title: Compliance with screening guidelines for diabetic retinopathy in a large academic children's hospital in the Bronx.
abstract: OBJECTIVE
  As the rate of type 2 diabetes mellitus (DM) in children is increasing, the number of children with complications of DM, such as retinopathy, will also increase. American Diabetes Association and American Academy of Pediatrics guidelines recommend annual eye exams for children with type 1 DM who are older than 10 years, starting 3-5 years after diagnosis. Adolescents with type 2 DM should have an exam when diagnosed. This study was designed to determine if these guidelines are followed and to determine factors that influence providers to follow them.
  
  
  METHODS
  We identified all 15- to 20-year-old patients seen in a pediatric diabetes clinic over 6 months. All patients with type 2 DM and those with type 1 DM diagnosed at least 5 years prior were included. Charts were reviewed for 18 months to determine whether patients were referred for an eye exam. Data extracted included demographics, DM type, DM duration, hemoglobin A(1C), and presence of microalbuminuria.
  
  
  RESULTS
  Of 80 patients, 28 (35%) were referred for an eye exam. Patients with a longer duration of DM (P=.006) and those with microalbuminuria (P=.02) were more likely to be referred for screening.
  
  
  CONCLUSIONS
  As only 35% of the patients in this study were referred for eye exams, patients at risk for retinopathy are missing opportunities for screening and early treatment. With the increasing number of children with type 2 DM, more patients will be at risk for retinopathy and its consequences. Pediatricians and endocrinologists should be educated about referring for annual eye exams.
authors.affiliation: Department of Ophthalmology, Montefiore Medical Center, Bronx, NY 10467, USA. jamiebella78@gmail.com
authors.forename: Jamie B
authors.initials: JB
authors.lastname: Rosenberg
authors.forename: Ilana B
authors.initials: IB
authors.lastname: Friedman
authors.forename: Judith E
authors.initials: JE
authors.lastname: Gurland
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D003928:Diabetic Nephropathies / Q000150:complications; D003930:Diabetic Retinopathy / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000652:urine; D005260:Female; D019983:Guideline Adherence; D006776:Hospitals, Pediatric; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008499:Medical Records; D009519:New York City; D010044:Outpatient Clinics, Hospital; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015351:Vision Screening; D055815:Young Adult