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. Copyright © 2015 John Wiley & Sons.