Trends of barriers to eye care among adults with diagnosed diabetes in Germany, 1997-2012

•The prevalence of diabetes is increasing but diabetics are not receiving eye care at recommended intervals.•A downward trend in annual eye-care visits occurred over the last decade.•Stronger decline occurred in lower socio-economic groups and those with poor diabetic control, comorbidities, and complications.•Awareness to perform regular eye examination needs to raised among patients and general practitioners.

Background and aimsTo study trends of barriers to receiving recommended eye care among subjects with diabetes aged 20-81 years in northeast Germany.Methods and resultsWe analyzed population-based data from two repeated cross-sectional surveys conducted in 1997-2001 and 2008-2012 (Ns of 4308 and 4402). Andersen's Behavioral Model of Health Services Utilization was used to identify individual-level demographic, financial and health-related barriers to annual eye-care utilization in subjects with a self-reported physician's diabetes and to examine population trends in these barriers. The prevalence of diabetes increased from 6.5% to 11.4%. The prevalence of annual eye-care utilization among persons with diabetes decreased from 69.4% to 56.0% (adjusted relative risk = 0.77, p < 0.001). The decline of eye care utilization over the past decade in eye-care use was more pronounced in groups at risk for diabetes-related complications (i.e., lower socio-economic status, >5 years since diagnosis of diabetes, poor glycemic control, obesity, smoking, lack of physical activity, co-existing diseases). We identified relevant predictors of missed annual eye-care use among diabetics.ConclusionThe increase of diabetes prevalence and downward trend of eye-care visits at the recommended level call for development, implementation and evaluation of continued efforts to improve access to eye specialists, particularly among those with poor diabetic control, co-existing diabetic complications, and comorbidities.