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:grees@unimelb.edu.au9929 8048

Prue Spencer:prue.spencer@unimelb.edu.au9929 8174