Adherence and Associated Follow-Ups for Diabetic Eye Examinations in Japan

Diabetic retinopathy (DR) is a serious complication of diabetes that causes visual impairment and blindness in Japan. Adherence to follow-up services is a key component for effective DR management. However, the attendance rates for DR follow-ups and eye examinations are unknown. We assessed the rate of follow-up for ophthalmic examinations and factors associated with discontinuation of eye examinations for patients with type 2 diabetes. In total, 624 patients with type 2 diabetes mellitus (348 males, 276 females; age 63.5±12.8 years, HbA1c 7.1±0.9%) were included. After obtaining informed consent, a questionnaire and review of the medical records were used to obtain data regarding sex, diabetic complications, body mass index (BMI), diabetes treatment, periodic eye examinations at least once a year, alcohol consumption, smoking status, the quality of life instruments (Short Form 36: SF-36), brief depression measures (CES-D), and the Big Five Personality Test (TIPI-J). In total, 510 patients (82.6%) had undergone periodic eye examinations and 114 (18.4%) had not been examined for 1 year. Patients not having examinations (non-attendance) were older (p=0.04), with higher HbA1c levels (p=0.01), and higher depression (p=0.01), and were single (p=0.03). There was no significant association between the attendance and non-attendance groups regarding sex, BMI, alcohol consumption, smoking, or stages of DR. The non-attendance group had lower scores in vitality and mental health (using the SF-36) than the attendance group (p<0.01). The non-attendance group scored lower on the neuroticism scale compared to the attendance group (p=0.04). The attendance percentage for the DR group follow-up examinations was 82%. The non-attendance group had higher depression symptom scores, higher HbA1c levels, lower quality of life and neuroticism scores, were older, and more likely divorced or separated. Improving the use of follow-up services is needed, particularly regarding improved psychosocial aspects.