Racial disparities in diabetic eye care need bigger solutions, study finds

ByMartha R. Camara

Apr 1, 2022

Diabetes-related blindness is the leading cause of preventable blindness among working-age adults in the United States. But only about half of diabetic patients undergo regular dilated eye exams despite recommendations from medical groups.

Racial and ethnic disparities in diabetic eye care may help explain this gap, according to a new study. White diabetic patients were more likely to receive routine eye examinations and participate in clinical services and diabetes self-management education.

Conversely, Hispanic patients had the highest prevalence of diabetic eye complications from 2009 to 2018, followed by black patients and white patients, the researchers found. Ocular complication rates ranged from 12 to 19%.

Over 30% of white patients with eye complications completed all care recommended by the American Diabetes Association, a significantly higher percentage than among Hispanic and black patients.

The study, led by researchers at the University of Houston, analyzed 10 years of survey data from 8,080 diabetes patients.

This research “not only documents the burden of diabetic ocular complications nationwide, but also identifies why racial and ethnic minorities are disproportionately affected,” said Sang Kyu Cho, professor of pharmaceutical health policy and outcomes.

The researchers urged healthcare providers and policy makers to promote interventions and educational programs to reduce the development of ocular complications.

“Because diabetic eye complications are consequences of poorly managed diabetes over time, such racial/ethnic disparities in the prevalence of diabetic eye complications are likely rooted in deeper systemic inequality in access to diabetes care. health,” said Wendy Harrison, professor of optometry at the University of Houston.

Several studies have previously assessed racial and ethnic disparities in the prevalence and management of diabetes, but research on ocular complications of diabetes has been limited.

In 2010, the National Eye Institute reported that Hispanic people age 50 and older had an 8% prevalence of diabetic retinopathy, compared to a 5.4% prevalence among blacks and a 5.1% prevalence among men. Whites. The number of Hispanic people with diabetic retinopathy is expected to triple from 1.2 million in 2010 to 5.3 million by 2050, while the prevalence among whites is expected to remain relatively stable.

Diabetic retinopathy occurs when high blood sugar levels damage blood vessels in the retina. These blood vessels can swell and leak, or even close, preventing blood from passing through. New abnormal blood vessels can also grow on the retina. All of these changes can lead to visual impairment and blindness.

Additionally, the Los Angeles Latino Eye Study analyzed data from more than 6,000 Latinos, mostly Mexican Americans, over the age of 40. The researchers found that Latinos developed visual impairment and blindness – regardless of cause – at the highest rate of any ethnic group in the country. Nearly 3% developed visual impairment and 0.3% developed blindness in both eyes.

Latinos were also more likely to develop diabetic retinopathy than whites. Of the 1,064 Latinos with diabetes included in the analysis, 46.9% had diabetic retinopathy and 6.1% showed signs of advanced disease. During the four-year study, 34% of Latinos with diabetes developed diabetic retinopathy, with those ages 40 to 59 having the highest rate. The longer the duration of diabetes, the more likely the person is to develop diabetic retinopathy.

Experts say racial and ethnic disparities in the prevalence of diabetic eye complications may be due to inequities in screening for diabetic retinopathy and how quickly the disease is diagnosed. Access to care and coexisting medical conditions, such as high blood pressure, can also be factors.

In a study of 7,341 people diagnosed with diabetes, Hispanic patients had lower insurance coverage rates than white and black patients. They were also less likely to have had an eye exam in the previous year and a blood pressure check. The researchers said that lack of insurance and socioeconomic status may partly explain some of the disparities in diabetic eye care.