Diabetes

Rational:

Diabetes is a complex group of diseases marked by high blood glucose (blood sugar) due to the body’s inability to make or use insulin. Left unmanaged, diabetes can lead to serious micro- and macro-vascular complications, including heart disease, stroke, hypertension, blindness, kidney disease, diseases of the nervous system, amputations; and premature death. In addition to proper diabetes management to control blood glucose, it is essential to monitor the development of complications and provide treatment at their early stages. Diabetic retinopathy is a major cause of blindness in developed countries. The risk for retinopathy is higher in diabetes patients with poor blood glucose control, unbalanced blood pressure and hyperlipidemia; the risk also increases with time elapsed since onset of the disease. Since non-proliferative retinopathy may remain a-symptomatic event in advanced stages of the condition, it is essential to conduct routine eye examinations (which includes thorough examination of the retina). The original quality measure referred to a yearly examination. However, updated guidelines recommend an eye examination every two years in patients with controlled diabetes, whose previous eye examination was normal [1]. Since data regarding the results of eye examinations cannot be retrieved uniformly from the HMOs databases, the updated quality measure uses as a proxy the time elapsed since onset of diabetes: a yearly eye exam for individuals who’ve had diabetes for at least 10 years, and an eye exam once in two years for those who’ve had diabetes for less than 10 years.