The current status of diabetes care, diabetic retinopathy screening and eye-care in British Columbia's First Nations Communities

Objectives. The objective of this study was to evaluate the current status of primary diabetes care, diabetic retinopathy screening, and eyecare for First Nations individuals with diabetes living on-reserve in British Columbia. Study Design. Prospective cross-sectional observational survey. Methods. A mail-out survey was sent to all BC First Nations Communities in the format of a 26-item questionnaire. A series of general questions were asked concerning community populations, regional transportation options and the availability of local healthcare providers. Specific questions about the frequency and source of eye and diabetic retinopathy care in each community were also solicited. Results. A sixty-seven percent questionnaire response rate was achieved (136/202 communities). The community-reported rate of diabetes mellitus ranged from 4.8 to 11.8% with an average of 6.4%. The proportion of on-reserve individuals with diabetes receiving yearly retinal examinations for diabetic retinopathy was found to be only 33%. Many communities received eye-care from more than one professional group, but the majority of basic eye-care and retinopathy screening was provided by optometrists. Ophthalmologists were less likely to provide eye-care for these communities; however, family physicians and nurses were frequently responsible for performing eye evaluations. Conclusions. The vast majority of First Nations people with diabetes who live on-reserve in British Columbia do not have access to annual examinations by an eye-care professional. Eye evaluations and retinal screening were often the responsibility of individuals with little formal training in this area. (Int J Circumpolar Health 2004; 63(3):277-285) Keywords: diabetes, diabetic retinopathy, First Nations, screening