1. Personalised Eye Consultation (PEC) to improve outcomes in DR Dr Eva Fenwick (Research Fellow) Behavioural Research in Ophthalmology Prue Spencer, Project Manager

2. Behavioural Research in Ophthalmology Unit Four main themes: 1.Prevention and management of eye diseases 2.Development of new patient-centred outcome measures 3.Development and evaluation of interventions to improve patient- centred outcomes 4.Translating our research into policy and practice

3. Study Rationale For every 1% reduction in blood glucose there is a 25% reduction in microvascular complications NHMRC guidelines state that helping people to improve glycaemic control is essential to reduce risk and progression of diabetic retinopathy (DR) Source:Diabetes Control and Complications Trial Study Group (1995) Diabetes, 44: 968-83

4. Patients at RVEEH Only 14% achieve optimal blood glucose control (Wong et al., 2009) Those with DR are 3x more likely to have suboptimal blood glucose control Only 17% correctly understood the meaning of the HbA1c test (Wang et al., 2008) 57% rated blood glucose control as important for eye health (Wang et al., 2008)

5. Understanding of DR Patients with DR: (Fenwick et al, 2013) “I was just in this fool’s paradise, I’m just diabetic, oh background retinopathy there’s nothing to worry about, and then all of a sudden your eye’s full of blood and there’s plenty to worry about” “I don't know how exactly you get eye problems [from diabetes]. I can fix cars but I can't fix human beings” Retinal specialists: (Fenwick et al, 2013) “My experience is that almost no person with diabetes who ends up with vision loss has a correct understanding of what happened”

6. Lack of support in diabetes management Half Australians have never been offered structured diabetes education. For those that have, the majority only offered this at diagnosis. Many diabetes education initiatives fail to improve blood glucose control.

7. Our approach Incorporate evidence- based behaviour change techniques alongside routine consultations. Personalised Eye Consultation Personal Retinal Image Individualised behaviour change techniques

8. Retinal images Healthy retina Mild non-proliferative DR Moderate non-proliferative DR Proliferative DR

10. Study Aims Aim 1: To assess the effectiveness of PEC on clinical and behavioural outcomes. Aim 2: To determine factors associated with improved clinical outcomes and identify mechanisms of change. Aim 3: To determine the cost-effectiveness of PEC. Primary outcome: HbA 1c Secondary outcomes: cognitive, behavioural and psychological outcomes Assessment schedule: 3-, 6- and 12-months follow-ups. Primary outcome: HbA 1c Secondary outcomes: cognitive, behavioural and psychological outcomes Assessment schedule: 3-, 6- and 12-months follow-ups.

11. Inclusion criteria: Type 2 diabetes Mild/Moderate NPDR Suboptimal HbA1c (≥8%) No previous treatment for DR 18 years or over No cognitive impairment English speaking

12. Project significance Our Personalised Eye Consultation: Addresses urgent need to assist patients with DR to achieve optimal blood glucose levels and avoid vision loss. Can fit alongside routine eye consultations and could be administered by a range of allied health professionals. Provides a far reaching and accessible approach. Has wider application to other diabetes related conditions or other chronic disease.

13. Do you have Type 2 diabetes and early stage DR? Would you like to be involved in the trial? Do you know anyone who would be interested in participating? Talk to Prue today!! Principle Investigator Gwyn Rees: grees@unimelb.edu.au 9929 8048 Prue Spencer: prue.spencer@unimelb.edu.au 9929 8174