Diabetes: Personalized Care During Eye Checks Has No Benefit

Susan London

May 21, 2015

Adding personalized education and risk assessment to routine eye exams does not improve glycemic control among patients with diabetes, according to a randomized trial conducted by the Diabetic Retinopathy Clinical Research Network.

Patients who received such augmented care from their ophthalmologist did not fare significantly better with respect to changes in hemoglobin A1c (HbA1c) levels than counterparts receiving usual care, researchers report in an article published online May 21 in JAMA Ophthalmology.

"Although the addition of personalized education and risk assessment during ophthalmologic visits in our study did not improve glycemic control, long-term optimization of glycemic control is still a cornerstone of diabetes care," maintain the investigators, led by Lloyd Paul Aiello, MD, PhD, from the Beetham Eye Institute, Joslin Diabetes Center, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.

"These results suggest that optimizing glycemic control requires more extensive interventional paradigms than were examined in our study and further research into new technologies and models of behavioral change. In the meantime, ophthalmologists and all other diabetes care professionals should continue their efforts to maximize education, assessment, systemic control, and treatment of complications for patients with diabetes," they recommend.

In the trial, ophthalmologists at 42 sites were randomly assigned to provide either augmented diabetes care or usual care at routine visits. Augmented care consisted of point-of-care measurements of HbA1c, blood pressure, and retinopathy severity; an individualized estimate of the risk for retinopathy progression based on findings from ophthalmologic visits; structured comparison and review of past and current clinical findings; and structured education with immediate assessment and feedback regarding the patient's understanding. Results were mailed to each patient's primary care physician.

Patients participating in the trial were adults with either type 1 or type 2 diabetes and a baseline HbA1c level of 6.0% or higher (with a mean of 8.3% - 8.6%) who fell into one of two cohorts: 990 had follow-up more frequently than annually and 756 had follow-up annually.

In the cohort with more frequent follow-up, the median number of ophthalmologic visits at 1 year was three in the usual care group and two in the augmented care group.

Trial results showed no significant difference in the mean change in HbA1c level at 1 year — the primary outcome — between usual care and augmented care, either in the cohort with more-frequent-than-annual follow-up (−0.1% and −0.3%, respectively) or in the cohort with annual follow-up (0.0% and −0.1%, respectively).

In addition, the usual care and augmented care groups did not differ significantly with respect to a variety of secondary outcomes, including changes in body mass index, changes in blood pressure, and responses on the Problem Areas in Diabetes (PAID) questionnaire, which addresses emotional problems common among people with diabetes, and the Self-Care Inventory 2 (SCI-2), which assesses perceived adherence to diabetes self-care recommendations.

One coauthor reports having received personal fees from Genentech-Roche outside the submitted work; Another coauthor reports having received personal fees from Janssen Pharmaceuticals outside the submitted work. Another coauthor reports having received personal fees from Allergan, Genentech, and Regeneron outside the submitted work. The other authors have disclosed no relevant financial relationships.

JAMA Ophthalmol. Published online May 21, 2015. Abstract

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