Clinical features of diabetic patients referred by general physicians due to less ophthalmic examinations

Abstract

Yayoi Otsu, Masato Matsuoka, Kayako Matsuyama, Tetsuya Nishimura Department of Ophthalmology, Kansai Medical University, Takii Hospital, Osaka, Japan Background: The purpose of this study was to determine the clinical features of patients with type 2 diabetes, and less ophthalmic examinations, referred by general physicians to ophthalmologists. Methods: The medical charts of 327 patients with type 2 diabetes referred to our department from general physicians were reviewed. A detailed medical history was taken and a complete ophthalmic examination was performed for all patients. The patients were divided into two groups, ie, those with a history of missing ophthalmic examinations for more than a year (noncompliant group) and those with no previous ophthalmic examinations (never-examined group). Serum levels of glycosylated hemoglobin and creatinine, estimated glomerular filtration rate, and urine albumin/creatinine ratio were obtained from medical records. Results: Of the 327 patients, 102 had diabetic retinopathy (31.2%), with a mean best-corrected visual acuity of 0.037±0.36 logMAR (logarithm of the minimum angle of resolution) units. Of the 327 patients, 203 were in the never-examined group and 124 were in the noncompliant group. The incidence of diabetic retinopathy in the noncompliant group was significantly higher than that in the never-examined group (P<0.001). Best-corrected visual acuity in the noncompliant group was significantly worse than in the never-examined group (P=0.004). Glycosylated hemoglobin levels and estimated glomerular filtration rate in the noncompliant group were significantly lower than in the never-examined group (P<0.001 and P<0.003, respectively); serum creatinine levels and urine albumin/creatinine ratio were significantly higher (P=0.020 and P=0.001, respectively). The severity of the diabetic retinopathy was significantly correlated with compliance in terms of ophthalmic examinations and with urine albumin/creatinine ratio (multiple regression analysis, P=0.047 and P<0.001, respectively). Conclusion: Our results show that diabetic patients referred from general physicians due to less ophthalmic examinations generally have good visual acuity, but one third of them have diabetic retinopathy. A history of missing ophthalmic examinations and albuminuria are risk factors for diabetic retinopathy. Keywords: diabetic retinopathy, general physician, ophthalmologists, albuminuria