ACBRD published a qualitative study examining barriers to screening for diabetic retinopathy.
by Amelia Lake
Once again, one of the world’s leading medical science journals, The Lancet, is raising the profile of a burgeoning public health issue: young-onset type 2 diabetes (T2D). Timed to coincide with the 77th Scientific Sessions of the American Diabetes Association, the journal highlighted the problem in an editorial , supplemented by seminar  and review  papers from leading researchers and clinicians. A key imperative, according to the editorial, is the development of tailored interventions to encourage active self-management.
Adults with young-onset T2D (aged 18-39 years) are at risk of early development and rapid progression of diabetes-related complications, including diabetic retinopathy – the leading cause of vision loss in working age adults. Asymptomatic in the early stages, diabetic retinopathy can only be detected via retinal screening; timely treatment thereafter can significantly reduce risk of vision loss. Unfortunately, young adults with T2D are less likely to screen for retinopathy than their older counterparts (aged 40+ years). In response to a lack of published literature on the factors impacting uptake of retinal screening for young adults with T2D, Amelia Lake , Dr Jessica Browne and Prof Jane Speight  have been working with colleagues at the Centre for Eye Research Australia (CERA ), Vision 2020 Australia  and Diabetes Victoria  to explore the issue.
We conducted 30 in-depth telephone interviews (10 young adults, 20 older adults) systematically comparing barriers and facilitators  to uptake of retinal screening between the two groups. While many facilitators of screening are shared between the two groups, young adults cite concern for the impact of vision loss on the family unit as an important reason for retinal screening. Compared to older adults, young adults experience additional barriers screening barriers. These include lack of opportunity for social comparison (i.e. not knowing other people with T2D), lack of social support, unrealistic optimism, perceptions of invulnerability, and low prioritisation of screening due to the demands of young adult life.
These findings confirm that younger and older adults with T2D differ in the significance given to a range of psychosocial factors associated with retinal screening uptake. They provide an evidence base upon which to build quantitative studies and develop an intervention to promote retinal screening among young adults with T2D.
Lake AJ, Browne JL, Rees G, Speight J. What factors influence uptake of retinal screening among young adults with type 2 diabetes? A qualitative study informed by the Theoretical Domains Framework . Journal of Diabetes and its Complications, 2017; 31(6): 997-1006.