Background and Aims: Early detection and treatment of diabetic retinopathy (DR) and the measurement, modification and monitoring of behaviours that increase DR risk are key in DR management. Primary care-based digital retinal imaging with remote DR grading in conjunction with the electronic capture, monitoring and reporting of relevant lifestyle behaviours may assist individuals with diabetes and their health-care providers to protect against vision loss. Comprehensive Indigenous data are lacking. We aim to develop, implement and assess user acceptance of and data from complementary telehealth retinal imaging and lifestyle survey applications as a DR screening tool for reducing risk of vision loss in Indigenous people with diabetes in remote Australia.
Methods/Design: A suite of five electronic lifestyle surveys based on recommendations in the Standard Treatment Manual [6th edition] of the Central Australian Rural Practitioner’s Association is being developed to capture smoking history, nutrition/diet quality, alcohol intake, physical activity and emotional well-being/depression. Retinal imaging software used by the (US) Indian Health Service will be modified for use in remote Australian communities by trained, mainly Indigenous primary care staff. Indigenous Australians with type 2 diabetes (n=200) will be recruited from a remote Aboriginal Controlled Community Health Organisation in the Northern Territory. Diabetes status will be based on clinical records. Analyses will include user acceptance and relationships between lifestyle and retinopathy profiles in study participants who actively engage with the lifestyle assessment tool following a retinal imaging session during which the importance of metabolic control on eye health/vision is discussed.
Conclusion: A DR screening model for primary care health services that combines telehealth applications for retinal imaging, remote grading and structured lifestyle assessment may be an acceptable approach to reduce risk of vision loss in Indigenous Australians with diabetes.
Key words: telehealth, diabetes, diabetic retinopathy, lifestyle, survey, smoking, nutrition, diet, alcohol, physical activity, depression