Prevalence of Diabetic Retinopathy Among Native Americans with Diabetes at a Tribal Clinic in Oklahoma.

Purpose: Native Americans (NAs) have the highest prevalence of diabetes mellitus (DM) of any racial group in the USA and are therefore at higher risk for diabetic retinopathy (DR) and diabetic macular edema (DME). This study estimated the prevalence of DR and DME among NAs receiving eye exams at the Citizen Potawatomi Nation (CPN) clinic, a tribal clinic in Oklahoma serving members of multiple tribes, and characterized risk markers associated with the presence and severity of DR.

Methods: A retrospective chart review identified tribal members with DM who received dilated retinal fundus exams at the CPN clinic between 2021 and 2023. The presence and stage of DR and DME among participants were recorded. Hypotheses of association between the presence or severity of DR and medical and socioeconomic factors were tested.

Results: Among the 504 participants, the prevalence of DR was 19.4% (95% CI 16.1-23.2%), including 16.3% (95% CI 13.2-19.8%) with non-proliferative DR and 3.2% (95% CI 1.8-5.1%) with proliferative DR, and 3.4% (95% CI 2.0-5.4%) with DME. Nephropathy, longer duration of DM, higher HbA1c, insulin use, and Medicaid insurance were associated with the presence of DR (p < 0.05).

Conclusions: This study found a lower prevalence of DR than did earlier studies of NAs with DM. The mean HbA1c in this cohort was lower than in earlier studies, suggesting that diabetes management has improved. Several medical or socioeconomic factors were associated with the presence and severity of DR.