Clinical and Psychosocial Factors Influencing Retinal Screening Uptake Among Young Adults with Type 2 Diabetes

  • A. J. LakeEmail author
  • G. Rees
  • J. Speight
Psychosocial Aspects (SS Jaser, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Psychosocial Aspects


Purpose of Review

Young adults with type 2 diabetes (T2D, 18–39 years) experience early-onset and rapid progression of diabetic retinopathy (DR), the leading cause of vision loss for working age adults. Despite this, uptake of retinal screening, the crucial first step in preventing vision loss from DR, is low. The aim of this review is to summarize the clinical and psychosocial factors affecting uptake of retinal screening.

Recent Findings

Barriers include lack of diabetes-related symptoms, low personal DR risk perception, high rates of depression and diabetes-related distress, fatalism about inevitability of complications, time and financial constraints, disengagement with existing diabetes self-management services, and perceived stigma due to having a condition associated with older adults.


Young adults with T2D are an under-researched population who face an accumulation of barriers to retinal screening. Tailored interventions that address the needs, characteristics, and priorities of young adults with T2D are warranted.


Diabetic retinopathy Young adults Type 2 diabetes Retinal screening Patient barriers Psychosocial Clinical 


Funding Information

Amelia Lake was supported by a Deakin University, School of Psychology Higher Degree Research publication award. Jane Speight is the Foundation Director of the Australian Centre for Behavioural Research in Diabetes, with core funding provided by a collaboration between Diabetes Victoria and Deakin University.

Compliance with Ethical Standards

Conflict of Interest

A. J. Lake, G. Rees, and J. Speight declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

The studies involving human participants, which were conducted by the authors and which are contained in this review, were conducted in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the studies.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    •• Lascar N, Brown J, Pattison H, Barnett AH, Bailey CJ, Bellary S. Type 2 diabetes in adolescents and young adults. Lancet Diabetes Endocrinol. 2018;6(1):69–80. This paper describes the epidemiology, pathophysiology, socioecological determinants, and clinical and complication characteristics of younger-onset T2D. CrossRefPubMedGoogle Scholar
  2. 2.
    Al-Saeed AH, Constantino MI, Molyneaux L, D’Souza M, Limacher-Gisler F, Luo C, et al. An inverse relationship between age of type 2 diabetes onset and complication risk and mortality: the impact of youth-onset type 2 diabetes. Diabetes Care. 2016;39:823–9. Scholar
  3. 3.
    Leasher JL, Bourne RAA, Flaxman SR, Jonas JB, Keeffe J, Naidoo K, et al. Global estimates on the number of people blind or visually impaired by diabetic retinopathy: a meta-analysis from 1990 to 2010. Diabetes Care. 2016;39:1643–9. Scholar
  4. 4.
    Wong J, Molyneaux L, Constantino M, Twigg SM, Yue DK. Timing is everything: age of onset influences long-term retinopathy risk in type 2 diabetes, independent of traditional risk factors. Diabetes Care. 2008;31(10):1985–91. Scholar
  5. 5.
    Zimmet P, Magliano DJ, Herman W, Shaw J. Diabetes: a 21st century challenge. The Lancet Diabetes & Endocrinology. 2014;2(1):56–64. Scholar
  6. 6.
    Agardh E, Agardh CD, Hansson-Lundblad C. The five-year incidence of blindness after introducing a screening programme for early detection of treatable diabetic retinopathy. Diabet Med. 1993;10(6):555–9. Scholar
  7. 7.
    Arun CS, Ngugi N, Lovelock L, Taylor R. Effectiveness of screening in preventing blindness due to diabetic retinopathy. Diabet Med. 2003;20(3):186–90. Scholar
  8. 8.
    Ferris FL. How effective are treatments for diabetic retinopathy? J Am Med Assoc. 1993;269(10):1290–1.CrossRefGoogle Scholar
  9. 9.
    Gibson DM. Eye care availability and access among individuals with diabetes, diabetic retinopathy, or age-related macular degeneration. JAMA Ophthalmol. 2014;132(4):471–7. Scholar
  10. 10.
    Hutchinson A, McIntosh A, Peters J, O'Keeffe C, Khunti K, Baker R, et al. Effectiveness of screening and monitoring tests for diabetic retinopathy—a systematic review. Diabet Med. 2000;17(7):495–506.CrossRefPubMedGoogle Scholar
  11. 11.
    Mitchell P, Foran S. Guidelines for the management of diabetic retinopathy. National Health and Medical Research Council, Commonwealth of Australia. 2008. Accessed 22 Aug 2017.
  12. 12.
    American Diabetes Association. Standards of care: microvascular complications and foot care. Diabetes Care. 2017;40(Suppl 1):88–98. Scholar
  13. 13.
    National Institute for health and Care Excellence. Type 2 diabetes in adults: management NICE guideline [NG28]. 2015. Accessed 22 Aug 2017.
  14. 14.
    Foreman J, Keel S, Xie J, Van Wijngaarden P, Taylor HR, Dirani M. Adherence to diabetic eye examination guidelines in Australia: the National Eye Health Survey. Med J Aust. 2017;206(9):402–6.CrossRefPubMedGoogle Scholar
  15. 15.
    •• Scanlon PH, Stratton IM, Leese GP, Bachmann MO, Land M, Jones C, et al. Screening attendance, age group and diabetic retinopathy level at first screen. Diabetic Medicine. 2016;33(7):904–11. This paper demonstrates the considerable delay in retinal screening uptake for young adults with T2D and links time to first screen with rate of vision-threatening retinopathy. CrossRefPubMedGoogle Scholar
  16. 16.
    Moreton RBR, Stratton IM, Chave SJ, Lipinski H, Scanlon PH. Factors determining uptake of diabetic retinopathy screening in Oxfordshire. Diabet Med. 2017;34(7):993–9. Scholar
  17. 17.
    Paksin-Hall A, Dent ML, Dong F, Ablah E. Factors contributing to diabetes patients not receiving annual dilated eye examinations. Ophthalmic Epidemiol. 2013;20:281–7. Scholar
  18. 18.
    Shi Q, Zhao Y, Fonseca V, Krousel-Wood M, Shi L. Racial disparity of eye examinations among the U.S. working-age population with diabetes: 2002-2009. Diabetes Care. 2014;37(5):1321–8. Scholar
  19. 19.
    Villarroel MA, Vahratian A, Ward BW. Health care utilization among U.S. adults with diagnosed diabetes, 2013. In: National Centre for Health Statistics Data Brief. US Department of Health and Human Services. 2015. Accessed 22 Aug 2017.
  20. 20.
    MacLennan PA, McGwin G, Heckemeyer C, et al. Eye care use among a high-risk diabetic population seen in a public hospital’s clinics. JAMA Ophthalmol. 2014;132(2):162–7. Scholar
  21. 21.
    Sachdeva A, Stratton IM, Unwin J, Moreton R, Scanlon PH. Diabetic retinopathy screening: study to determine risk factors for non-attendance. Diabetes Primary Care. 2012;14(5):308–16.Google Scholar
  22. 22.
    • Kashim R, Ojo O, Newton P. Diabetic retinopathy screening: a systematic review on patients’ non-attendance. Int J Environ Res Public Health. 2017;15:157–69. The first systematic review of patient and system-level barriers and facilitators to patients’ non-attendance to retinal screening. CrossRefGoogle Scholar
  23. 23.
    Raikou M, McGuire A. The economics of screening and treatment in type 2 diabetes mellitus. PharmacoEconomics. 2003;21(8):543–64.CrossRefPubMedGoogle Scholar
  24. 24.
    Song SH. Emerging type 2 diabetes in young adults. In: Ahmad SI, editor. Diabetes: an old disease, a new insight. New York: Springer Science; 2012.Google Scholar
  25. 25.
    • Bo A, Thomsen RW, Nielsen JS, Nicolaisen SK, Beck-Nielsen H, Rungby J et al. Early-onset type 2 diabetes: age gradient in clinical and behavioural risk factors in 5115 persons with newly diagnosed type 2 diabetes—results from the DD2 study. Diabetes/Metab Res Rev. 2017:n/a-n/a. This paper summarizes clinical and behavioral risk factors for people diagnosed with T2D before aged 45 years compared with older age at diagnosis groupings (46–55 years, 56–65 years, 66–75 years, and > 75 years).
  26. 26.
    Wang SY, Andrews CA, Gardner TW, Wood M, Singer K, Stein JD. Ophthalmic screening patterns among youths with diabetes enrolled in a large US managed care network. JAMA Ophthalmol. 2017;35(5):432–8. Scholar
  27. 27.
    Amed S, Nuernberger K, Reimer K, Krueger H, Aydede SK, Ayers D, et al. Care delivery in youth with type 2 diabetes—are we meeting clinical practice guidelines? Pediatr Diabetes. 2014;15(7):477–83.CrossRefPubMedGoogle Scholar
  28. 28.
    Forward H, Hewitt AW, Mackey DA. Missing X and Y: a review of participant ages in population-based eye studies. Clin Exp Ophthalmol. 2012;40(3):305–19. Scholar
  29. 29.
    • Liu Y, Swearingen R. Diabetic eye screening: knowledge and perspectives from providers and patients. Curr Diab Rep. 2017;17(10):94. A summary of primary care providers’ and patients’ perspectives of retinal screening. This summary highlights the crucial role of proactive care coordination and the opportunity provided by advances in teleophthalmology in improving retinal screening uptake. CrossRefPubMedGoogle Scholar
  30. 30.
    Hipwell AE, Sturt J, Lindenmeyer A, Stratton I, Gadsby R, O'Hare PO, et al. Attitudes, access and anguish: a qualitative interview study of staff and patients’ experiences of diabetic retinopathy screening. BMJ Open. 2014;4(12):e005498. Scholar
  31. 31.
    John A, Cooper J, Serrant-Green L. Barriers to diabetic retinopathy screening in south Asian groups. Primary Health Care. 2014;24(8):25–30. Scholar
  32. 32.
    Lewis K, Patel D, Yorston D, Charteris D. A qualitative study in the United Kingdom of factors influencing attendance by patients with diabetes at ophthalmic outpatient clinics. Ophthalmic Epidemiol. 2007;14(6):375–80. Scholar
  33. 33.
    Ellish NJ, Royak-Schaler R, Passmore SR, Higginbotham EJ. Knowledge, attitudes, and beliefs about dilated eye examinations among African-Americans. Ophthalmol Vis Sci. 2007;48(5):1989–94. Scholar
  34. 34.
    Hartnett ME, Key IJ, Loyacano NM, Horswell RL, DeSalvo KB. Perceived barriers to diabetic eye care: qualitative study of patients and physicians. Arch Ophthalmol. 2005;123(3):387–91. Scholar
  35. 35.
    Al-Alawi A, Al-Hassan A, Chauhan D, Al-Futais M, Khandekar R. Knowledge, attitude, and perception of barriers for eye care among diabetic persons registered at employee health department of a Tertiary Eye Hospital of Central Saudi Arabia. Middle East Afr J Ophthalmol. 2016;23(1):71–4. Scholar
  36. 36.
    Browne JL, Nefs G, Pouwer F, Speight J. Depression, anxiety and self-care behaviours of young adults with type 2 diabetes: results from the International Diabetes Management and Impact for Long-term Empowerment and Success (MILES) Study. Diabet Med. 2014;32(1):133–40. Scholar
  37. 37.
    Gregg EW, Sattar N, Ali MK. The changing face of diabetes complications. Lancet Diabetes Endocrinol. 2016;4(6):537–47. Scholar
  38. 38.
    Crume TL, Hamman RF, Isom S, Talton J, Divers J, Mayer-Davis EJ, et al. Factors influencing time to case registration for youth with type 1 and type 2 diabetes: SEARCH for Diabetes in Youth Study. Ann Epidemiol. 2016;26(9):631–7. Scholar
  39. 39.
    Browne JL, Scibilia R, Speight J. The needs, concerns, and characteristics of younger Australian adults with type 2 diabetes. Diabet Med. 2013;30(5):620–6. Scholar
  40. 40.
    Savage S, Dabkowski S, Dunning T. The education and information needs of young adults with type 2 diabetes: a qualitative study. J Nursing Healthc Chronic Illnesses. 2009;1(4):321–30. Scholar
  41. 41.
    Wong J, Constantino M, Yue DK. Morbidity and mortality in young-onset type 2 diabetes in comparison to type 1 diabetes: where are we now? Current Diabetes Reports. 2015;15(1):566. Scholar
  42. 42.
    Horigan G, Davies M, Findlay-White F, Chaney D, Coates V. Reasons why patients referred to diabetes education programmes choose not to attend: a systematic review. Diabet Med. 2017;34(1):14–26. Scholar
  43. 43.
    •• Cavan D, Makaroff L, da Rocha FJ, Sylvanowicz M, Ackland P, Conlon J, et al. The Diabetic Retinopathy Barometer Study: global perspectives on access to and experiences of diabetic retinopathy screening and treatment. Diabetes Res Clin Pract. 2017;129:16–24. This paper provides a global perspective on the experience of DR screening and treatment across 41 countries from both the patient and provider. CrossRefPubMedGoogle Scholar
  44. 44.
    Yamashita T, Kart CS, Noe DA. Predictors of adherence with self-care guidelines among persons with type 2 diabetes: results from a logistic regression tree analysis. J Behav Med. 2012;35(6):603–15. Scholar
  45. 45.
    Dart AB, Martens PJ, Rigatto C, Brownell MD, Dean HJ, Sellers EA. Earlier onset of complications in youth with type 2 diabetes. Diabetes Care. 2014;37(2):436–43. Scholar
  46. 46.
    Koelmeyer RL, Dharmage SC, English DR. Diabetes in young adult men: social and health-related correlates. BMC Public Health. 2016;16(S3):63–9. Scholar
  47. 47.
    Auslander WF, Sterzing PR, Zayas LE, White NH. Psychosocial resources and barriers to self-management in African American adolescents with type 2 diabetes: a qualitative analysis. Diabetes Educ. 2010;36(4):613–22. Scholar
  48. 48.
    Nguyen TT, Jayadeva V, Cizza G, Brown RJ, Nandagopal R, Rodriguez LM, et al. Challenging recruitment of youth with type 2 diabetes into clinical trials. J Adolesc Health. 2014;54(3):247–54. Scholar
  49. 49.
    Ting D, Ng J, Morlet N, Yuen J, Clark A, Taylor H, et al. Diabetic retinopathy: screening and management by Australian GPs. Aust Fam Physician. 2011;40(4):233–8.PubMedGoogle Scholar
  50. 50.
    • Lake AJ, Browne JL, Abraham C, Tumino D, Hines C, Rees G, et al. A tailored intervention to promote uptake of retinal screening among young adults with type 2 diabetes—an intervention mapping approach. BMC Health Serv Res. in press; This paper reports findings of a comprehensive needs assessment, exploring factors impacting retinal screening for young adults with T2D, including results from a nationwide survey Google Scholar
  51. 51.
    Cha E, Umpierrez G, Kim KH, Bello MK, Dunbar SB. Characteristics of American young adults with increased risk for type 2 diabetes: a pilot study. Diabetes Educ. 2013;39(4):454–63. Scholar
  52. 52.
    Diabetes Australia. Young adults with diabetes needs analysis. Diabetes Australia, Canberra, Canberra. 2006. Accessed 22 Aug 2017.
  53. 53.
    Arnett JJ. Emerging adulthood: a theory of development from the late teens through the twenties. Am Psychol. 2000;55(5):469–80. Scholar
  54. 54.
    Moss SE, Klein R, Klein BE. Factors associated with having eye examinations in persons with diabetes. Arch Fam Med. 1995;4(6):529–34.CrossRefPubMedGoogle Scholar
  55. 55.
    Strutton R, Du Chemin A, Stratton IM, Forster AS. System-level and patient-level explanations for non-attendance at diabetic retinopathy screening in Sutton and Merton (London, UK): a qualitative analysis of a service evaluation. BMJ Open. 2016;6(5):e010952. Scholar
  56. 56.
    • Lake AJ, Browne JL, Rees G, Speight J. What factors influence uptake of retinal screening among young adults with type 2 diabetes? A qualitative study informed by the Theoretical Domains Framework. J Diabetes Complicat. 2017;31(6):997–1006. This paper is the first to explore, in-depth, the barriers and facilitators to retinal screening for young adults with T2D. Using an older-adult with T2D comparator group, salient factors were identified. CrossRefPubMedGoogle Scholar
  57. 57.
    Shickle D, Griffin M, Evans R, Brown B, Haseeb A, Knight S, et al. Why don’t younger adults in England go to have their eyes examined? Ophthalmic Physiol Opt. 2014;34(1):30–7. Scholar
  58. 58.
    Turner KM, Percival J, Dunger DB, Olbers T, Barrett T, Shield JPH. Adolescents’ views and experiences of treatments for type 2 diabetes: a qualitative study. Diabet Med. 2015;32(2):250–6. Scholar
  59. 59.
    Silverstein J, Cheng P, Ruedy KJ, Kollman C, Beck RW, Klingensmith GJ, et al. Depressive symptoms in youth with type 1 or type 2 diabetes: results of the Pediatric Diabetes Consortium Screening Assessment of Depression in Diabetes Study. Diabetes Care. 2015;38:2341–3. Scholar
  60. 60.
    Protudjer JL, Dumontet J, McGavock JM. My voice: a grounded theory analysis of the lived experience of type 2 diabetes in adolescence. Can J Diabetes. 2014;38(4):229–36. Scholar
  61. 61.
    Brouwer AM, Salamon KS, Olson KA, Fox MM, Yelich-Koth SL, Fleischman KM, et al. Adolescents and type 2 diabetes mellitus: a qualitative analysis of the experience of social support. Clin Pediatr. 2012;51(12):1130–9. Scholar
  62. 62.
    Lindenmeyer A, Sturt J, Hipwell AE, Stratton I, Al-Athamneh N, Gadsby R, et al. Influence of primary care practices on patients’ uptake of diabetic retinopathy screening: a qualitative case study. Br J Gen Pract. 2014;64(625):e484–92. Scholar
  63. 63.
    Orton E, Forbes-Haley A, Tunbridge L, Cohen S. Equity of uptake of a diabetic retinopathy screening programme in a geographically and socio-economically diverse population. Public Health. 2013;127(9):814–21. Scholar
  64. 64.
    Elam AR, Lee PP. High-risk populations for vision loss and eye care underutilization: a review of the literature and ideas on moving forward. Surv Ophthalmol. 2013;58(4):348–58. Scholar
  65. 65.
    Waqar S, Bullen G, Chant S, Salman R, Vaidya B, Ling R. Cost implications, deprivation and geodemographic segmentation analysis of non-attenders (DNA) in an established diabetic retinopathy screening programme. Diabetes Metab Syndr Clin Res Rev. 2012;6(4):199–202. Scholar
  66. 66.
    Murchison AP, Hark L, Pizzi LT, Dai Y, Mayro EL, Storey PP, et al. Non-adherence to eye care in people with diabetes. BMJ Open Diabetes Res Care. 2017;5:5(1). Scholar
  67. 67.
    van Eijk KND, Blom JW, Gussekloo J, Polak BCP, Groeneveld Y. Diabetic retinopathy screening in patients with diabetes mellitus in primary care: incentives and barriers to screening attendance. Diabetes Res Clin Pract. 2012;96(1):10–6. Scholar
  68. 68.
    Klein R, Klein BEK. The epidemiology of eye disease: from glycemia to genetics: the Friedenwald lecture. Investig Ophthalmol Vis Sci. 2006;47(5):1747–53. Scholar
  69. 69.
    Dervan E, Lillis D, Flynn L, Staines A, O'Shea D. Factors that influence the patient uptake of diabetic retinopathy screening. Ir J Med Sci. 2008;177(4):303–8.CrossRefPubMedGoogle Scholar
  70. 70.
    Parchman ML. Encounters by patients with type 2 diabetes—complex and demanding: an observational study. Ann Fam Med. 2006;4(1):40–5. Scholar
  71. 71.
    Song SH. Young-onset type 2 diabetes—time to realign clinical priorities. Int J Diabetes Clin Res. 2015;2:39.CrossRefGoogle Scholar
  72. 72.
    Stratton IM, Kohner EM, Aldington SJ, Turner RC, Holman RR, Manley SE, et al. UKPDS 50: risk factors for incidence and progression of retinopathy in type II diabetes over 6 years from diagnosis. Diabetologia. 2001;44:9.CrossRefGoogle Scholar
  73. 73.
    Rubin R, Peyrot M. Psychosocial adjustment to diabetes and critical periods of psychological risk. In: Young-Hyman D, Peyrot M, editors. Psychosocial care for people with diabetes: American Diabetes Association; 2012.Google Scholar
  74. 74.
    Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care. 2000;23(7):943–50. Scholar
  75. 75.
    Williams MV, Baker DW, Parker RM, Nurss JR. Relationship of functional health literacy to patients’ knowledge of their chronic disease. Arch Intern Med. 1998;158:7.Google Scholar
  76. 76.
    Paduch A, Kuske S, Schiereck T, Droste S, Loerbroks A, Sørensen M, et al. Psychosocial barriers to healthcare use among individuals with diabetes mellitus: a systematic review. Primary Care Diabetes. 2017;11(6):495–514. Scholar
  77. 77.
    Li R, Sundar S, Lipman R, Burrows N, Kolb LE, Rutledge S. Diabetes self-management education and training among privately insured persons with newly diagnosed diabetes—United States, 2011–2012. Atlanta, GA 2014 November 21 Contract No.: 46.Google Scholar
  78. 78.
    Strain WD, Cos X, Hirst M, Vencio S, Mohan V, Vokó Z, et al. Time to do more: addressing clinical inertia in the management of type 2 diabetes mellitus. Diabetes Res Clin Pract. 2014;105(3):302–12. Scholar
  79. 79.
    Rouyard T, Kent S, Baskerville R, Leal J, Gray A. Perceptions of risks for diabetes-related complications in type 2 diabetes populations: a systematic review. Diabet Med. 2017;34(4):467–77. Scholar
  80. 80.
    Lapsley DK, Hill PL. Subjective invulnerability, optimism bias and adjustment in emerging adulthood. J Youth Adolescence. 2010;39(8):847–57. Scholar
  81. 81.
    Osataphan S, Chalermchai T, Ngaosuwan K. Clinical inertia causing new or progression of diabetic retinopathy in type 2 diabetes: a retrospective cohort study. J Diabetes. 2017;9(3):267–74. Scholar
  82. 82.
    Zeitler P, Chou HS, Copeland KC, Geffner M. Clinical trials in youth-onset type 2 diabetes: needs, barriers, and options. Curr Diabetes Rep. 2015;15(5):1–8. Scholar
  83. 83.
    Sumlin LL, Garcia TJ, Brown SA, Winter MA, Garcia AA, Brown A, et al. Depression and adherence to lifestyle changes in type 2 diabetes: a systematic review. Diabetes Educ. 2014;40(6):731–44. Scholar
  84. 84.
    Ducat L, Philipson LH, Anderson BJ. The mental health comorbidities of diabetes. J Am Med Assoc. 2014;312(7):691–2. Scholar
  85. 85.
    Browne JL, Ventura A, Mosely K, Speight J. ‘I call it the blame and shame disease’: a qualitative study about perceptions of social stigma surrounding type 2 diabetes. BMJ Open. 2013;3(11):e003384. Scholar
  86. 86.
    McGavock J, Dart A, Wicklow B. Lifestyle therapy for the treatment of youth with type 2 diabetes. Curr Diab Rep. 2015;15(1):1–11. Scholar
  87. 87.
    Lee SJ, Sicari C, Harper CA, Livingston PM, McCarty CA, Taylor H, et al. Examination compliance and screening for diabetic retinopathy: a 2-year follow-up study. Clin Exp Ophthalmol. 2000;28(3):149–52. Scholar
  88. 88.
    Wilson JMG, Jungner G. Principles and practice of screening for disease. In: Public Health Papers No.34. 1968. Accessed 23 Nov 2017.
  89. 89.
    Hazin R, Colyer M, Lum F, Barazi MK. Revisiting diabetes 2000: challenges in establishing nationwide diabetic retinopathy prevention programs. Am J Ophthalmol. 2011;152(5):723–9. Scholar
  90. 90.
    Scanlon PH. The English National Screening Programme for diabetic retinopathy 2003-2016. Acta Diabetol. 2017;54(6):515–25. Scholar
  91. 91.
    Forster AS, Forbes A, Dodhia H, Connor C, Du Chemin A, Sivaprasad S, et al. Changes in detection of retinopathy in type 2 diabetes in the first 4 years of a population-based diabetic eye screening program: retrospective cohort study. Diabetes Care. 2013;36(9):2663–9. Scholar
  92. 92.
    Wilmot E, Idris I. Early onset type 2 diabetes: risk factors, clinical impact and management. Ther Adv Chronic Dis. 2014;5(6):11–244. Scholar
  93. 93.
    Zhang Y, Ning G. Diabetes: young-onset type 2 diabetes mellitus-a challenge for Asia. Nat Rev Endocrinol. 2014;10(12):703–4. Scholar
  94. 94.
    Muir KW, Lee PP. Health literacy and ophthalmic patient education. Surv Ophthalmol. 2010;55(5):454–9. Scholar
  95. 95.
    Parikh NS, Parker RM, Nurss JR, Baker DW, Williams MV. Shame and health literacy: the unspoken connection. Patient Educ Couns. 1996;27(1):33–9. Scholar
  96. 96.
    Halliday JA, Hendrieckx C, Busija L, Browne JL, Nefs G, Pouwer F, et al. Validation of the WHO-5 as a first-step screening instrument for depression in adults with diabetes: results from diabetes MILES—Australia. Diabetes Res Clin Pract. 2017;132:27–35. Scholar
  97. 97.
    Fisher L, Glasgow RE, Mullan JT, Skaff MM, Polonsky WH. Development of a brief diabetes distress screening instrument. Ann Fam Med. 2008;6(3):246–52. Scholar
  98. 98.
    Kroenke K, Spitzer RL, Williams JBW. The patient health questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41(11):1284–92.CrossRefPubMedGoogle Scholar
  99. 99.
    Hendrieckx C, Halliday JA, Beeney LJ, Speight J. Diabetes and emotional health : a handbook for health professionals supporting adults with type 1 or type 2 diabetes. Australian Centre for Behavioural Research in Diabetes Melbourne 2016. Accessed 12 Apr 2018.
  100. 100.
    Bjornstad P, Cherney DZ, Maahs DM, Nadeau KJ. Diabetic kidney disease in adolescents with type 2 diabetes: new insights and potential therapies. Curr Diabetes Rep. 2016;16(2):1–11. Scholar
  101. 101.
    Wilmot EG, Leggate M, Khan JN, Yates T, Gorely T, Bodicoat DH, et al. Type 2 diabetes mellitus and obesity in young adults: the extreme phenotype with early cardiovascular dysfunction. Diabet Med. 2014;31(7):794–8. Scholar
  102. 102.
    Deconinck B, Mathieu C, Benhalima K. Characteristics and cardiovascular complications of a large cohort of adults diagnosed with type 2 diabetes <45 years. Diabetol Metab Syndr. 2017;9:28. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of PsychologyDeakin UniversityGeelongAustralia
  2. 2.The Australian Centre for Behavioural Research in DiabetesDiabetes VictoriaMelbourneAustralia
  3. 3.Centre for Eye Research AustraliaRoyal Victorian Eye and Ear HospitalMelbourneAustralia
  4. 4.Ophthalmology, Department of SurgeryUniversity of MelbourneMelbourneAustralia
  5. 5.AHP ResearchHornchurchUK

Personalised recommendations