Diabetes is a chronic medical condition that requires ongoing management with no days off. Adding COVID-19 to the mix has had a significant impact on those living with diabetes and for some, their appropriate healthcare has suffered.
A holistic and multidisciplinary approach is essential to best support those living with diabetes and related medical conditions; and crucial to ensure they do not fall through the cracks due to the uncertainty and unpredictability of the pandemic.
There is no doubt that COVID-19 has impacted everyone around the globe. Our healthcare system, across the public and private sectors and including the delivery of chronic healthcare, has been under extreme pressure. The pandemic has altered the way people interact and the additional decisions they now have to make.
While it may feel ‘out-of-scope’ for an optometrist to identify people in high-risk diabetes groups, doing so… can make a significant difference to the person’s long term health outcomes
Chronic medical conditions such as type 1 and type 2 diabetes require regular, ideally face-to-face, consultations with general practitioners, endocrinologists, diabetes educators, dieticians, optometrists and podiatrists to optimise glycaemic control. Additionally, specialists may be required due to diabetes and/or other related complications. However, with recommendations regarding social isolation to minimise the spread of COVID-19, health care services have increasingly been delivered via telehealth or spread out and delayed. Although telehealth has been greatly facilitated in Australia during the COVID-19 pandemic, with temporary Medical Benefits Schedule telehealth item numbers, many whose health is best managed via ongoing face-to-face care are avoiding appointments out of fear of infection.
It is important, as primary eye care practitioners, to work collaboratively with the wider community of medical practitioners and specialists to ensure people in higher risk groups are maintaining their appointments – including those who require follow-up due to diabetes eye-related examinations. It is well established that early signs of diabetes eyerelated changes are often asymptomatic, requiring continual monitoring, despite the absence of symptoms.
While it may feel ‘out-of-scope’ for an optometrist to identify people in high-risk diabetes groups, doing so and contacting the patient’s general practitioner and/or endocrinologist, can make a significant difference to the person’s long term health outcomes. It is important to remember that as eye care practitioners, we do not just manage eye conditions, we manage people who happen to have an eye condition. As such, understanding their full medical and ocular history, including their risk level, is crucial to providing adequate eye health care and being able to schedule timely inperson or telehealth consultations.
High-risk groups include people:
- With diabetes eye-related changes,
- With type 1 diabetes,
- Who are aged ≥ 65 years,
- With insulin-requiring type 2 diabetes,
- With multimorbidity or diabetes complications,
- With unstable HbA1c ≥8.5% or with no recorded HbA1c in the past six to 12 months, and
- Who smoke.
In addition to these factors for risk, it is important to realise that during times such as COVID-19, factors including reduced physical activity, delayed and/or a localised shortages of medical supplies, as well as the impact on mental health, may place patients in a higher risk category. Therefore, all patients with diabetes need advice on preventive eye health care management and risk-reduction behaviours in accordance with the most current and relevant public health messages for COVID-19. This advice can include reinforcing the importance of achieving healthy goals for nutrition, alcohol/smoking and physical activity; asking about personal concerns including mental health related to diabetes distress; and enquiring about any diabetes-specific management concerns or symptoms that are suggestive of complications. Information gathered should be communicated through appropriate reporting and referrals to the relevant specialist/s involved in the patient’s medical care.
KEEPSIGHT TRUSTED REMINDER SERVICE
Another way that eye care practitioners can support people living with diabetes is to register as a practitioner with KeepSight and to register patients with the program so they can be reminded of when their next diabetes related eye examination is due.
KeepSight was established by Diabetes Australia, Vision 2020 Australia, Oculo and the Centre for Eye Research Australia in collaboration with the Australian Government and several industry funding partners including Specsavers, Bayer, Novartis and Mylan. The program has widespread support from leading diabetes and eye health groups including the Royal Australian and New Zealand College of Ophthalmologists, Orthoptics Australia, Optometry Australia, the Australian Diabetes Society and the Australian Diabetes Educators Association. The aim of the program is to reduce diabetes-related vision loss by making it easier for people to have regular diabetes eye checks with their existing eye health and primary care practitioners under existing Medicare Benefits Schedule (MBS) item numbers.
KeepSight is led by Diabetes Australia, which has administered the National Diabetes Services Scheme for more than 30 years, and as such is widely seen as ‘a trusted voice’. Patients who register with KeepSight are sent reminders to have an eye check via their preferred mode (email, SMS or post). These are independent of any reminders sent by the patient’s regular eye health practitioner, and according to a KeepSight survey, this two-pronged approach is appreciated by people living with diabetes and is proving to be effective.
HOW TO REGISTER AS A KEEPSIGHT PROVIDER
Registering as a KeepSight provider is quick and easy – it takes only a minute.
Eye care providers who already use the Oculo system can log on to Oculo, select a patient, and follow the prompts for KeepSight registration.
Practices that don’t use Oculo can register through the KeepSight web portal with three easy steps:
- Visit www.keepsight.org.au and select ‘For health professionals’ at the right of the screen. On the next screen, click ‘Register today’.
- Provide your email address and create a password, then receive a confirmation email.
- Click on the link in the confirmation email, and then login with the password you have just created. Follow the prompts to enter your information – please note you will need your Australian Health Practitioner Regulation Agency (Aphra) number as part of the registration, or an Orthoptics Australia membership number for orthoptist staff.
You only need to do this once, but you do need to be registered with the system before you can register patients.
HOW TO REGISTER PATIENTS WITH KEEPSIGHT
- Login to the KeepSight website using your email and password created at registration.
- Follow the prompts to record a patient visit.
- Record your patient’s name, some basic information about the eye check provided, and when they will need a follow up eye check. Record their National Diabetes Services Scheme (NDSS) number if they can provide it.
Practices using Oculo will be prompted to register patients with diabetes to KeepSight when managing referrals and clinical correspondence.
PATIENT DATA SECURITY
Patient information collected by KeepSight is strictly managed in accordance with industry best practice to safeguard data security and patient privacy. Identifiable patient information is only available to Diabetes Australia, as the KeepSight lead partner, to remind the patient when eye examinations are due in the future. The data will not be released or shared.
The KeepSight program is not intended to disrupt existing arrangements between eye care providers and their patients, rather it will reinforce this with an additional recall and reminder system.
FIND OUT MORE
Visit www.keepsight.org.au Call (AUS) 1800 533 774 Email firstname.lastname@example.org
Dr Amira Howari B.Optom (Hons) GradCertOcTher, M.Optom (UNSW) is a senior clinical optometrist, healthcare industry and motivational keynote speaker; Diabetes Australia Ambassador, KeepSight Ambassador and former Optometry Australia Councillor (NSW/ACT).
Dr Howari has worked in corporate, independent, ophthalmology and pharmaceutical settings; and at the University of New South Wales as a guest lecturer and clinical supervisor. She currently serves as a member of the Diabetes and Endocrine Network – Agency of Clinical Innovation (NSW Health) and was the founder of the PEACE conference.