An invited review published by the ACBRD investigates the clinical and psychosocial factors influencing this important aspect of diabetes self-care.
By Dr Amelia Lake 
Earlier this week, Diabetes Australia launched KeepSight , a new national diabetes eye screening reminder program, designed to curb rates of preventable blindness in the 1.3 million people living with diabetes in Australia – around 600,000 of these are not currently accessing regular eye checks. Engaging those who have never had eye checks or who do not screen regularly will be an important priority for KeepSight. In order to do this, it is crucial to understand the barriers to, and enablers of, screening of ‘high-risk’ groups, so that messages can be tailored to their unmet needs.
One such group is those with younger-onset type 2 diabetes (T2D), i.e. diagnosed before age 40 years. This number of people in this category is increasing in Australia and worldwide. They are particularly vulnerable to diabetes-related complications, including retinopathy. Diabetes-related retinopathy occurs when blood glucose levels remain high over a long period of time and damage the tiny blood vessels at the back of the eye. It is the leading cause of vision loss among adults of working age. Fortunately, a simple eye check can detect retinopathy before symptoms appear. Once detected, timely treatment can prevent almost all potential vision loss. National guidelines recommend that people with T2D have their first eye check when their diabetes is diagnosed and have repeat eye checks at least every two years thereafter. However, in practice, only about 50% of young adults with T2D have an eye check, compared to 78% of older adults .
Although our research has shown that younger adults face more barriers to screening  than older adults, there was no review bringing all the evidence together. In response to this clear knowledge gap, Dr Amelia J Lake , Dr Gwyn Rees (formerly of CERA ), and Professor Jane Speight  were invited to publish a review: Clinical and Psychosocial Factors Influencing Retinal Screening Uptake Among Young Adults With Type 2 Diabetes  in Current Diabetes Reports . The review highlighted that there are many important clinical and psychosocial factors, including: lack of diabetes-related symptoms; low of perception of personal risk of diabetic retinopathy; high emotional health burden, such as depression, anxiety and diabetes-related distress; fatalism about inevitability of complications; time and financial constraints; lack of engagement with existing diabetes self-management services; lack of age-appropriate support services; and perceived stigma due to having a condition traditionally associated with older adults.
Addressing these issues is key to avoiding preventable vision loss in young adults with T2D. We are delighted that KeepSight is already using messaging from our research to inform the national eye check reminder program and engage people with diabetes in crucial, sight-saving eye checks.
Lake AJ, Rees G, Speight J (2018) Clinical and Psychosocial Factors Influencing Retinal Screening Uptake Among Young Adults With Type 2 Diabetes . Current Diabetes Reports, 18(41): https://doi.org/10.1007/s11892-018-1007-3