title: Prevalence of undiagnosed diabetic retinopathy among inpatients with diabetes: the diabetic retinopathy inpatient study (DRIPS).
abstract: OBJECTIVE
  To determine the prevalence and risk factors of diabetic retinopathy in the inpatient diabetic population in the USA and to determine the barriers to ophthalmic examinations and treatment among this population.
  
  
  METHODS
  A cross-sectional analysis of 113 inpatients with diabetes mellitus admitted to an inner city community teaching hospital in Pittsburgh. Digital fundus photographs of the posterior pole were taken of each eye after pharmacological dilation. Presence, absence and severity of diabetic retinopathy and macular edema were graded on the basis of internationally accepted criteria. An investigator-administered questionnaire and review of the medical record were used to obtain data about patient demographics, clinical characteristics and barriers to ophthalmic care. The association between these data and the presence of diabetic retinopathy was tested.
  
  
  RESULTS
  The estimated prevalence of diabetic retinopathy in the inpatient population was 44% (95% CI 34% to 53%). The prevalence of previously undiagnosed diabetic retinopathy and sight-threatening retinopathy was 25% (95% CI 17% to 33%) and 19% (95% CI 11% to 26%), respectively. Renal disease was independently associated with the presence of diabetic retinopathy (OR, 3.86; 95% CI 1.22 to 12.27), as well as a longer duration of diabetes (OR, 1.08 per year; 95% CI 1.014 to 1.147). Diabetic retinopathy was seen in 15 of 17 patients admitted with diabetic foot ulcers or osteomyelitis. Frequently reported barriers to ophthalmic examinations included lack of transportation and physical disability.
  
  
  CONCLUSIONS
  The prevalence of diabetic retinopathy and sight-threatening diabetic retinopathy in the inpatient population is likely significantly higher than in the general diabetic population in the USA. These patients have barriers to care that need to be addressed to make standard of care ophthalmic examinations and treatment possible in this population.
authors.affiliation: Department of Ophthalmology , UPMC Eye Center, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania , USA.
authors.forename: Jessica J
authors.initials: JJ
authors.lastname: Kovarik
authors.affiliation: Department of Ophthalmology , UPMC Eye Center, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania , USA.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Eller
authors.affiliation: Department of Internal Medicine , UPMC Mercy Hospital , Pittsburgh, Pennsylvania , USA.
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Willard
authors.affiliation: Department of Internal Medicine , UPMC Mercy Hospital , Pittsburgh, Pennsylvania , USA.
authors.forename: Jiaxi
authors.initials: J
authors.lastname: Ding
authors.affiliation: Department of Endocrinology , UPMC Mercy Hospital , Pittsburgh, Pennsylvania , USA.
authors.forename: Jann M
authors.initials: JM
authors.lastname: Johnston
authors.affiliation: Department of Ophthalmology , UPMC Eye Center, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania , USA.
authors.forename: Evan L
authors.initials: EL
authors.lastname: Waxman
keywords: Inpatient Diabetes Management; Retinal Screening; Underserved Populations