By Madeline Klinger
Though it is estimated that over 11% of adults in the US have diabetes, nearly 25% remain undiagnosed. It is also estimated that 38% of adults in the US are prediabetic, with that number increasing to nearly 50% in adults 65 years and older. Diabetes is the 7th leading cause of death and the leading cause of preventable blindness in US adults. Unfortunately, less than ⅔ of people diagnosed with diabetes get an annual dilated eye exam.
Racially and ethnically minoritized groups and financially underprivileged people continue to be disproportionately affected by diabetes by all metrics. One recent study examined rates of diabetic retinopathy in the US between 2009 and 2018 and found that those who self-identified as hispanic/latinx or black consistently exhibited higher rates of diabetic eye complications than white people (18.78% and 18.18%, respectively, vs. 12.71%). This trend corresponded to consistently lower rates of dilated eye exams in hispanic and black populations than white populations. Overall, even after controlling for socioeconomic demographics, hispanic/latinx and black people were over 60% more likely to develop diabetic eye complications. Those in the LGBTQ+ community also face higher prevalence in diabetic diagnosis, access, and care.
One clear issue is healthcare accessibility. From 2009-2018, black patients were 29% less likely than white patients to complete all of the American Diabetes Association-recommended processes for diabetes, with these groups often seeking care only after the onset of diabetic eye disease or blindness. Eyecare providers can intervene by working together with general healthcare practitioners to inform at-risk populations on diabetes management requirements. Importantly, this education needs to be situated within an appropriate cultural context. Community-based diabetes management and diabetic retinopathy screening programs can help, as can personalized follow-ups and appointment reminders. Additionally, improved access to reliable transportation, childcare, the ability to take time away from work to attend appointments, and lower healthcare costs are all systemic issues that will also help to reduce disparities. We must remember that diabetes and diabetic eye disease is a public health issue.
To learn more about how diabetes impacts eye health, register for the upcoming webinar hosted by the National Caucus and Center on Black Aging, Inc., and the National Optometric Association, featuring our colleague, Dr. Sherrol Reynolds.DEIB