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Organisation of seamless teleophthalmology reliable management of diabetic retinopathy screening through
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CANADIAN JOURNAL OF DIABETES
P-1313 sixty second screening identifies persons at risk for diabetic foot ulcers B. Ostrow1, R.G. Sibbald2, K. Woo2, M.G. Rambaran3 1 University of Toronto, Office of International Surgery, Guelph, Canada 2 University of Toronto, Women’s College Hospital, Toronto, Canada 3 Georgetown Public Hospital Corporation, Medical and Professional Services, Georgetown, Guyana aim: To develop and apply a low-tech screening tool for risk status of developing diabetic foot ulcers in a resource-poor setting. Methods: The 60 second screening tool identifies high risk status on the basis of history, examination of the foot for lesions or deformity, monofilament loss of protective sensation, joint stiffness and the absence of a pedal pulse. The tool was applied in a weekly medical diabetic clinic at Georgetown Public Hospital Corporation, (Guyana’s only referral and teaching hospital). The clinic has a population base of more than 2000 patients. High risk status was defined as a single positive score on the tool. Identified high risk patients were referred to the Diabetic Foot Centre for further assessment to prevent foot ulcers through patient education and the supply of appropriate footwear and orthotics. results: Audit of initial screened 1000 patients: 70% of screened population is female; 40% of total screened population is at high risk; 13% had previous ulcers; 5% previous amputation; 8.5% an absent foot pulse; 7.7% an active ulcer. The tool profiles the frequencies of risk factors in the population. Inter- and intra-rater reliability of the tool will be presented. High risk patients referred to DFC form a cohort to determine the effects of patient education, follow-up concerning foot care and the wearing of appropriate footwear on ulcer prevention. Discussion/conclusions: Screening of people with diabetes for high risk status is an essential component of comprehensive diabetes care. It focuses preventive practices and reduces workload for the treatment of foot ulcers and their complications. It also identifies unrecognized ulcers at an early stage. Screening and patient education to change behaviors are the keys to preventing diabetic foot ulcers. The 60 second tool has been adopted by the Ministry of Health in Guyana. Screening Conflict of interest Employee: M.G. Rambaran, Georgetown Public Hospital Corporation P-1316 organisation of seamless and reliable management of diabetic retinopathy screening through teleophthalmology M.C. Boucher1 1 Hôpital Maisonneuve-Rosemont, Ophthalmology, Montréal, Canada aims: Teleophthalmology for screening for diabetic retinopathy (DR) has shown significant visual health results and savings of medical resources in urban and remote communities. Although data and image capture and their electronic transfer are relatively straightforward, management and overview of the screening process are necessary to monitor and insure quality of all steps, from creation of appointments to follow-up with an ophthalmologist and yearly patient recall. Methods: Management tools are needed to insure retrieval of any scheduled patient who has not followed on examination, prompt interpretation of data by the ophthalmologists with an automated redistribution towards other ophthalmologists when delays for interpretation are not met, to flag amongst a large volume of patients any diabetic presenting with a condition dictating intervention or surveillance. Over viewing of timely and appropriate follow-up for each screened diabetic as well as quality control of the medical diagnostics are also needed. Any screening program must insure security and confidentiality, easy management of protected levels of access for specific tasks for imagers, ophthalmologists, computer technicians, administrators as well as tracing of all actions to all
individuals who intervene. Continuing care needs be insured by systematic transmission of screening results to medical doctors involved in the care of the diabetics and by feedback to and recall of screened diabetics. Organized and easily retrievable data for public health analysis providing a prospective DR registry is also pertinent. Management tools need be compatible with any camera used for screening and be usable in conditions with no immediate access to internet. Using specially developed software with all of the above characteristics, screening for DR through teleophthalmology has been performed since 2005 in urban, semi urban and remote communities in over 8,000 diabetics through mobile and permanently located cameras, with and without immediate access to internet. conclusion: Such management software permits easy overview and reliable, safe management of patients screened for DR, monitoring every step of the screening process from the creation of a screening appointment to follow-up with an ophthalmologist to yearly patient recall, while insuring quality control and access to epidemiological data. It could be advantageously used in any public health care screening program for DR. Screening Conflict of interest Stock ownership: Developer and owner of Laboratoires de la Rétine RD, company providing telemedical screening for diabetic retinopathy P-1317 High prevalence of metabolic syndrome in a group of hypertensive patients in Haiti N. Charles-Larco1, E. Jean-Baptiste1, P. Larco1, S. Chauvet1, R. Charles1 1 Fondation Haïtienne de Diabète et des Maladies Cardiovasculaires, Clinique d’hypertension artérielle, Port-au-Prince, Haiti aims: The prevalence of arterial hypertension is high (47%) among people aged = 20 years in the metropolitan area of Port-au-Prince, according to a previously published study. Hypertension is one of the main components of the metabolic syndrome (MS). A high frequency of MS in hypertensive patients can strongly suggest a high prevalence of this syndrome in the same population. The purpose of this study is to evaluate the prevalence of MS and to analyze the relationship between its components among patients of a hypertension outpatient clinic in Port-au-Prince. Methods: A total of 119 consecutive hypertensive patients referred to the hypertension clinic, over a period of 3 months, were assigned to the study group. Hypertension was defined as Blood Pressure = 140/90 mmHg or treatment of previously diagnosed hypertension. Demographic data and anthropometric measurements were collected. Fasting blood glucose and lipid profile were performed by venous sample for each participant. Metabolic Syndrome was defined using the IDF criteria. results: Mean age was 58.0 ± 11.6 years; 77.3% were women. Median duration of hypertension was 4 years, and all the patients were receiving oral medications. MS was found in 64.7% of these hypertensive patients. In 74.8% of the patients, hypertension was associated with at least 2 factors of MS. A total of 78 (65.5%) hypertensive subjects also had abdominal obesity and only 1 patient with abdominal obesity did not have MS. In patients with MS, 80.5% had 4 of the 5 diagnostic components, and the frequency of the components associated with abdominal obesity and hypertension was: reduced HDL cholesterol (97.4%), raised fasting glucose (79.2%) and raised triglycerides (27.7%).Furthermore, 81.5% of hypertensive patients with reduced HDL cholesterol versus 11.1% with normal HDL cholesterol also have abdominal obesity (p<0.001). Logistic regression showed that reduced HDL cholesterol was independently associated with abdominal obesity (p<0.001). conclusions: Our study showed a high prevalence of metabolic syndrome in a group of hypertensive patients in Haiti. This finding associated with the known high prevalence of hypertension in
CANADIAN JOURNAL OF DIABETES
P-1313 sixty second screening identifies persons at risk for diabetic foot ulcers B. Ostrow1, R.G. Sibbald2, K. Woo2, M.G. Rambaran3 1 University of Toronto, Office of International Surgery, Guelph, Canada 2 University of Toronto, Women’s College Hospital, Toronto, Canada 3 Georgetown Public Hospital Corporation, Medical and Professional Services, Georgetown, Guyana aim: To develop and apply a low-tech screening tool for risk status of developing diabetic foot ulcers in a resource-poor setting. Methods: The 60 second screening tool identifies high risk status on the basis of history, examination of the foot for lesions or deformity, monofilament loss of protective sensation, joint stiffness and the absence of a pedal pulse. The tool was applied in a weekly medical diabetic clinic at Georgetown Public Hospital Corporation, (Guyana’s only referral and teaching hospital). The clinic has a population base of more than 2000 patients. High risk status was defined as a single positive score on the tool. Identified high risk patients were referred to the Diabetic Foot Centre for further assessment to prevent foot ulcers through patient education and the supply of appropriate footwear and orthotics. results: Audit of initial screened 1000 patients: 70% of screened population is female; 40% of total screened population is at high risk; 13% had previous ulcers; 5% previous amputation; 8.5% an absent foot pulse; 7.7% an active ulcer. The tool profiles the frequencies of risk factors in the population. Inter- and intra-rater reliability of the tool will be presented. High risk patients referred to DFC form a cohort to determine the effects of patient education, follow-up concerning foot care and the wearing of appropriate footwear on ulcer prevention. Discussion/conclusions: Screening of people with diabetes for high risk status is an essential component of comprehensive diabetes care. It focuses preventive practices and reduces workload for the treatment of foot ulcers and their complications. It also identifies unrecognized ulcers at an early stage. Screening and patient education to change behaviors are the keys to preventing diabetic foot ulcers. The 60 second tool has been adopted by the Ministry of Health in Guyana. Screening Conflict of interest Employee: M.G. Rambaran, Georgetown Public Hospital Corporation P-1316 organisation of seamless and reliable management of diabetic retinopathy screening through teleophthalmology M.C. Boucher1 1 Hôpital Maisonneuve-Rosemont, Ophthalmology, Montréal, Canada aims: Teleophthalmology for screening for diabetic retinopathy (DR) has shown significant visual health results and savings of medical resources in urban and remote communities. Although data and image capture and their electronic transfer are relatively straightforward, management and overview of the screening process are necessary to monitor and insure quality of all steps, from creation of appointments to follow-up with an ophthalmologist and yearly patient recall. Methods: Management tools are needed to insure retrieval of any scheduled patient who has not followed on examination, prompt interpretation of data by the ophthalmologists with an automated redistribution towards other ophthalmologists when delays for interpretation are not met, to flag amongst a large volume of patients any diabetic presenting with a condition dictating intervention or surveillance. Over viewing of timely and appropriate follow-up for each screened diabetic as well as quality control of the medical diagnostics are also needed. Any screening program must insure security and confidentiality, easy management of protected levels of access for specific tasks for imagers, ophthalmologists, computer technicians, administrators as well as tracing of all actions to all
individuals who intervene. Continuing care needs be insured by systematic transmission of screening results to medical doctors involved in the care of the diabetics and by feedback to and recall of screened diabetics. Organized and easily retrievable data for public health analysis providing a prospective DR registry is also pertinent. Management tools need be compatible with any camera used for screening and be usable in conditions with no immediate access to internet. Using specially developed software with all of the above characteristics, screening for DR through teleophthalmology has been performed since 2005 in urban, semi urban and remote communities in over 8,000 diabetics through mobile and permanently located cameras, with and without immediate access to internet. conclusion: Such management software permits easy overview and reliable, safe management of patients screened for DR, monitoring every step of the screening process from the creation of a screening appointment to follow-up with an ophthalmologist to yearly patient recall, while insuring quality control and access to epidemiological data. It could be advantageously used in any public health care screening program for DR. Screening Conflict of interest Stock ownership: Developer and owner of Laboratoires de la Rétine RD, company providing telemedical screening for diabetic retinopathy P-1317 High prevalence of metabolic syndrome in a group of hypertensive patients in Haiti N. Charles-Larco1, E. Jean-Baptiste1, P. Larco1, S. Chauvet1, R. Charles1 1 Fondation Haïtienne de Diabète et des Maladies Cardiovasculaires, Clinique d’hypertension artérielle, Port-au-Prince, Haiti aims: The prevalence of arterial hypertension is high (47%) among people aged = 20 years in the metropolitan area of Port-au-Prince, according to a previously published study. Hypertension is one of the main components of the metabolic syndrome (MS). A high frequency of MS in hypertensive patients can strongly suggest a high prevalence of this syndrome in the same population. The purpose of this study is to evaluate the prevalence of MS and to analyze the relationship between its components among patients of a hypertension outpatient clinic in Port-au-Prince. Methods: A total of 119 consecutive hypertensive patients referred to the hypertension clinic, over a period of 3 months, were assigned to the study group. Hypertension was defined as Blood Pressure = 140/90 mmHg or treatment of previously diagnosed hypertension. Demographic data and anthropometric measurements were collected. Fasting blood glucose and lipid profile were performed by venous sample for each participant. Metabolic Syndrome was defined using the IDF criteria. results: Mean age was 58.0 ± 11.6 years; 77.3% were women. Median duration of hypertension was 4 years, and all the patients were receiving oral medications. MS was found in 64.7% of these hypertensive patients. In 74.8% of the patients, hypertension was associated with at least 2 factors of MS. A total of 78 (65.5%) hypertensive subjects also had abdominal obesity and only 1 patient with abdominal obesity did not have MS. In patients with MS, 80.5% had 4 of the 5 diagnostic components, and the frequency of the components associated with abdominal obesity and hypertension was: reduced HDL cholesterol (97.4%), raised fasting glucose (79.2%) and raised triglycerides (27.7%).Furthermore, 81.5% of hypertensive patients with reduced HDL cholesterol versus 11.1% with normal HDL cholesterol also have abdominal obesity (p<0.001). Logistic regression showed that reduced HDL cholesterol was independently associated with abdominal obesity (p<0.001). conclusions: Our study showed a high prevalence of metabolic syndrome in a group of hypertensive patients in Haiti. This finding associated with the known high prevalence of hypertension in