Abstract
Purpose :
Native Americans (NAs) have the highest prevalence of diabetes mellitus (DM) of any racial group in the US and are at higher risk for developing diabetic retinopathy (DR) and macular edema (ME). Previous studies on DR among NAs are dated with estimated rates as high as 49%, but new evidence suggests rates are falling. Updated data is necessary to characterize the needs of NA patients. The Citizen Potawatomi Nation (CPN) is a tribe in Oklahoma with a clinic that offers eye care to tribal members. This study estimated the prevalence of DR among NA patients at the CPN clinic and characterized risk factors associated with the presence and severity of DR.
Methods :
A retrospective chart review was conducted on adult tribal members with DM receiving dilated eye exams at the CPN clinic between 2021- 2023, and the presence and stage of DR and ME was recorded. Body mass index (BMI), hemoglobin A1c (HgA1c), duration of DM, insulin use, comorbid hypertension, hyperlipidemia, nephropathy, and smoking were recorded. Demographic data, insurance status, adherence to annual screening, and driving distance to clinic were also recorded. Statistical analysis was performed to identify associations between recorded variables and the presence or stage of DR.
Results :
A total of 504 patients with DM were included. The overall prevalence of any DR was 19.4% including 16.3% with non-proliferative DR, 3.2% with proliferative DR, and 3.4% with ME. The presence of DR was associated with higher HgA1c, nephropathy, longer duration of DM, use of insulin, and having Medicaid or tribal insurance coverage only (all p < 0.05). There was no statistically significant association between the presence of DR and gender, age, BMI, hypertension, smoking, hyperlipidemia, adherence to annual screening, or driving distance to the clinic. Only 35% of patients had a documented eye exam within the last year.
Conclusions :
This study supports that rates of DR are decreasing amongst NAs in Oklahoma. The rate of DR in this NA cohort was lower than older studies, despite a high rate of comorbidities. The average HgA1c in this cohort was lower than previously published studies, suggesting improved diabetes care accounts for the decrease in DR. Screening adherence to annual eye examinations was poor, but this may be confounded by the COVID-19 pandemic and clinic administration factors.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.