AOA releases second edition of diabetes clinical practice guideline

Citing the significant public and economic burden posed by diabetes in the U.S., the AOA has issued its revised, evidence-based clinical practice guideline on the disease for doctors of optometry and other health professionals who deliver care to patients with diabetes.

The AOA's Evidence-Based Clinical Practice Guideline: Eye Care of the Patient with Diabetes Mellitus, Second Edition, recommends 31 actions doctors of optometry can take to enhance the care they provide to patients with diabetes. The guideline represented two years of revision by the AOA's Evidence-Based Optometry (EBO) Committee, using a systematic and rigorous clinical review process. The previous evidence-based AOA guideline on diabetes was published in 2012.

An estimated 12-14% of Americans have diabetes and its financial burden was over $400 billion in 2017, according to the guideline.

"Diabetes has reached epidemic proportions in this country and, as America's eye doctors, we can make an impact on the lives of millions of Americans who have the disease," says AOA President Barbara L. Horn, O.D., who thanked the EBO committee for its considerable and significant work.

"Doctors of optometry are often the first health care provider to examine persons with undiagnosed diabetes,' Dr. Horn says. "This updated, evidence-based guideline provides them with recommendations for the timely diagnosis and appropriate care of these patients. A handy reference, it should be in the practice of every doctor of optometry and any health professional who manages the care of patients with diabetes."

Diane Adamczyk, O.D, EBO Committee chair, calls the content of the newly revised diabetes guideline "stellar" and a "wealth of good information" for doctors, whether they are new or seasoned on the subject.

"Diabetes is one of the leading causes of preventable blindness in the United States," Dr. Adamczyk says. "It often appears first and is discovered first through an eye exam. We're seeing more and more people suffering from diabetes. With millions of Americans having been diagnosed with diabetes, this guideline can help make a difference in raising the quality of their lives."

The AOA has reported that doctors of optometry found more than 301,000 patients with diabetes-related eye manifestations in 2018 who did not know they were prediabetic/diabetic.

In a Q&A, Dr. Adamczyk, who has chaired the EBO Committee since 2012, discusses the newly revised diabetes guideline and what it means for doctors and diabetic patients.

The AOA has produced four clinical practice guidelines, but you've called this latest AOA guideline on diabetes a "wow." Why? What's in it?

First, with each evidence-based guideline we've done, the evidence-based process has been improved and that's reflected in the second edition of the diabetes guideline. Take, for example, the evidence-based action statements contained in the diabetes guideline. They provide not only important direction to the clinician in their care of a diabetic patient, but also clearly delineate the evidence that is the foundation for the action statement. Second, the tables and appendix items provide exceptional overviews of the evidence (studies) and how the evidence translates into clinical care. Through the literature search, we identified more than a thousand relevant abstracts, reviewed them and assigned more than 400 articles for grading and referencing in the guideline. And third, the guideline takes the vast amount of information on diabetes and provides an exceptional, comprehensive document for those providing eye care to diabetic patients.

What's the purpose of a clinical practice guideline?

As the title suggests, the guideline provides guidance to the clinician, specifically to the optometrists in providing eye care that's based on the most current, highest-level, scientific evidence. Giving the best care possible to these patients is the bottom line.

Why was the clinical practice guideline on diabetes revised?

Changes in health care are ongoing and this is especially seen in the care of the diabetic patient. New studies are always coming out. New drugs and treatment modalities are being developed. New diagnostic tools and technology are available. Revision of the guideline reflects these ongoing changes and is built on the solid foundation of the first edition.

Who should use the guideline?

The primary audience is the optometrist who is providing eye care to the diabetic patient. But the guidance contains important information for others, including primary care doctors, endocrinologists, patients, paraoptometrics and other health care professionals who are a part of the team that provides care to diabetic patients. It is also an exceptional resource for optometry students and educators.

Who serves on the EBO diabetes guideline development group?

Part of the brilliance of the process is that the development group must be made up of several stakeholders other than doctors of optometry. In addition to optometrists, the development group included an endocrinologist, a retinologist, a patient advocate and a patient with diabetes. They all provided important input and perspective to the guideline that not only elevates the quality of the guideline, but ultimately helps to elevate the eye care provided. The work of the committee and its dedicated members was just outstanding.