Spurr Shelley, Bullin Carol, Bally Jill, Trinder Krista, Khan Shahab
a College of Nursing , University of Saskatchewan , Saskatoon , Canada.
b College of Medicine , University of Saskatchewan , Saskatoon , Canada.
Int J Circumpolar Health. 2018 Dec;77(1):1422670. doi: 10.1080/22423982.2017.1422670.
Diabetic retinopathy is the most common cause of new cases of blindness and is pandemic among Aboriginal people around the world. To reduce health inequities, accessible vision screening among these high-risk populations is essential. To assess cardio-metabolic co-morbidities associated with type 2 diabetes and the use of a portable fundus camera as a novel approach for convenient, earlier and more accessible vision screening for Aboriginal peoples living with type 2 diabetes in northern and remote Canadian communities. This quantitative pilot study screened participants diagnosed with type 2 diabetes for commonly associated cardio-metabolic co-morbidities using anthropometrical measurements, blood pressure and a A1c (HbA1c) blood glucose test, followed by vision exams conducted first by a trained nurse and then by an ophthalmologist to screen for signs of retinopathy using fundus photography. Large numbers of the participants presented with overweight/obese (84.8%), pre-hypertension/hypertension (69.7%) and an elevated A1C (78.8%). Inter-rater reliability demonstrated substantial agreement between vision exam judgements made by the nurse and ophthalmologist (k = .67). Nurse-led vision screening in remote or northern communities can improve the standard of care by extending access to health services, lowering the costs to families by reducing travel expenses and preventing vision loss in a family member.
糖尿病性视网膜病变是导致失明新病例的最常见原因，在世界各地的原住民中广泛流行。为了减少健康不平等现象，在这些高危人群中进行可及的视力筛查至关重要。评估与2型糖尿病相关的心脏代谢合并症，并使用便携式眼底相机作为一种新颖的方法，为生活在加拿大北部和偏远社区的2型糖尿病原住民提供方便、早期且更易获得的视力筛查。这项定量试点研究使用人体测量、血压和糖化血红蛋白（HbA1c）血糖测试，对被诊断为2型糖尿病的参与者进行常见相关心脏代谢合并症的筛查，随后先由一名经过培训的护士进行视力检查，然后由一名眼科医生使用眼底摄影筛查视网膜病变迹象。大量参与者存在超重/肥胖（84.8%）、高血压前期/高血压（69.7%）以及糖化血红蛋白升高（78.8%）。评分者间信度表明护士和眼科医生做出的视力检查判断之间存在高度一致性（k = 0.67）。在偏远或北部社区由护士主导的视力筛查可以通过扩大医疗服务可及性、减少家庭旅行费用从而降低家庭成本以及预防家庭成员视力丧失来提高护理标准。
