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Association Between Perceived Barriers to Diabetes Self-management and Diabetic Retinopathy in Asian Patients With Type 2 Diabetes.

Publication ,  Journal Article
Man, REK; Fenwick, EK; Gan, ATL; Sabanayagam, C; Gupta, P; Aravindhan, A; Wong, TY; Tan, GSW; Lamoureux, EL
Published in: JAMA Ophthalmol
December 1, 2017

IMPORTANCE: A patient’s perceived barriers to diabetes self-management (DSM) may affect his or her risk of diabetic retinopathy (DR); however, few studies have examined this association. OBJECTIVE: To examine the association between perceived barriers to DSM and the severity spectrum of DR in Asian patients with type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional clinic-based study, the Singapore Diabetes Management Project, was conducted from December 28, 2010, to March 20, 2013, at the Singapore National Eye Centre, a tertiary eye care institute. After excluding patients with type 1 diabetes and ungradable fundus images, 361 participants were included in the analyses. Statistical analysis was conducted from July 20 to September 8, 2017. EXPOSURE: The degree of perceived barriers to DSM was assessed using a 23-item questionnaire comprising items about knowledge of DSM, access to care, and confidence in health care professionals. Rasch analysis was used to optimize the scale’s psychometric properties, with lower scores indicating a higher degree of self-perceived barriers. MAIN OUTCOMES AND MEASURES: Diabetic retinopathy was graded from 2-field retinal images into categories of no DR (Early Treatment Diabetic Retinopathy Study levels 10-15; n = 154), mild to moderate DR (levels 20-43; n = 112), and severe DR (levels ≥53 and/or presence of clinically significant macular edema; n = 95) using the modified Airlie House classification system of DR. Multinomial logistic regression models were used to assess the association between perceived barriers and severity of DR in the worse-affected eye. RESULTS: Among the 361 participants (105 women and 256 men; mean [SD] age, 57 [8] years), a greater magnitude of perceived barriers to DSM was independently associated with higher odds of having any DR (odds ratio, 1.32; 95% CI, 1.06-1.66), mild to moderate DR (odds ratio, 1.30; 95% CI, 1.01-1.68), and severe DR (odds ratio, 1.36; 95% CI, 1.03-1.79). This association was independent of diabetes control (hemoglobin A1c, blood pressure, and lipid levels), presenting visual acuity, and socioeconomic indicators. CONCLUSIONS AND RELEVANCE: These results suggest that greater perceived barriers to DSM are independently associated with severity of DR. Although longitudinal data are needed, these findings suggest that evidence-based interventions to reduce patient-, practitioner-, and system-related barriers to diabetes care may help reduce the risk of DR.

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Published In

JAMA Ophthalmol

DOI

EISSN

2168-6173

Publication Date

December 1, 2017

Volume

135

Issue

12

Start / End Page

1387 / 1393

Location

United States

Related Subject Headings

  • Visual Acuity
  • Surveys and Questionnaires
  • Singapore
  • Self-Management
  • Risk Factors
  • Ophthalmology & Optometry
  • Middle Aged
  • Male
  • Macular Edema
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Man, R. E. K., Fenwick, E. K., Gan, A. T. L., Sabanayagam, C., Gupta, P., Aravindhan, A., … Lamoureux, E. L. (2017). Association Between Perceived Barriers to Diabetes Self-management and Diabetic Retinopathy in Asian Patients With Type 2 Diabetes. JAMA Ophthalmol, 135(12), 1387–1393. https://doi.org/10.1001/jamaophthalmol.2017.4888
Man, Ryan Eyn Kidd, Eva K. Fenwick, Alfred Tau Liang Gan, Charumathi Sabanayagam, Preeti Gupta, Amudha Aravindhan, Tien Yin Wong, Gavin Siew Wei Tan, and Ecosse L. Lamoureux. “Association Between Perceived Barriers to Diabetes Self-management and Diabetic Retinopathy in Asian Patients With Type 2 Diabetes.JAMA Ophthalmol 135, no. 12 (December 1, 2017): 1387–93. https://doi.org/10.1001/jamaophthalmol.2017.4888.
Man REK, Fenwick EK, Gan ATL, Sabanayagam C, Gupta P, Aravindhan A, et al. Association Between Perceived Barriers to Diabetes Self-management and Diabetic Retinopathy in Asian Patients With Type 2 Diabetes. JAMA Ophthalmol. 2017 Dec 1;135(12):1387–93.
Man, Ryan Eyn Kidd, et al. “Association Between Perceived Barriers to Diabetes Self-management and Diabetic Retinopathy in Asian Patients With Type 2 Diabetes.JAMA Ophthalmol, vol. 135, no. 12, Dec. 2017, pp. 1387–93. Pubmed, doi:10.1001/jamaophthalmol.2017.4888.
Man REK, Fenwick EK, Gan ATL, Sabanayagam C, Gupta P, Aravindhan A, Wong TY, Tan GSW, Lamoureux EL. Association Between Perceived Barriers to Diabetes Self-management and Diabetic Retinopathy in Asian Patients With Type 2 Diabetes. JAMA Ophthalmol. 2017 Dec 1;135(12):1387–1393.

Published In

JAMA Ophthalmol

DOI

EISSN

2168-6173

Publication Date

December 1, 2017

Volume

135

Issue

12

Start / End Page

1387 / 1393

Location

United States

Related Subject Headings

  • Visual Acuity
  • Surveys and Questionnaires
  • Singapore
  • Self-Management
  • Risk Factors
  • Ophthalmology & Optometry
  • Middle Aged
  • Male
  • Macular Edema
  • Humans