Findings from the DR Barometer Study supports the clear the urgent need to improve the experience of, and outcomes for, adults living with diabetes, who find themselves at risk of developing eye complications.

To ensure that meaningful change is achieved across the patient care pathway, a comprehensive series of evidence-based recommendations are proposed.

Click on each section to find out more:

Research and Policy Agenda Setting +

  • Establish a cross-discipline, cross-border coalition platform to identify synergies and good practices for the improvement of diabetes-related eye health, and further the work and findings of the DR Barometer Study in order to improve standards and practices within health systems
  • Develop a new advocacy model comprising patients, diabetes, vision-related and ageing organisations, academia and clinicians, to address barriers and identify solutions at a national level in order to join up policy developments, foster intergovernmental dialogue within ministries with the end goal of developing a national strategy for diabetes-related eye complications
  • Establish a multi-sectorial, multi-disciplinary research consortium which aims to address the research gaps in the understanding of disease-specific modifiers or indicators within diabetes health, socio-economic implications of diabetes-related eye complications, and future translational research needed to achieve optimised patient outcomes and improved service provision
  • Identify good practices in joined-up care and patient education, to establish baseline approaches for patient care with the aim of replicating and scaling-up, as appropriate, within specific health system frameworks within each country
  • Inform the United Nations Sustainable Development Goals (SDGs), particularly Goal 3 related to health and the promotion of universal health coverage which provides opportunities to include eye health services, the WHO Global Strategy and Action Plan on Healthy Ageing, the WHO Universal Eye Health global action plan, the NCD Alliance, and the Vision 2020 Action Plan of the social and economic consequences of diabetes-related eye complications

Awareness and Information for the management of diabetes and diabetes-related eye complications +

  • Evaluate the uptake and barriers of patient support programmes, and the effectiveness of eye-related information within such programmes, to ensure appropriate access to education on lifestyle and behavioural interventions
    Establish universal principles of information requirements of patients regarding diabetes-related vision loss and develop a suite of relevant patient education resources
  • Ensure clinical settings of all health care professionals managing people with diabetes are equipped with sufficient and suitable patient education information on diabetes-related eye complications. Information should be available in the patient’s native language and provided upon initial diagnosis of diabetes and initial eye exam
  • Train clinical staff to engage patients in a proactive dialogue on the importance of eye health and preventative strategies, including adherence to an annual exam, as the new standard of clinical care. Training should be provided to all health care professionals including, nurses, dietitians, nutritionists and health educators
  • Develop and pilot a patient-centric checklist and personalized logbook, with relevant health information, including clinical data and recommendations, to facilitate communication between health care professionals in order to achieve an effective, holistic management of diabetes
  • Collaborate with stakeholders in a government endorsed national health campaign on the importance of vision in the overall management of diabetes, to raise eye health as a priority on a national platform, and if available, inform patients of national screening services

Guidelines and Protocols +

  • National eye associations to develop a set of guidelines, for primary care providers and specialists, that include natural history of diabetic eye disease, recommended screening intervals, how to prepare the patient for screening, simple grading definitions, available treatment protocols, and further steps to ensure eye health. Uptake of these guidelines should be assessed on an annual basis and modifications made as appropriate
  • Ensure that diabetes-related eye complications are on the agenda of national and international medical congresses across disciplines and sectors
  • Invest in continuing education and training for all health care professionals, about the natural history of diabetes and its sequelae, including prevention strategies, advancements in available treatments, and the importance of rehabilitation services for those in need

Screening and Diagnosis addressing Gaps and Barriers to Eye Care and Referral +

  • Assess health system barriers to eye exams and define a national strategy to ensure they are accessible and affordable to all patients regardless of their age, duration of diabetes, gender, level of education, place of residence or income level
    Clinical practices to develop efficient and effective systems to provide patients, and where appropriate caregivers, with regular appointment reminders to ensure patients are able to attend their annual eye exam
  • Develop sound principles of an efficient, holistic patient-driven care system; ensure effective communication between relevant health care professionals, including the sharing of relevant patient data, toward optimising patient outcomes
  • Conduct cost-effectiveness and patient-reported outcome analyses on the value of a patient coordinator role to streamline the referral pathway, schedule appointments and coordinate follow-up care in order to determine the relevance, applicability and effectiveness within various healthcare systems
  • Study the disparities in access to care at a national level, such as proximity to available healthcare services, of various at-risk populations toward the development of national strategies and recommended actions to address identified inequalities
  • Strengthen human resources in eye care delivery and invest in the training of a new generation of eye care professionals, enhanced infrastructure and care-delivery resources, including mobile outreach and telemedicine, to alleviate the current capacity constraints in providing eye examinations and delivery of care
  • Conduct clinical efficiency assessments to optimise service provision, and eliminate redundancies and inadequacies in order to streamline the patient flow within a clinical setting
  • Consider the applicability of a government funded national eye screening service such as the United Kingdom National Health Service (NHS) Diabetic Retinopathy Screening Programme. Invest in the training and certification of grading technicians, diagnostic equipment and information technology (IT) platforms

Treatment of DED and DME and Rehabilitation +

  • Inform patients of the results of their screening exam, their diagnosis, rationale if treatment is not recommended or of recommended treatment, protocol and relative expectations, and any further preventative measures to ensure they are an active participant in their medical care
  • Ensure patients have access to quality low-vision rehabilitation services and support programmes to ensure physical and mental health of people with DED or DME is not compromised
  • Conduct cost-effectiveness analyses comparing short term gains derived from reimbursement restrictions on approved therapies, or diagnostic exams, with long-term socio-economic impact and patient outcomes
  • Enhance advocacy efforts to ensure patients are not denied access to evidence-based treatment, or screening services, due to reimbursement restrictions or the inability to pay for services

International Federation on Ageing

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