{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:53:26Z","timestamp":1787025206923,"version":"build-2736575974"},"reference-count":16,"publisher":"American Diabetes Association","issue":"11","license":[{"start":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T00:00:00Z","timestamp":1757376000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"DOI":"10.13039\/100004328","name":"Genentech Inc","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100004328","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,11,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>This study aimed to evaluate the diabetic eye disease screening continuum at two academic centers and identify its barriers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>We analyzed health records from the University of California, San Francisco, and University of California, Irvine, to identify primary care patients needing diabetic eye screening. We tracked referrals, screenings, diagnoses, and treatments to evaluate predictors and the impact of an automated referral system. We analyzed physician notes using GPT-4o to determine reasons for missed screenings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Of 8,240 unscreened patients with type 2 diabetes mellitus (T2DM), 43% received a referral, and only 16% completed screening within 1 year. Demographic, provider, and socioeconomic factors predicted adherence, with referrals being the strongest predictor. An automated referral system could improve screening rates to 22\u201334%. Clinician notes cited comorbidities, scheduling challenges, logistical issues, coronavirus disease 2019, and personal circumstances as barriers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Many patients with T2DM remain unscreened after primary care visits. Although an automated referral system may partially improve adherence, additional tailored strategies are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc25-0951","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T19:36:36Z","timestamp":1757446596000},"page":"1914-1919","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":2,"title":["Quantifying Barriers to Diabetic Eye Screening: A Two-Center Study at the University of California"],"prefix":"10.2337","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0241-6865","authenticated-orcid":false,"given":"Aryan","family":"Ayati","sequence":"first","affiliation":[{"name":"Bakar Computational Health Sciences Institute, University of California 1 , San Francisco, San Francisco, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shadera","family":"Azzam","sequence":"additional","affiliation":[{"name":"Bakar Computational Health Sciences Institute, University of California 1 , San Francisco, San Francisco, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stella","family":"Ko","sequence":"additional","affiliation":[{"name":"Genentech, Inc., South San Francisco 2 , CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cobi","family":"Ben-David","sequence":"additional","affiliation":[{"name":"Gavin Herbert Eye Institute, University of California 3 , Irvine, Irvine, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3207-1490","authenticated-orcid":false,"given":"Michelle","family":"Wang","sequence":"additional","affiliation":[{"name":"Bakar Computational Health Sciences Institute, University of California 1 , San Francisco, San Francisco, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Bonine","sequence":"additional","affiliation":[{"name":"Genentech, Inc., South San Francisco 2 , CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Tabano","sequence":"additional","affiliation":[{"name":"Genentech, Inc., South San Francisco 2 , CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Malik","sequence":"additional","affiliation":[{"name":"Genentech, Inc., South San Francisco 2 , CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Brodie","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of California 4 , San Francisco, San Francisco, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitul C.","family":"Mehta","sequence":"additional","affiliation":[{"name":"Gavin Herbert Eye Institute, University of California 3 , Irvine, Irvine, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1789-3004","authenticated-orcid":false,"given":"Vivek A.","family":"Rudrapatna","sequence":"additional","affiliation":[{"name":"Bakar Computational Health Sciences Institute, University of California 1 , San Francisco, San Francisco, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2025,9,9]]},"reference":[{"key":"2026061714522520800_B1","doi-asserted-by":"crossref","first-page":"S231","DOI":"10.2337\/dc24-S012","article-title":"12. Retinopathy, neuropathy, and foot care: Standards of Care in Diabetes\u20142024","volume":"47","author":"American Diabetes Association","year":"2024","journal-title":"Diabetes Care"},{"key":"2026061714522520800_B2","unstructured":"Diabetic retinopathy\n          . Guideline Central. Accessed 2 June 2025. Available from https:\/\/www.guidelinecentral.com\/guideline\/10563"},{"key":"2026061714522520800_B3","doi-asserted-by":"crossref","first-page":"e001154","DOI":"10.1136\/bmjdrc-2019-001154","article-title":"Adherence to ophthalmology referral, treatment and follow-up after diabetic retinopathy screening in the primary care setting","volume":"8","author":"Bresnick","year":"2020","journal-title":"BMJ Open Diabetes Res Care"},{"key":"2026061714522520800_B4","first-page":"258","article-title":"Factors associated with adherence to screening guidelines for diabetic retinopathy among low-income metropolitan patients","volume":"117","author":"Kuo","year":"2020","journal-title":"Mo Med"},{"key":"2026061714522520800_B5","unstructured":"UCSF Data\n          . UCSF clinical data. Accessed 2 June 2025. Available from https:\/\/data.ucsf.edu\/research\/ucsf-data"},{"key":"2026061714522520800_B6","doi-asserted-by":"crossref","first-page":"ooad045","DOI":"10.1093\/jamiaopen\/ooad045","article-title":"A certified de-identification system for all clinical text documents for information extraction at scale","volume":"6","author":"Radhakrishnan","year":"2023","journal-title":"JAMIA Open"},{"key":"2026061714522520800_B7","doi-asserted-by":"crossref","first-page":"2456","DOI":"10.1056\/NEJMp1802313","article-title":"Making neighborhood-disadvantage metrics accessible\u2014the neighborhood atlas","volume":"378","author":"Kind","year":"2018","journal-title":"N Engl J Med"},{"key":"2026061714522520800_B8","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1007\/s11892-017-0911-2","article-title":"Diabetic eye screening: knowledge and perspectives from providers and patients","volume":"17","author":"Liu","year":"2017","journal-title":"Curr Diab Rep"},{"key":"2026061714522520800_B9","doi-asserted-by":"crossref","first-page":"223","DOI":"10.2337\/cd23-0032","article-title":"Implementation of diabetic retinopathy screening in adult patients with type 2 diabetes in a primary care setting","volume":"42","author":"Clark","year":"2024","journal-title":"Clin Diabetes"},{"key":"2026061714522520800_B10","doi-asserted-by":"crossref","first-page":"e203","DOI":"10.3346\/jkms.2024.39.e203","article-title":"Trends and barriers in diabetic retinopathy screening: Korea National Health and Nutritional Examination Survey 2016\u20132021","volume":"39","author":"Kim","year":"2024","journal-title":"J Korean Med Sci"},{"key":"2026061714522520800_B11","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1001\/jamaophthalmol.2021.1551","article-title":"Racial\/ethnic disparities and barriers to diabetic retinopathy screening in youths","volume":"139","author":"Thomas","year":"2021","journal-title":"JAMA Ophthalmol"},{"key":"2026061714522520800_B12","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1001\/jamaophthalmol.2023.5287","article-title":"Social determinants of health and perceived barriers to care in diabetic retinopathy screening","volume":"141","author":"Ravindranath","year":"2023","journal-title":"JAMA Ophthalmol"},{"key":"2026061714522520800_B13","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1001\/jamaophthalmol.2024.3528","article-title":"Race, social determinants of health, and the quality of diabetic eye care","volume":"142","author":"Chaudhury","year":"2024","journal-title":"JAMA Ophthalmol"},{"key":"2026061714522520800_B14","doi-asserted-by":"crossref","first-page":"e089710","DOI":"10.1136\/bmjopen-2024-089710","article-title":"Impact of COVID-19 and recovery of routine diabetic retinopathy digital screening across different regions in England: an analysis of publicly available data","volume":"14","author":"Pardhan","year":"2024","journal-title":"BMJ Open"},{"key":"2026061714522520800_B15","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1080\/09286586.2024.2372045","article-title":"The continuing impact of the COVID-19 pandemic on diabetic retinopathy screenings","volume":"32","author":"Bilsbury","year":"2025","journal-title":"Ophthalmic Epidemiol"},{"key":"2026061714522520800_B16","doi-asserted-by":"crossref","first-page":"7121","DOI":"10.3390\/jcm11237121","article-title":"Impact of the COVID-19 pandemic on the metabolic control of diabetic patients in diabetic retinopathy and its screening","volume":"11","author":"Romero-Aroca","year":"2022","journal-title":"J Clin Med"}],"container-title":["Diabetes Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/48\/11\/1914\/840943\/dc250951.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/48\/11\/1914\/840943\/dc250951.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T18:52:35Z","timestamp":1781722355000},"score":1,"resource":{"primary":{"URL":"https:\/\/diabetesjournals.org\/care\/article\/48\/11\/1914\/163381\/Quantifying-Barriers-to-Diabetic-Eye-Screening-A"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,9]]},"references-count":16,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,9,9]]},"published-print":{"date-parts":[[2025,11,1]]}},"URL":"https:\/\/doi.org\/10.2337\/dc25-0951","relation":{},"ISSN":["0149-5992","1935-5548"],"issn-type":[{"value":"0149-5992","type":"print"},{"value":"1935-5548","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,9]]}}}