Kentuckiana Health Collaborative (KHC), in partnership with the Kentucky Department for Public Health’s (KDPH) Diabetes Prevention and Control Program, has released Recommendations to Improve Screening for Diabetes-Related Nephropathy and Retinopathy.
Kentucky has the 9th highest rate of diabetes-related mortality in the country. As of 2023, in Kentucky, 482,202 people (13.7% of the population) were estimated to have diabetes, with an additional 380,916 people with prediabetes, meaning they were at-risk for developing diabetes in the future. Diabetes contributes to increased risk for morbidities such as nephropathy (kidney disease) and retinopathy (eye disease).
The American Diabetes Association (ADA) recommends that adults with type 1 and type 2 diabetes have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist within five years of diabetes onset (type 1) or at the time of diagnosis (type 2). Screening every one to two years is recommended if there is no evidence of retinopathy from one or more annual eye exams and glycemic indicators are within range.
The ADA recommends that kidney function be assessed through a urine albumin and estimated glomerular filtration rate (eGFR) in people who have had type 1 diabetes for five years or greater and in all people with type 2 diabetes, regardless of treatment. Among those with established CKD, urinary albumin and eGFR is recommended one to four times annually depending on the stage of the disease.
Without proper screening, diabetes-related complications can go undetected until they reach advanced, costly stages with potentially irreversible outcomes. Increasing screening rates can reduce the incidence and severity of preventable kidney and eye diseases and enhance the quality of life for people with diabetes in Kentucky.
Why This Report Was Developed
The report was developed in response to low screening rates for diabetes-related kidney and eye disease in Kentucky. KDPH partnered with KHC to better understand the barriers that prevent people with diabetes from receiving recommended screenings and to develop recommendations that reflect the expertise of a diverse group of healthcare stakeholders, ultimately leading to earlier detection of retinopathy and nephropathy in people with diabetes and improved health outcomes.
Understanding the Current Landscape
The report draws on three sources of information: KHC’s Consolidated Measurement Reports (CMR), a statewide survey of healthcare providers and healthcare practice administrators, and a stakeholder roundtable.
Data from the CMRs provided rates of diabetes-related kidney and eye screening using healthcare claims data. The provider survey examined current screening practices and identified barriers that may prevent people with diabetes from receiving recommended kidney and eye screenings. Survey questions were developed using American Diabetes Association screening recommendations as a framework and explored current practices, referral processes, and challenges experienced in clinical settings.
CMR and survey findings were presented during a stakeholder roundtable that brought together healthcare professionals, public health representatives, subject matter experts, and individuals with lived experience. Participants provided their front line perspectives and discussed opportunities to improve diabetes-related kidney and eye screening.
From Findings to Recommendations
The recommendations in the report reflect findings from the statewide assessment and input from stakeholders across Kentucky. They are intended to support healthcare organizations, providers, public health agencies, payers, and community partners in increasing diabetes-related kidney and eye screening and improving early detection of diabetes-related complications.
Report Recommendations
- Strengthen Education for Providers and People with Diabetes
- Improve Care Coordination and Navigation
- Optimize Data Infrastructure
- Expand Community-Based Screening Access
- Align Quality Improvement Activities and Incentives
- Reduce Financial Barriers to Care
Looking Ahead
Given the low eye and kidney screening rates for people with diabetes in Kentucky, and the growing number of people with diabetes, it is imperative to use data to drive collective action toward improvement. This report provides six recommendations that can serve as a foundation for driving momentum forward.
Stakeholders across the healthcare ecosystem are encouraged to review these recommendations, assess their application within their organizations, evaluate their data to identify opportunities for quality improvement, and leverage new and existing partnerships to reduce fragmentation of efforts and maximize available resources.
The KHC and KDPH Diabetes Prevention and Control Program will build on this report in the next phase of work by engaging employers and their primary care partners in data collection, peer learning, and quality improvement activities. These efforts will focus on increasing screening rates for nephropathy and retinopathy among their employees and covered lives with diabetes. Additional information will be available soon.
Read the full report to learn more about the project’s methodology, findings, and recommendations.
