Diabetes and eye health are very important care considerations for everyone with diabetes. Visual impairment and blindness as a consequence of diabetes retinopathy are one of the most feared complications of diabetes (Rafferty et al, 2021). Good glycaemic control and blood pressure management are pivotal in both the primary prevention and the prevention of progression of diabetic retinopathy (Rafferty et al, 2021). Practice nurses are pivotal in ensuring that people with diabetes have been invited to retinal screening at annual reviews, and also checking that individuals have had their annual digital retinal photograph in accordance with the UK National Health Diabetes Eye Screening Service (Public Health England, 2014). The recent re-opening of services for diabetes retinal screening has been welcomed after a prolonged period of limited or no screening due to COVID-19 and social distancing. However, a multitude of unrealised diabetes-related complications have occurred during lockdowns which now require diagnosis and urgent care escalation (Ghosal et al, 2020). These in particular affect eye health and, as such, promoting diabetes retinal screening is essential for everyone (Scanlon, 2021).
Targeting the whole population diagnosed with diabetes is crucial; however, it is also paramount to identify known vulnerable groups in the population to target (Gale et al, 2021). For example, Lawrenson et al's (2020) retrospective study of three UK diabetes retinal screening services reported that younger age, social deprivation, ethnicity and duration of diabetes were independent predictors of non-attendance to retinal screening invitations and increased incidence of referable retinopathy. Additionally, higher HbA1c, being male, having type 1 diabetes and being of African ethnicity correlated with more consecutive missed appointments (Virk et al, 2021).
Studies have also found that having type 1 diabetes for a longer duration or higher HbA1c and diastolic blood pressure increased the risk of retinopathy (Rafferty et al, 2021). Many people with type 2 diabetes are diagnosed with retinopathy already present and their individual presentations of retinopathy can progress differently depending on a variety of factors and phenotypes (Marques et al, 2020; 2021).
Although Lawrenson et al (2020) reported that the last 10 years have seen an overall reduction in vision impairment certification attributable to diabetes-related eye disease – potentially due to the co-ordination of the UK NHS Diabetes Retinal Screening Services (Public Health England, 2014) – the incidence of vision impairment in those aged <35 years was unchanged. This is of paramount importance in local populations as diabetes retinal screening services are unpaused (Diabetes UK, 2021).
SCREEN NOW
The iDEAL Diabetes (2021a) advocacy multi-disciplinary (MDT) group – following the successes of ACT NOW (2020), LET'S TALK NOW (2021b) and PROTECT NOW (2021c) endorsed by Diabetes UK, JDRF, IDF Europe, D-Foot International, Diabetes Research and Wellness Foundation, Primary Care Diabetes Society and the UK Diabetes Footcare Networks – has launched their new initiative to encourage and support everyone to attend screening appointments and learn about the importance of diabetes and eye health through the SCREEN NOW approach.
Following on from previous initiatives and the national and international outreach these had, iDEAL brought together leading experts in diabetes and eye health to design and create a series of information-giving resources for people living with diabetes about their eye health. With the unpausing of diabetes retinal screening services, a gap was recognised in the accessibility and availability of information on this topic for people with diabetes and their families, so the SCREEN NOW resources were designed and created.
Virk et al (2021) identified through a retrospective observational audit in London that there is a relationship between the number of missed consecutive screening appointments and the increased incidence of referable retinopathy at the time of the next screening attended.
SCREEN NOW focuses on diabetes and eye health and promotes understanding of the reasons and need for regular annual retinal screening. This resource offers information and easy to understand evidence for both people with diabetes and their families and also health professionals. The intention of SCREEN NOW is to increase understanding and engagement with diabetes eye screening services to reduce and prevent incidences of retinopathy.
iDEAL identified that using a MDT approach with resources that are person-facing in one easily accessible website was the best and most efficient way forward to share understandable information and knowledge about diabetes and eye health. Easy to understand resources and feedback from a person with diabetes who has experienced retinopathy are featured on the web page (https://idealdiabetes.com/screen-now-main-page/).
SCREEN NOW is an acronym presented in Figure 1 and has been developed with a person-centred approach underpinning it (NHS England, 2018).
Figure 1. SCREEN NOW acronym
SCREEN NOW:
- S – Screening your eyes (retinal screening) is an important part of your diabetes care
- C – Choosing treatment options that protect your retinal health
- R – Your retinal health check is important, you may not even know there are problems at the start
- E – Escalate any retinal problems quickly
- E – Education and support for people with diabetes regarding their diabetes and retinal screening results
- N – Never being afraid to ask about your eye health
- N – Not being anxious to ask for information or support about your retinal screening
- O - Optimising your diabetes self-management and blood pressure control
- W – Wellbeing and good health choices will help your eye health.
SCREEN NOW is an accessible educational approach to reach people with diabetes and their families in a user friendly way that can work with virtual diabetes care in both general practice (Diggle, 2020; Diggle and Brown, 2020) and specialist practice. Education in an easily accessible format in diabetes care for both health professionals and diabetes (Phillips et al, 2019) is the pivotal way of breaking down barriers and sharing knowledge about diabetes care approaches.
Conclusion
Reaching people with diabetes and health professionals with easy-to-access resources and information like SCREEN NOW offers increased knowledge sharing and information about diabetes and eye health to aim to protect both, especially as retinal screening services are becoming available again. For practice nurses to have knowledge about SCREEN NOW can guide their care and approaches, while sharing useful web information and approaches with and for people with diabetes.