Diabetic retinopathy (DR) is a leading cause of vision loss worldwide. Screening for DR is recommended in children and adolescents, but adherence is poor. Recently, autonomous artificial intelligence (AI) systems have been developed for early detection of DR and have been included in the American Diabetes Association's guidelines for screening in adults. We sought to determine the diagnostic efficacy of autonomous AI for the diabetic eye exam in youth with diabetes. RESEARCH DESIGN AND METHODSIn this prospective study, point-of-care diabetic eye exam was implemented using a nonmydriatic fundus camera with an autonomous AI system for detection of DR in a multidisciplinary pediatric diabetes center. Sensitivity, specificity, and diagnosability of AI was compared with consensus grading by retinal specialists, who were masked to AI output. Adherence to screening guidelines was measured before and after AI implementation. RESULTSThree hundred ten youth with diabetes aged 5-21 years were included, of whom 4.2% had DR. Diagnosability of AI was 97.5% (302 of 310). The sensitivity and specificity of AI to detect more-than-mild DR was 85.7% (95% CI 42.1-99.6%) and 79.3% (74.3-83.8%), respectively, compared with the reference standard as defined by retina specialists. Adherence improved from 49% to 95% after AI implementation. CONCLUSIONSUse of a nonmydriatic fundus camera with autonomous AI was safe and effective for the diabetic eye exam in youth in our study. Adherence to screening guidelines improved with AI implementation. As the prevalence of diabetes increases in youth and adherence to screening guidelines remains suboptimal, effective strategies for diabetic eye exams in this population are needed.Diabetes is a significant public health problem worldwide, and in the U.S., it affects almost 30 million people (1). In youth, diabetes is one of the most common chronic childhood diseases, with an incidence that has been increasing over the past decade for both type 1 diabetes (T1D) and type 2 diabetes (T2D) (2). Children with diabetes are at risk for diabetes-related complications, including diabetic retinopathy (DR), which

IMPORTANCE Diabetic retinopathy is a major complication of diabetes for which regular screening improves visual health outcomes, yet adherence to screening is suboptimal.OBJECTIVE To assess disparities in diabetic eye examination completion rates and evaluate barriers in those not previously screened. DESIGN, SETTING, AND PARTICIPANTSIn this cohort study at a single academic center (Johns Hopkins Hospital pediatric diabetes center in Baltimore, Maryland) from December 2018 to November 2019, youths with type 1 or type 2 diabetes who met criteria for diabetic retinopathy screening and were enrolled in a prospective observational trial implementing point-of-care diabetic retinopathy screening were asked about prior diabetic retinopathy screening.MAIN OUTCOMES AND MEASURES Demographic and clinical characteristics were compared between those who did and did not have a previous diabetic eye examination and stratified according to race/ethnicity, using t tests and χ 2 tests. Multivariate logistic regression was used to analyze the association between race/ethnicity, screening, and other social determinants of health. A questionnaire assessing barriers to screening adherence was administered. RESULTSOf 149 participants (76 male patients [51.0%]; mean [SD] age, 14.5 [2.3] years), 51 (34.2%) had not had a prior diabetic eye examination. These individuals were more likely than those who had prior diabetic eye examinations to be non-White youths (38 [75%] vs 31 [32%]; P < .001) and have type 2 diabetes (38 [75%] vs 10 [10%]; P < .001), Medicaid or public insurance (43 [84%] vs 31 [32%]; P < .001), lower household income (annual income Յ$25 000, 21 [41%] vs 9 [9%]; P < .001), and parents with education levels of high school or less (29 [67%] vs 22 [35%]; P < .001). The main barriers reported included not recalling being recommended to obtain a diabetic eye examination (19 [56%]), difficulty finding time for an additional appointment (10 [29%]), and transportation issues (7 [20%]). Minority youths were less likely to have a previous diabetic eye examination 34 [46%] vs White, 64 [85%]; P < .001) and more likely to have diabetic retinopathy (11 [15%] v 2 [3%]; P = .008). Minority youths were less likely to get diabetic eye examinations even after adjusting for insurance, household income, and parental education level (odds ratio, 0.29 [95% CI, 0.10-0.79]; P = .02). CONCLUSIONS AND RELEVANCEIn this cohort study, non-White youths were less likely to undergo diabetic eye examinations yet more likely to have diabetic retinopathy compared with White youths. Addressing barriers to diabetic retinopathy screening may improve access to diabetic eye examination and facilitate early detection.

ObjectivesChildren with diabetes are advised to see their diabetes team every 3 months, with interim communication to address insulin dose adjustments. Despite increasing digital accessibility, there is limited data on whether provider–patient communication frequency is associated with glycemic control in pediatric diabetes. We assessed patterns of communication between diabetes clinic visits and whether communication frequency via electronic messaging (EM) and telephone was associated with glycemic control in pediatric diabetes.MethodsRetrospective chart review of 267 children with type 1 (T1DM) and type 2 diabetes (T2DM) over a 1-year period (July 2018–June 2019) at an urban academic pediatric diabetes center. Association between frequency of communication (via EM and telephone) and HbA1c was analyzed using regression analysis.ResultsOf 267 participants, 224 (84%) had T1DM, 43 (16%) had T2DM, mean age 11.6 years (SD 4), mean duration of diabetes 3.5 years (SD 3.4), and mean HbA1c 73.8 ± 23 mmol/mol (8.9 ± 2.2%). Most participants (82%) communicated with their diabetes team at least once per year, with a mean number of overall communications of 10.3 ± 13.6 times. Communications were via EM (48%), phone (40%), or both (53%). Participants with more frequent communication had lower HbA1c values (p=0.007), even when controlling for age, sex, provider, and number of clinic visits per year. We determined that a threshold of three communications per year was associated with a lower HbA1c (p=0.006).ConclusionsMore frequent communication with the diabetes team between visits is associated with improved glycemic control. Initiatives to contact diabetes patients between clinic visits may impact their overall glycemic control.

Background: Children with diabetes are advised to see their diabetes team every 3 months. While we encourage patients and caregivers to communicate between visits, there is limited evidence to support this recommendation. Therefore, we assessed patterns of communication between visits and whether communication frequency via phone and electronic messaging (EMs) is associated with glycemic control. We hypothesized that patients who communicate more frequently will have better glycemic control as measured by hemoglobin A1c (HbA1c). Methods: We assessed communication patterns via EMs and phone calls in children with type 1 and type 2 diabetes over a 1-year period at an urban academic pediatric diabetes center. Demographic and clinical data were extracted from the electronic medical record. The association between frequency of communication and HbA1c was analyzed using regression analysis. Results: 122 patients were included in this analysis, of which 99 (80%) had T1D, 23 (20%) had T2D. Mean age 11.8y (SD 3.9), mean duration of diabetes 3.5y (SD 3.4), and mean HbA1c 9% (range 4.7-15%). Most patients/caregivers (101/122, 89%) communicated with the diabetes team between office visits. Communications were via phone (27%), EM (29%), or both (42%). Patients with more frequent communication had lower HbA1c values (p=0.008, β =-0.04). Method of communication was not associated with HbA1c. Conclusions: More frequent communication with the diabetes team between visits is associated with improved glycemic control, irrespective of the method of communication. Thus, communication with patients should be tailored to their preference. Disclosure K. Abel: None. R. Verma: None. C.G. Thomas: None. M. West: None. C. Glancey: None. J. Tracey: None. K. Arcara: None. S.N. Magge: None. R. Wolf: None.

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