Diabetic Retinopathy in Primary Healthcare in a Brazilian Municipality: A Cross-Sectional Study Using Teleophthalmology.

Background: Diabetic retinopathy is a complication of diabetes and the leading cause of irreversible blindness in people of working age. This study aims to estimate the prevalence of diabetic retinopathy among individuals taking insulin who attend the primary healthcare in the municipality of Jardinópolis, state of São Paulo, Brazil. Methods: This is a cross-sectional study with a sample of 152 participants, in which data collection occurred in March 2023 by means of interviews, laboratory exams and fundoscopy with a portable retinal camera mounted onto a device attached to a smartphone. The captured images were automatically analysed by means of deep learning algorithms for grading retinal alterations, as well as diabetic retinopathy. Results: The prevalence of diabetic retinopathy was estimated to be 28.3% (95% CI 21.1-35.4), with most of the cases corresponding to mild non-proliferative diabetic retinopathy (65.1%). No association was found between diabetic retinopathy and the variables investigated. Concordance test between self-reported and diagnosed diabetic retinopathy showed a Kappa coefficient of 0.30 (95% CI, 0.13-0.47), in which 16.5% of the participants reported having no diabetic retinopathy despite being diagnosed as having it. However, 9.9% of the participants self-reporting having diabetic retinopathy were not diagnosed with it. Conclusions: The prevalence of diabetic retinopathy is within the national range. The lack of knowledge on the diagnosis of diabetic retinopathy and aspects related to such a complication of diabetes was found to be worrying. Therefore, one highlights the importance of primary healthcare programmes in promoting integral care to people with diabetes, including ocular health.