed through treatment
The rapid review methodology was chosen in order to rapidly synthesise the available evidence to support programme implementers and policy-makers in designing evidence-based health programmes and public health policy and inform the allocation of resources
Patients with vision-threatening diabetic retinopathy (VTDR), including proliferative diabetic retinopathy (PDR) and/or diabetic macular oedema (DMO), are offered laser treatment and/or intravitreal injections which often require more than one treatment visit [1, 2]
Summary
Rapid review question What interventions are effective in increasing uptake and completion of treatment for DR and/or DMO among people with diabetes in LMICs?. Eligibility criteria We will limit the search to peer-reviewed publications of studies conducted in LMICs in any setting in the last 20 years (i.e. community or facility based), which examine the uptake and/or completion of treatment prescribed for DR or DMO. We will report outcomes in terms of proportions in intervention and comparator groups and will calculate the risk ratio with 95% confidence intervals as the main measure of effect, but this will be dependent on how the data are reported by the included studies. Cost-effectiveness of intervention to increase DR/DMO treatment uptake or completion they have been applied. For each comparison and outcome, we will provide a description of the findings alongside the certainty of the evidence, ensuring consistency with the review question and providing a judgement as to the extent to which the studies contribute to the synthesis
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