Duncan C, Gabbay RA, Gardner TW. Ophthalmology Patient Knowledge of Personal and Recommended ABCs of Diabetes Care. Arch Ophthalmol. 2010;128(11):1495-1496. doi:10.1001/archophthalmol.2010.269
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Diabetes-induced vision loss is a massive health care problem in the United States and around the world. The problem is becoming worse with the increasing prevalence of obesity. By 2050, the number of Americans with diabetic retinopathy is projected to triple from 5.5 million to 16 million, and vision-threatening retinopathy is projected to increase from 1.2 million to 3.4 million.1 The only proven medical therapy for diabetic retinopathy is control of blood glucose level and blood pressure, so it is crucial for ophthalmologists to identify patients at risk.2 In many cases the “ABCs” (hemoglobin A1c [HbA1c] level, blood pressure values, and low-density lipoprotein cholesterol [LDL-C] levels) are not communicated between ophthalmologists and other primary care physicians, so patient understanding of these risk factors is crucial for proper management. Do et al3 investigated awareness of HbA1c, but to our knowledge no study has assessed all 3 levels. Therefore, the rationale for this study is to determine the proportion of ophthalmology patients with diabetes who know personal and recommended ABCs of diabetes care.
A standardized survey was created for adult participants with diabetes mellitus to investigate their knowledge of personal and recommended ABCs of diabetes care. The recommended levels were as follows based on the recommendations from the American Diabetes Association and national expert committees and panels: HbA1c, less than 7.0%; blood pressure, lower than 130/80 mm Hg; and LDL-C levels, less than 100 mg/dL (to convert to millimoles per liter, multiply by 0.0259).4- 6 The study was conducted between May 13, 2009, and July 22, 2009, at the Penn State Hershey Ophthalmology outpatient clinic. All patients who were aged 18 years or older, had a diagnosis of type 1 or type 2 diabetes mellitus, and were seen at the ophthalmology clinic were eligible for inclusion in the study. Exclusion criteria included being younger than 18 years, not having a diagnosis of diabetes mellitus, and having mental impairment. Surveys were completed verbally by the same investigator (C.D.) to ensure consistency and include persons with visual impairment.
After asking 166 patients with diabetes to participate, a total of 161 participants were enrolled in the study. There were 72 male participants (45%) and 89 female participants (55%). The mean age was 61.7 years, with an age range from 19 to 89 years. The Table demonstrates the numbers of participants with self-reported knowledge of personal and recommended levels of HbA1c, blood pressure, and LDL-C. When combined, only 7 patients (4%) reported meeting the recommendation for all 3 of the ABCs of diabetes care and 10 patients (6%) reported knowing all 3 recommendations. These rates increased to 38 patients (23%) and 64 patients (40%), respectively, for those surveyed who reported meeting and knowing at least 2 of the 3 recommendations.
The major finding of this study is that only 4% of persons with diabetes reported meeting the therapeutic goals for the major risk factors for diabetes complications. This demonstrates the lack of patient knowledge regarding the relationship between systemic risk factors and diabetic eye disease. While more than those described were most likely meeting the recommended goals, the numbers obtained closely mirror those of a recent study in which only 7.3% of diabetic patients met the same 3 therapeutic goals.7
Ophthalmologists have a unique opportunity to influence patient behavior because the loss of vision is one of the most feared complications of diabetes. One way of helping could be the implementation of a “know your numbers” card on which the recent HbA1c, blood pressure, and LDL-C values are recorded and kept by the patient. This card could be reviewed by the patient's ophthalmologist, primary care physician, and other physicians. This tool would allow better coordination between physicians and reinforce goals to patients with diabetes. Such a simple tool could serve as an inexpensive, yet tangible means for ophthalmologists to educate patients and decrease the risk of vision loss from diabetic retinopathy using established medical practice guidelines.
Correspondence: Dr Duncan, Department of Internal Medicine, University of Texas Health Science Center, 7703 Floyd Curl Dr, San Antonio, TX 78229-3901 (firstname.lastname@example.org).
Financial Disclosure: None reported.