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C. R. Sanchez, K. M. Agarwal, A. Millan-Ferro, J. K. Sun, P. S. Silva, J. D. Cavallerano, L. M. Aiello, L. P. Aiello, A. E. Caballero; Diabetes and Ophthalmic Outcomes Following Integration of a Culturally Oriented Program for Diabetic Latino Patients and an Ocular Telemedicine Program. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2080.
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© ARVO (1962-2015); The Authors (2016-present)
To describe effects of the Latino Diabetes Initiative (LDI), a Latino culturally oriented program, on ophthalmic and diabetes (DM) outcomes in diabetic patients and to determine if the Joslin Vision Network (JVN) telemedicine eye care program further benefits diabetic Latino patients.
Retrospective structured electronic medical record query of all BEI patients between 1/2006 and 10/2008 as well as LDI participants with 2 years followup with or without JVN imaging between 7/2002 and 11/2007. Ocular and systemic outcomes were compared between LDI participants and Latino non-participants, and between those who did and did not have JVN imaging.
Of 13,815 patients at the BEI, 522 (4%) were identified as Latino. There were 257 (49%) subjects who participated in LDI and 265 (51%) who did not. LDI subjects were more likely to be older (median 55 vs 48 yrs; p<0.001), female (60% vs 47%; p=0.009), and have type 2 DM (86% vs 57%; p<0.001), higher systolic blood pressure (126 vs 120 mmHg; p=0.006), hyperlipidemia (81% vs 57%; p=0.023), or microalbuminuria (37% vs 23%; p=0.014). There was no significant difference in HbA1c, DR severity, or presence of vision threatening DR, DME, or PRP between LDI and non-LDI subjects. However, LDI subjects had better VA (mean VA 20/17 vs 20/19; p=0.04) and were more likely to undergo focal laser (11% vs 6%; p= 0.04) or any treatment for DME including intravitreal injection (12% vs 7%; p<0.05). Of 145 LDI subjects with 2 years followup, 46 (31.7%) had JVN imaging. Baseline characteristics of JVN and non-JVN subjects, including HbA1c were not statistically different. Over 2 years, all LDI patients had improvement in HbA1c (mean 8.5% to 8.0%; p=0.004), total cholesterol (184 to 169 mg/dL; p=0.001), and LDL (112 to 98 mg/dL; p=0.007). In JVN imaged LDI subjects, HbA1c after 2 years was lower (7.5% vs 8.0%; p=0.002) with a trend towards greater change in HbA1c (-0.9% vs -0.3%; p=0.13).
Latinos participating in a culturally oriented program were more likely to undergo treatment for macular edema and have better vision than non-participants, suggesting that the program had a beneficial effect on diabetes eye care and visual outcome. Furthermore, LDI participants who underwent JVN imaging had better glycemic control after 2 years than those not imaged, suggesting a beneficial effect of an ocular telemedicine initiative on diabetes parameters in Latino patients.
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