Kristen Nwanyanwu, MD.

  
According to the 2022 National Diabetes Statistics Report from the Centers for Disease Control and Prevention, more than 11 percent of the U.S. population (approximately 37.3 million people) have diabetes. Alarmingly, 96 million people aged 18 years or older have prediabetes, which is 38 percent of the adult U.S. population. And, diabetes is the leading cause of new cases of blindness among adults aged 18–64 years. This month, Prevent Blindness sounded the alarm about the dangers of diabetes to our vision and declared November as Diabetes-Related Eye Disease Awareness Month.

VMAIL Weekend sat down with Kristen Nwanyanwu, MD, MBA, MHS, associate professor of Ophthalmology and Visual Science, Yale School of Medicine. Dr. Nwanyanwu is also the principal investigator at the SEEN Lab which stands for Sight-Saving Engagement and Evaluation in New Haven, Connecticut. Here’s what she had to say about how ECPs can improve the lines of communication with Primary Care Physicians and why it’s so important for diabetes patients to have a care plan and advocate for themselves.

Question 1: During the webinar titled “Diabetes and Your Eyes,” your description of how diabetes affects the eyes was very informative. Could you summarize it for our readers?

A: The inflammatory environment in the body impacts the blood vessels of the eyes. Those vessels leak and new, very fragile vessels are formed. That is what causes macular edema and diabetic retinopathy. When treating patients with diabetes, optometrists should follow practice patterns recommended by the American Diabetes Association and the American Academy of Optometry. And if they have any doubts they should always refer patients to a specialist in diabetic retinopathy. Timing is very important when it comes to diabetic retinopathy.

The Sight-Saving Engagement and Evaluation in New Haven seeks to decrease preventable blindness from diabetic retinopathy through research and community engagement. Our team employs quantitative and qualitative research methods to address health disparities in diabetic retinopathy. We not only identify and contextualize health disparities; we also design sustainable, community-engaged solutions along the path toward equity.

 
 
Question 2: Can you talk about how important it is for a Primary Care Physician (PCP) and an optometrist or ophthalmologist to discuss a patient’s progress or lack thereof in the fight against diabetes. How can ECPs improve the lines of communication with PCPs and how big a role do electronic health care records play when it comes to doctors’ communication?

A: It’s important to acknowledge that one’s journey with diabetes is very personal and can be very challenging. Moving forward with the resources available and without shame is paramount to pursuing one’s best health with diabetes. Communication between providers can be challenging. Electronic medical records lack interoperability and do not communicate well with one another. Faxed documents often end up in the “junk drawer” of those electronic medical records, rendering them useless.

The American Diabetes Association is working hard on this. Our health system can definitely improve the information safety-net, which is paramount to optimizing care. In the interim, I encourage all providers to take the extra time to send notes to the diabetes care team of all your patients. As a retina surgeon, my diagnosis of proliferative diabetic retinopathy is important to my primary care colleagues because it is associated with increased mortality, heart attack and stroke. We have to work together to not only usher our patients to their best vision, but also to their best health. The best way to do that is to work with a team.

Question 3: Diabetes brings about many challenges for patients, especially the fear of the unknown when it comes to the possibility of losing their sight. How can ODs and MDs help patients overcome these challenges and its psychological effects?

A: There is a body of literature about the shame that comes from the arduous task of diabetes management. Open and honest communication is the best way to discuss the realities of a diagnosis of diabetes with patients. We have to work together with the patient in the center of our diabetes care community. Mental health is an important part of that care team. Depressed mood may worsen diabetes control and I have referred several patients to mental health professionals to support their diabetes care.


  
Question 4: As a researcher, are there any new treatments that seem especially promising for diabetes patients when it comes to saving their sight?

A: Continuous glucose monitoring has been incredible. Also, the number of diabetes medication that can act at different areas of the pathway is phenomenal. There are so many more choices for our colleagues that manage blood glucose. Now, we need to continue to work on increasing accessibility to those medication to all of our patients. Currently, there is a subset of disadvantaged patients that are unable to receive or afford the best medications for their health.

Question 5: Finally, what kind of an effect did the pandemic have on the rise of diabetes? Did the lockdowns and years-long fight against COVID discourage people from seeking help when it came to diabetes related eye diseases?

A: Many studies have demonstrated the delayed examination and treatment of diabetic retinopathy rose during the pandemic. Currently, we are still learning about the association between COVID-19 and diabetes.

Learn More About It
Panelists of the “Diabetes and Your Eyes: A Conversation Around Patient-Centered Care” webinar discuss how health care providers coordinate care for persons with diabetes, talk with each other, and consider patient needs. Leading doctors from throughout the U.S. who care for individuals with diabetes as well as a patient with diabetes participated in the conversation which was moderated by Jeff Todd, president and CEO of Prevent Blindness.

Diabetes and its care has been front page news for years now, especially with the debate over the price of lifesaving insulin. And, of course, it is always top of mind for those in the eyecare industry—especially ECPs, who are often a patient’s first line of defense against the disease. In the feature titled “This November, Diabetes Awareness Takes Center Stage for Indies,” VM takes a look at some social media posts from ECPs and organizations who’ve already stepped up.

For more on how ODs and primary care physicians can work together as a team, read "American Optometric Association Partners With American Diabetes Association and Leading Eye Organizations to Improve Eye Health Outcomes."