Abstract
Lack of awareness about Diabetic Retinopathy (DR) is the most commonly cited reason why many persons with type 2 diabetes are non-compliant with referral instruction to undergo retinal screening. The purpose of this study was to evaluate the efficacy of a culturally, geographically and socially appropriate, locally adapted five-month-long health education on referral compliance of participants. A prospective randomized, open-label parallel group study was conducted on persons with type 2 diabetes who underwent basic eye screening at a diabetes hospital between September 2017 and August 2018. Participants who were noncompliant with referral instruction to visit a hospital for advanced DR management were randomly divided into health education intervention group (n = 143) and control group (n = 156). Both groups received information regarding DR and referral instruction at the diabetes hospital. The intervention group was provided personalized education followed by telephonic reminders. The primary endpoint was 'increase in referral compliance' and the secondary endpoint was 'increase in knowledge of DR'. Multivariate logistic regression model was used to identify significant predictors of compliance to referral. A total of nine participants dropped and 290 completed the post intervention survey. The compliance rate in intervention group was found to be significantly higher than the control group (64.3% vs 28.2%; OR 4.73; 95% CI 2.87-7.79; p<0.001). Participants in the intervention group acquired better knowledge on DR (p<0.05). Apart from intervention, referral compliance rate was also found to be significantly associated with participants' self-perception of vision problem (OR 2.02; 95% CI 1.02-4.01; p = 0.045) and participants' income (OR 1.24; 95% CI 1.06-1.44; p = 0.008). Our results suggest that intensive health education on DR should be integrated with diabetes education as it may result in significantly improved referral compliance. Outcomes may be sustainable if interventions are institutionalized at referral point. Clinical Trials.gov (Registration # NCT03658980); https://clinicaltrials.gov/ct2/show/NCT03658980.
Highlights
Type 2 Diabetes Mellitus (T2DM) is on an alarming rise in the world [1]
The compliance rate in intervention group was found to be significantly higher than the control group (64.3% vs 28.2%; odds ratio (OR) 4.73; 95% confidence intervals (CI) 2.87–7.79; p
Our results suggest that intensive health education on Diabetic Retinopathy (DR) should be integrated with diabetes education as it may result in significantly improved referral compliance
Summary
In 2019, approximately 463 million adults (20–79 years) were living with diabetes and by 2045 this will rise to 700 million [2]. Bangladesh has been identified as one of the top ten countries worldwide in terms of the number of people living with diabetes [3]. In 2019, there was an estimated 8.4 million people with diabetes in the age bracket 20–79 in Bangladesh, and this number is predicted to increase to 15 million by 2045 [4]. In Bangladesh, the national prevalence of diabetes is estimated to be 8.4% in population aged 20–79 years, with approximately 56% of them undiagnosed [4]. The estimated number of individuals with DR in Bangladesh is 1.8 million (21.6% of people with diabetes) [7]. Higher prevalence of DR has been reported in the coastal areas compared to rural population from other areas of Bangladesh, according to a study that was conducted in Barishal Division [8]
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