The Optometrist’s Role in the Diabetes Care Team

Diabetes is one of the most common, chronic health issues in the world, affecting nearly 30.5 million Americans. It’s also one of the leading causes of vision impairment. According to the Centers for Disease Control and Prevention, someone with diabetes loses visual function every 15 minutes.

Current Data Trends

• Approximately 11.0% of U.S. adults with diabetes have some form of visual impairment (3.8% uncorrectable and 7.2% correctable).
• Diabetes is the leading cause of new cases of blindness among adults ages 20 to 74 years.
• Currently 4.2 million people with diabetes ages 40 years or older (28.5%) had diabetic retinopathy (DR).
  • Of these, 655,000 (4.4% of those with diabetes) had advanced DR that could lead to severe vision loss.
• DR is projected to affect 16 million people with diabetes by 2050.

Although the statistics indicate that more people are developing diabetes, the numbers also show that there is increasing awareness of the causes, prevalence, and available care options of diabetes. The good news: with this increased awareness and appropriate care, many complications from diabetes can be delayed or avoided. For example:

• The Diabetes Control and Complication Trial (DCCT) found that intensive blood glucose control reduced the risk of eye disease by 76%.
• The Early Treatment of Diabetic Retinopathy Study (ETDRS) found that 50% of blindness caused by DR could have been prevented with the early diagnosis of diabetes and early detection of retinal complications.

What Role Do Optometrists Play in Diabetes Care?

As essential health care providers, optometrists can play a crucial role in increasing patient awareness,  facilitating early detection, promoting proactive care, and assisting in the management and care of patients with diabetes. A. Paul Chous, OD, AOA representative to the National Diabetes Education Program (NDEP), says:

“Ideally, outright diabetes prevention is the best course of action; however, in the face of this massive reported onset, it’s important that practitioners help delay development. We, as primary care providers, have an obligation to talk to our patients about primary diabetes prevention, and if or when they are diagnosed, then we can educate them about ways in which they can prevent complications, in particular diabetes-related eye disease.”

Proactive care and early intervention typically include lifestyle modifications such as diet and exercise, and are the recommended first steps in patients showing signs of prediabetes or diabetes. In addition, science-based nutritional supplements for the eye may be added to support blood vessel health. Ultimately, maintaining healthy blood vessels in the eye is essential in protecting optimal vision, especially for patients at risk of retinal blood vessel degeneration.

The Diabetes Visual Function Supplement Study

The Diabetes Visual Function Supplement Study (DiVFuSS) tested the effects of a multicomponent, nutritional supplement on visual function in patients with type 1 and type 2 diabetes and early stages of non-proliferative diabetic retinopathy (NPDR). The combination of nutrients was successful in improving several different aspects of eye health related to diabetes without impacting blood glucose levels. Medication therapy is often introduced if the patient needs to lower their blood glucose levels. That said, for interventions and patient compliance to be sustainable, education and communication is vital.

The Importance of Communication

Effective communication and collaboration with the rest of the diabetes care team result in optimum patient care. A diabetes management team often includes the patient, the primary care physician, an endocrinologist, a dietician, a nurse educator, an eye care professional, a podiatrist, and a dentist. In addition, an exercise consultant, a pharmacist, and other necessary professionals may be included.

Provider-Provider Communication

Coordinating care can be a challenge when there are multiple providers, especially when they’re scattered over a variety of locations. Bridging the communication gap starts by establishing relationships and a mutual referral network with the various care team members within your community and utilizing the available channels of communication.

Provider-Patient Communication

When talking directly with patients, it’s best to discuss general diabetes education, smoking cessation, nutrition and diet, exercise, medications, blood glucose monitoring, and any problems or potential problems identified in the patients’ history and exam. Be sure to explain the complications that arise from uncontrolled diabetes and stress the importance of the ABCs of diabetes: A1C, blood pressure, and cholesterol.

Final Takeaways

While it’s important for patients to understand these points, don’t address everything at one exam. Focus on the most pertinent concerns during the initial visit and prepare patients for future visits to your practice and other professionals’ offices. This is the best time to explain the benefits of regular exams. From there, you can create a list and review the most pertinent concerns in each of the visits to come. Discuss the importance of keeping accurate and complete records; review your patients’ questions, goals, and plans; and ask for other care providers involved to send their clinical information to your office. It’s a good idea for patients, as well as family members and caregivers, to write down specific concerns/questions prior to their visits. The National Diabetes Education Program created a table to help generate several important questions and discussion points for health care providers to cover with patients who have diabetes. Topics include ocular and oral health and medication management. Another simple, helpful tool for patients is the American Association of Diabetes Educators’s (AADE) Seven Self Care Behaviors (AADE 7):

1. Healthy eating
2. Being active
3. Monitoring (blood glucose)
4. Taking medications
5. Problem-solving
6. Reducing risk
7. Healthy coping

Optometrists have an important place in the care of patients with diabetes. Understanding the effects of diabetes and educating your patients can not only save vision but save lives.

Sources

1. Centers for Disease Control and Prevention. Diabetes and eye diseases. 2011.
2. Centers for Disease Control and Prevention. National diabetes fact sheet: National estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.
3. Centers for Disease Control and Prevention. Self-reported visual impairment among persons with diagnosed diabetes— United States, 1997–2010. MMWR. 2011;60(45)1549–53.
4. The Centers for Disease Control and Prevention. National Diabetes Fact Sheet, 2007. Available at: www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf (Accessed August 27, 2010).
5. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993 Sep 30;329(14):977-86.
6. Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Arch Ophthalmol. 1985 Dec;103(12):1796-806.
7. Ferris F. Early photocoagulation in patients with either type I or type II diabetes. Trans Am Ophthalmol Soc. 1996;94:505–537.
8. Murphy RP. Management of diabetic retinopathy. Am Fam Physician. 1995 Mar;51(4):785-96.
9. American Optometric Association. Evidence-based Clinical Practice Guideline: Eye Care for the Patient with Diabetes Mellitus. Available at: https://www.aoa.org/optometrists/tools-and-resources/evidence-based-optometry/evidence-based-clinical-practice-guidlines/cpg-3–eye-care-of-the-patient-with-diabetes-mellitus Accessed 11/13/18.

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