Abstract
This study was performed to identify factors associated with screening for diabetic retinopathy and nephropathy. Data from the Korean National Health and Nutrition Examination Survey between 2007 and 2009 were analyzed. Of 24,871 participants, 1,288 patients diagnosed with diabetes at ≥30 years of age were included. 36.3% received screening for diabetic retinopathy, and 40.5% received screening for diabetic nephropathy during the previous year. Patients living in rural areas, those with less education, those who had not received education about diabetes care, and those who did not receive medical care for diabetes were screened less often for retinopathy or nephropathy. Patients with poorer self-reported health status were screened more often. Occupation, smoking status, and diabetes duration were associated with retinopathy screening. Lower family income was associated with decreased nephropathy screening. Receiving education about diabetes care and receiving medical care for diabetes were significant factors in patients with a shorter duration of diabetes (the significant odds ratio [OR] of not receiving education varied between 0.27 and 0.51, and that of not receiving medical care varied between 0.34 and 0.42). Sociodemographic factors and health-related factors as well as education and medical care influenced screening for diabetic complications among those with a longer duration of diabetes (for retinopathy and nephropathy, the significant OR of living in a rural area varied between 0.56 and 0.61; for retinopathy, the significant OR of current smokers was 0.55, and the p-trend of subjective health status was <0.001; for nephropathy, the significant OR of a monthly household income of <3000 dollars was 0.61 and the p-trends of education and subjective health status were 0.030 and 0.007, respectively). Efforts to decrease sociodemographic disparities should be combined with education about diabetes care to increase the screening, especially for those with a longer duration of diabetes.
Highlights
Diabetes is one of the most common and rapidly increasing chronic diseases globally, and has been called an ‘‘diabetes epidemic’’
People living in rural areas, current smokers, those who had not received an education about diabetes care, and those who had not received medical care for diabetes were screened significantly less often for diabetic retinopathy
The distributions of current smokers, self-reported health status, and education about diabetes care differed according to education level, we did not find any interaction effects between current smokers, self-reported health status, education about diabetes care, and education level in terms of diabetic retinopathy or diabetic nephropathy screening
Summary
Diabetes is one of the most common and rapidly increasing chronic diseases globally, and has been called an ‘‘diabetes epidemic’’. Preventing complications is important because of the morbidity, mortality, and health care costs associated with diabetes complications [2,5,6]. Microvascular complications such as diabetic retinopathy and diabetic nephropathy are common. Diabetic nephropathy develops in 40% of type 2 diabetic patients and characterized by persistent albuminuria [8] and diabetic nephropathy is the single most common cause of end-stage renal disease [9]. Early retinopathy and microalbuminuria are associated with low health care costs, they can progress to more costly advanced diseases such as blindness and end-stage renal disease [6,11]
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