Background:
More than one‐quarter of older patients with diabetes are readmitted to the hospital within three months of discharge. As a result of patients with diabetes’ increased risk for retinal disease and vision loss, those patients with poor vision may have difficulty performing self‐care tasks critical to diabetes self‐management, such as injecting insulin. As such, the hospital setting may be a missed opportunity to screen for poor vision and improve access to diabetes related vision care; in‐hospital interventions may improve patient self‐management on discharge and decrease readmissions. Our prior work has shown that more than one‐quarter of general medicine inpatients fail a vision screening test. However, to date, no data have specifically evaluated vision among inpatients with diabetes. Therefore, in this pilot project, we aim to evaluate the prevalence of poor vision and characterize access to vision care for inpatients with diabetes.
Methods:
Hospitalized adult general medicine inpatients were enrolled in an ongoing study of resource‐allocation and quality of care. Vision was tested using the Snellen eye chart; sufficient vision was defined as at least 20/50 in at least one eye. Diagnosis of diabetes was determined based on self‐report. Participants completed a survey about access to vision care. Descriptive statistics were used to determine means and proportions. Chi‐squared tests were used for categorical comparisons.
Results:
Vision screenings were completed in 705 participants, the majority of whom were female (55%) and African‐American (77%), with a mean age of 54. Among the participants, 34% had diabetes (mean HbA1c 8.37, range 4.7‐17.4) and 25% had insufficient vision. Participants with diabetes were more likely than those without diabetes to have insufficient vision (74/239, 31% vs. 101/466, 22%; p=0.007). Significantly more participants with diabetes reported that they “think that they need to see an eye doctor” (76/114, 67% vs. 110/202, 54%, p=0.03). While the majority of participants in both groups had ever seen an eye doctor (115/120, 94% vs. 198/210, 96%, p=0.541), participants with diabetes tended to be less likely to have seen one within the last two years (76/100, 41% vs. 110/156, 59%, p=0.3). Further, more participants with diabetes were told that they have eye disease (49/115, 43%, vs. 56/203, 64%, p=0.006). As this is a pilot study, data collection is ongoing.
Conclusions:
Our early pilot study demonstrates that the prevalence of poor vision is higher among inpatients with diabetes than those without diabetes and access to vision care for these patients may be inadequate. Hospitalists should not miss the opportunity to identify inpatients with diabetes and refer them for guideline‐recommended care. Future work should address possible hospital‐based interventions to reduce this disparity and improve vision‐related transition care for patients with diabetes after discharge home.