Associations with sight-threatening diabetic macular oedema among Indigenous adults with type 2 diabetes attending an Indigenous primary care clinic in remote Australia: a Centre of Research Excellence in Diabetic Retinopathy and Telehealth Eye and Associated Medical Services Network study

Laima Brazionis; Anthony Keech; Christopher Ryan; Alex Brown; David O'Neal; John Boffa; Sven-Erik Bursell; Alicia Jenkins

doi:10.1136/bmjophth-2020-000559

Associations with sight-threatening diabetic macular oedema among Indigenous adults with type 2 diabetes attending an Indigenous primary care clinic in remote Australia: a Centre of Research Excellence in Diabetic Retinopathy and Telehealth Eye and Associated Medical Services Network study

BMJ Open Ophthalmol. 2021 Jul 1;6(1):e000559. doi: 10.1136/bmjophth-2020-000559. eCollection 2021.

Authors

Laima Brazionis¹, Anthony Keech², Christopher Ryan², Alex Brown^{3

4}, David O'Neal¹, John Boffa⁵, Sven-Erik Bursell², Alicia Jenkins^{1

2}

Affiliations

¹ Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
² Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia.
³ Theme Leader Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
⁴ Aboriginal Health, The University of Adelaide, Adelaide, South Australia, Australia.
⁵ Head Office, Central Australian Aboriginal Congress, Alice Springs, Northern Territory, Australia.

Abstract

Objective: To identify factors associated with sight-threatening diabetic macular oedema (STDM) in Indigenous Australians attending an Indigenous primary care clinic in remote Australia.

Methods and analysis: A cross-sectional study design of retinopathy screening data and routinely-collected clinical data among 236 adult Indigenous participants with type 2 diabetes (35.6% men) set in one Indigenous primary care clinic in remote Australia. The primary outcome variable was STDM assessed from retinal images.

Results: Age (median (range)) was 48 (21-86) years, and known diabetes duration (median (range)) was 8.0 (0-24) years. Prevalence of STDM was high (14.8%) and similar in men and women. STDM was associated with longer diabetes duration (11.7 vs 7.9 years, respectively; p<0.001) and markers of renal impairment: abnormal estimated Glomerular Filtration Rate (eGFR) (62.9 vs 38.3%, respectively; p=0.007), severe macroalbuminuria (>300 mg/mmol) (20.6 vs 5.7%, respectively; p=0.014) and chronic kidney disease (25.7 vs 12.2%, respectively; p=0.035). Some clinical factors differed by sex: anaemia was more prevalent in women. A higher proportion of men were smokers, prescribed statins and had increased albuminuria. Men had higher blood pressure, but lower glycated Haemoglobin A1c (HbA1c) levels and body mass index, than women.

Conclusion: STDM prevalence was high and similar in men and women. Markers of renal impairment and longer diabetes duration were associated with STDM in this Indigenous primary care population. Embedded teleretinal screening, known diabetes duration-based risk stratification and targeted interventions may lower the prevalence of STDM in remote Indigenous primary care services.

Trial registration number: Australia and New Zealand Clinical Trials Register: ACTRN 12616000370404.

Keywords: epidemiology; imaging; macula; pathology; public health; retina; telemedicine; vision.