Screening for diabetic retinopathy in children and young people in the <scp>UK</scp>: potential gaps in ascertainment of those at risk

Ibanez-Bruron, Maria Carolina; Solebo, Ameenat Lola; Cumberland, Phillippa; Rahi, Jugnoo S

doi:10.1111/dme.13361

Cited by 6 publications

(7 citation statements)

References 6 publications

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“…9,10 Case ascertainment via BOSU, a unique and well-established ophthalmic public health active surveillance scheme comprising all consultant ophthalmologists in the UK, has ensured unbiased high ascertainment in prior studies of eye disease in children. 16 Our study was well publicised and strongly supported by a collaborative research network (the Diabetic Eye Disease in Childhood Study Group comprising >150 clinicians managing children with diabetes in the UK) 17 , predisposing to high ascertainment. Incident visual impairment and treatment-requiring cataract are symptomatic.…”

Section: Discussionmentioning

confidence: 99%

“…We have previously reported vulnerabilities in ascertainment of eligible children/young people in the UK's National Diabetic Eye Screening Programme 17,28 which is delivered through more than 60 standalone programmes designed for, and managing predominantly, adults with type 2 diabetes. Screening outcome is communicated directly (in adult-orientated letters) to the child/young person and family.…”

Section: Discussionmentioning

confidence: 99%

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Epidemiology of visual impairment, sight-threatening or treatment-requiring diabetic eye disease in children and young people in the UK: findings from DECS

et al. 2020

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BackgroundWe investigated the incidence and causes of sight-threatening diabetes-related eye disease in children living with diabetes in the UK, to inform the national eye screening programme and enable monitoring of trends.MethodsWe undertook a prospective active national surveillance via the British Ophthalmic Surveillance Unit. Eligible cases were children aged 18 years or younger, with type 1 or 2 diabetes, newly diagnosed between January 2015 and February 2017 with sight-threatening diabetic eye disease.ResultsEight children were reported. The annual incidence of all sight-threatening diabetes-related eye disease requiring referral to an ophthalmologist among children living with diabetes (n=8) in the UK was 1.21 per 10 000 person-years (95% CI 0.52 to 2.39) and was largely attributable to cataract (n=5) 0.76 per 10 000 person-years (95% CI 0.25 to 1.77). The incidence of sight-threatening diabetic retinopathy (n=3) among those eligible for screening (12 to 18 year-olds living with diabetes) was 1.18 per 10 000 person-years (95% CI 0.24 to 3.46). No subjects eligible for certification as visually impaired or blind were reported.ConclusionsSecondary prevention of visual disability due to retinopathy is currently the sole purpose of national eye screening programmes globally. However, the rarity of treatment-requiring retinopathy in children/young people living with diabetes, alongside growing concerns about suboptimal screening uptake, merit new consideration of the utility of screening for primary prevention of diabetes-related morbidity by using the screening event and findings as a catalyst for better diabetes self-management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Epidemiology of visual impairment, sight-threatening or treatment-requiring diabetic eye disease in children and young people in the UK: findings from DECS

et al. 2020

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“…Important potentially quantifiable factors not available to include in this analysis, since they are setting specific, are the extent of the estimated resource and cost savings recoverable from increasing screening intervals if the increase in screening intervals were implemented for the groups of people identified in this analysis. Also influential are the ascertainment rates of the population to be included in the screening programme [34], as well as uptake rates for the screening programme which in Wales is currently 80% [35]. These factors are likely to reduce the borderline costeffectiveness, based at the 3.5% discount rate, for T1DM as well as those in the sensitivity analysis at HbA 1c level of 72 mmol/mol (8.7%) and 6-12 years duration of diabetes to below the threshold of greater than £20,000 considered to be cost-effective by NICE.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of biennial screening for diabetes related retinopathy in people with type 1 and type 2 diabetes compared to annual screening

Thomas

Winfield²,

Prettyjohns³

et al. 2020

Eur J Health Econ

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Objective Examine the health and economic impact of extending screening intervals in people with Type 2 diabetes (T2DM) and Type 1 diabetes (T1DM) without diabetes-related retinopathy (DR). Setting Diabetic Eye Screening Wales (DESW). Study design Retrospective observational study with cost-utility analysis (CUA) and Decremental Cost-Effectiveness Ratios (DCER) study. Intervention Biennial screening versus usual care (annual screening). Inputs Anonymised data from DESW were linked to primary care data for people with two prior screening events with no DR. Transition probabilities for progression to DR were estimated based on a subset of 26,812 and 1232 people with T2DM and T1DM, respectively. DCER above £20,000 per QALY was considered cost-effective. Results The base case analysis DCER results of £71,243 and £23,446 per QALY for T2DM and T1DM respectively at a 3.5% discount rate and £56,822 and £14,221 respectively when discounted at 1.5%. Diabetes management represented by the mean HbA 1c was 7.5% for those with T2DM and 8.7% for T1DM. Sensitivity analysis Extending screening to biennial based on HbA 1c , being the strongest predictor of progression of DR, at three levels of HbA 1c 6.5%, 8.0% and 9.5% lost one QALY saving the NHS £106,075; £58,653 and £31,626 respectively for T2DM and £94,696, £37,646 and £11,089 respectively for T1DM. In addition, extending screening to biennial based on the duration of diabetes > 6 years for T2DM per QALY lost, saving the NHS £54,106 and for 6-12 and > 12 years for T1DM saving £83,856, £23,446 and £13,340 respectively. Conclusions Base case and sensitivity analyses indicate biennial screening to be cost-effective for T2DM irrespective of HbA 1c and duration of diabetes. However, the uncertainty around the DCER indicates that annual screening should be maintained for those with T1DM especially when the HbA 1c exceeds 80 mmol/mol (9.5%) and duration of diabetes is greater than 12 years.

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“…DECS is supported by the DECS group, which includes members of the United Kingdom's National Children & Young People's Diabetes Network. This network comprises health professionals including pediatricians/pediatric endocrinologists, pediatric diabetes nurses, dietitians, and psychologists, alongside health care commissioners, voluntary/lay groups and parent representatives, working together to share good practice and maintain high quality standards of care .…”

Section: Methodsmentioning

confidence: 99%

“…A large number of diabetic eye screening program (DESP) units deliver the national retinopathy screening service, and are independent of pediatric and ophthalmology services . DESPs rely on primary care diabetes registers as the main/sole source of patient identification, as this is where adults living with diabetes are principally managed.…”

Section: Introductionmentioning

confidence: 99%

Vulnerabilities in diabetic eye screening for children and young people in England

et al. 2019

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Background Children and young people (CYP) living with diabetes require integrated child‐centered care. We hypothesized that suboptimal uptake to diabetic retinopathy screening in CYP may be partly related to the degree of services integration. We investigated the structure of the current pediatric diabetic eye care pathway and associations between service‐level characteristics and screening uptake. Methods A quality improvement project between January and May 2017 comprising a survey of practice of all 158 pediatric diabetes services (pediatric diabetes units, PDUs) across England and secondary data analysis of routinely collected service data. Generalized linear models for proportional responses were fitted to investigate associations between reported PDU characteristics and screening uptake. Results 124 PDUs (78%) responded. In 67% (n = 83), patients could be referred directly to screening programs; the remainder relied on primary care for onward referral. 97% (n = 120) considered eye screening results useful for counseling patients but only 65% (n = 81) reported it was “easy” to obtain them. Factors independently associated with higher screening uptake were a higher proportion of patients referred from primary care (OR = 1.005; 95%CI = 1.004‐1.007 per 1% of increase), absence of “out‐of‐catchment area” patients (OR = 1.13; 95%CI = 1.04‐1.22), and easy access to eye screening results (OR = 1.45; 95%CI = 1.34‐1.56). Conclusions There is limited direct communication between the services involved in diabetic eye care for CYP in England. This risks reducing the effectiveness of diabetic retinopathy screening. Similar vulnerabilities are likely to exist in other countries where retinopathy screening for CYP has been “bolted on” to provision for adults.

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Screening for diabetic retinopathy in children and young people in the UK: potential gaps in ascertainment of those at risk

Cited by 6 publications

References 6 publications

Epidemiology of visual impairment, sight-threatening or treatment-requiring diabetic eye disease in children and young people in the UK: findings from DECS

Epidemiology of visual impairment, sight-threatening or treatment-requiring diabetic eye disease in children and young people in the UK: findings from DECS

Cost-effectiveness of biennial screening for diabetes related retinopathy in people with type 1 and type 2 diabetes compared to annual screening

Vulnerabilities in diabetic eye screening for children and young people in England

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