Does the Severity of Type 2 Diabetes Affect Yearly Diabetic Retinal Examination?: A Cross Sectional Analysis of the Korea National Health and Nutrition Examination Survey 2013-2015

Background: The purpose of this study was to analyze how the severity of type 2 diabetes impacts the prevalence of diabetic retinal examinations, to explore the prevention of microvascular complications and to clarify the factors associated with yearly eye examinations in diabetes patients. Methods: This was a cross-sectional study. We chose 11 factors related to type 2 diabetes patients, including hemoglobin A1c (HbA1c), age, education level, income level, and comorbidity with hypertension. We used the chi-square test and logistic regression to analyze these factors according to whether or not patients had undergone fundus examination. Results: After adjustment for covariates, we found no significant relationship between severity of type 2 diabetes and yearly diabetic retinal examinations. However, patients with severely uncontrolled type 2 diabetes (HbA1c≥10%) tended to undergo more diabetic retinal examinations than other groups. Additionally, individuals with lower levels of education were found to be significantly less likely to have a fundus examination, while patients with hypertension tend to more likely to undergo yearly diabetic retinal examinations. Conclusion: Patients with uncontrolled type 2 diabetes do not undergo more yearly diabetic retinal examinations than patients with controlled type 2 diabetes (HbA1c＜7%). Physicians should educate patients with severely uncontrolled type 2 diabetes on the importance of yearly retinal screening. Physicians and policy makers should also strongly recommend yearly eye examinations for diabetic patients who smoke, have lower levels of education, or have comorbidity with hypertension