Improving the communication pathway for eye screening in paediatric diabetes

Diabetic retinopathy is a leading cause of vision loss in young adults. Current National Institute for Health and Care Excellence guidelines require that all children aged ≥12 years with diabetes are offered retinal screening annually. A local 2009-2010 audit identified that 57% underwent screening but only 16% had results documented with the paediatric diabetes service, highlighting areas for improvement. In 2011, the paediatric diabetes service formulated a standard operating procedure with the eye screening programme to improve referrals, screening and data collection. We undertook a retrospective analysis of paediatric diabetes patients aged ≥12, attending a large paediatric diabetes service from April 2012 to April 2013. Out of an eligible 268, evidence of referral was available for 259 and nine had no data. A total of 241 (90%) had results recorded for submission to the National Paediatric Diabetes Audit (NPDA). The remaining 18 had screening but paediatric services had no recorded data. In all, 256 attended screening and three patients did not attend, thus giving a 96% screening rate (256/268). Of 251 with gradable images, 18 patients (7.2%) had retinopathy. Those with retinopathy had higher HbA_1c (85mmol/mol) than those without (73mmol/mol); p=0.011. No correlation was found with age of diagnosis or duration of diabetes. Improvements in screening rates from 57% to 96%, recording rates from 16% to 90% and a 96% local screening rate compared to a 49.7% national screening rate (NPDA 2012-2013) clearly demonstrate the effectiveness of collaboration between services and of a structured clinical pathway. The findings also confirm retinopathy is more prevalent in children with diabetes with poor glycaemic control, underlining the importance of improving glycaemic control.