Personalised Eye Consultation (PEC) to improve outcomes in DR
Dr Eva Fenwick (Research Fellow)Behavioural Research in Ophthalmology
Prue Spencer, Project Manager
Behavioural Research in Ophthalmology UnitFour main themes:
1. Prevention and management of eye diseases
2. Development of new patient-centred outcome measures
3. Development and evaluation of interventions to improve patient-centred outcomes
4. Translating our research into policy and practice
Study Rationale
• For every 1% reduction in blood glucose there is a 25% reduction in microvascular complications
• NHMRC guidelines state that helping people to improve glycaemic control is essential to reduce risk and progression of diabetic retinopathy (DR)
6 7 8 9 10 11 1202468
101214161820
RetinopathyNephropathyNeuropathyMicroalbuminuria
HbA1c %
Rela
tive
risk
Source: Diabetes Control and Complications Trial Study Group (1995) Diabetes, 44: 968-83
Patients at RVEEH
• Only 14% achieve optimal blood glucose control (Wong et al., 2009)
• Those with DR are 3x more likely to have suboptimal blood glucose control
• Only 17% correctly understood the meaning of the HbA1c test (Wang et al., 2008)
• 57% rated blood glucose control as important for eye health (Wang et al., 2008)
Understanding of DRPatients with DR: (Fenwick et al, 2013)“I was just in this fool’s paradise, I’m just diabetic, oh background retinopathy
there’s nothing to worry about, and then all of a sudden your eye’s full of blood and there’s plenty to worry about”
“I don't know how exactly you get eye problems [from diabetes]. I can fix cars but I can't fix human beings”
Retinal specialists: (Fenwick et al, 2013)“My experience is that almost no person with diabetes who ends up with vision
loss has a correct understanding of what happened”
Lack of support in diabetes management
• Half Australians have never been offered structured diabetes education.
• For those that have, the majority only offered this at diagnosis.
• Many diabetes education initiatives fail to improve blood glucose control.
Our approach
• Incorporate evidence-based behaviour change techniques alongside routine consultations.
Personalised Eye Consultation
Personal Retinal Image
Individualised behaviour change
techniques
Retinal imagesHealthy retina
Mild non-proliferative DR
Moderate non-proliferative DR
Proliferative DR
Study AimsAim 1: To assess the effectiveness of PEC on clinical and behavioural outcomes. Aim 2: To determine factors associated with improved clinical outcomes and identify mechanisms of change. Aim 3: To determine the cost-effectiveness of PEC.
Primary outcome: HbA1c
Secondary outcomes: cognitive, behavioural and psychological outcomes Assessment schedule: 3-, 6- and 12-months follow-ups.
Inclusion criteria:• Type 2 diabetes• Mild/Moderate
NPDR• Suboptimal
HbA1c (≥8%) • No previous
treatment for DR• 18 years or over• No cognitive
impairment• English speaking
Project significance
Our Personalised Eye Consultation:• Addresses urgent need to assist patients with DR to
achieve optimal blood glucose levels and avoid vision loss.
• Can fit alongside routine eye consultations and could be administered by a range of allied health professionals.
• Provides a far reaching and accessible approach. • Has wider application to other diabetes related
conditions or other chronic disease.
• Do you have Type 2 diabetes and early stage DR?
• Would you like to be involved in the trial?
• Do you know anyone who would be interested in participating?
• Talk to Prue today!!
Principle InvestigatorGwyn Rees:[email protected] 8048
Prue Spencer:[email protected] 8174