Availability of a Program to Screen for Retinopathy in Children with Type I Diabetes: Does It Improve Compliance?

Grant Application

Amy S. Gilliland, RN, MSN, CDE, and Ingrid Libman, MD, PhD, of Children’s Hospital of Pittsburgh of UPMC

Proposed Innovation

Children and adolescents with Type 1 diabetes (T1D) are at a high risk of developing vision-threatening retinopathy — a condition that can progress rapidly, especially in those with poor glycemic control. Although the American Diabetes Association and other organizations recommend annual screenings beginning at age 10, many children and their families fail to follow through — often due to barriers such as having to schedule ophthalmologist appointments at another location.

This project was designed to improve access by offering screening for retinopathy at the time of the patient’s regular diabetes visit at the Children’s Hospital of Pittsburgh Diabetes Clinic. In addition, age-appropriate tools were developed through the project to help adolescent patients learn about retinopathy, the importance of early screening, and what can be done to prevent or delay blindness.

Improvements

Tools already available to adults were reviewed and modified by the project team for use by children 10 years and older with T1D. Diabetes educators used the tools during clinic visits to teach young patients about the risk factors associated with the development and progression of retinopathy, such as smoking and the consequences of poor glycemic control. The goal of the project was to empower participating adolescents and their families by improving their understanding of the importance of yearly screenings and prevention of diabetes complications.

Outcomes

Through the project, 59 pre-teen and adolescent patients with diabetes (ages 10 to 21) were recruited to participate in the project through two clinic visits over a three-month period. Patients, parents and providers reported satisfaction with the convenience and speed of point-of-care eye evaluations, including results that could be incorporated into the same-day clinic visit. Patients also reported the tool improved their understanding of the importance of screenings and the relationship between diabetes care and eye health.

Findings demonstrated that a shared decision making approach and use of a tool designed for young patients with T1D is feasible and offers a learning opportunity that may help support informed decision making about their pediatric diabetes care.