Please select the eligibility criteria that correspond to the clinical trial below.
Title: Confronting Unequal Eye Care in Pennsylvania
Brief Summary: Pt. 1 Diabetic retinopathy is a common eye condition among diabetic adults and can lead to severe vision impairment and even blindness. African Americans are more likely to have vision loss from diabetic retinopathy due to a variety of factors, including cultural barriers to care. The investigators aim to increase the rates of eye exams in diabetic African American adults by providing culturally relevant home-based interventions. These interventions will increase the knowledge about diabetes and the eyes and the awareness of ocular risks due to diabetes.

206 African American adults, over the age of 65, with diabetes will be recruited from primary care clinics at Thomas Jefferson and Temple University. Eligible patients who consent to participate will have baseline information taken about medical and ocular history, understanding of diabetes and a hemoglobin A1C level obtained. The subjects will then be randomized to one of two treatment conditions: Behavioral Activation or Supportive Therapy, each of which will be delivered over 4 sessions. Behavioral Activation will consist of educational materials, referral assistance for eye clinics, and addressing patient specific barriers to care. Supportive Therapy will consist of supportive but non-directional interaction with the patient exploring the impact of aging and diabetes on the patient's life. The investigators hypothesize that more patients who receive Behavioral Activation will have a dilated fundus exam (the primary outcome variable), understand the risks of diabetic complications and feel less depression then subjects who receive Supportive Therapy.


Options:
A: Pt. 1

Inclusion Criteria:

* African-American race (self-identified)
* Age ≥ 65 years
* Type II Diabetes Mellitus (physician diagnosis) for at least 1 year
* No medical documentation of a DFE by an ophthalmologist or an optometrist within the past 12 months
* Self-report of no DFE within the past 12 months

Exclusion Criteria:

* Cognitive Impairment (Mini-Mental Status Examination ≤ 24)
* Current clinically significant psychiatric disorder other than depression
* Current medical disorder that limits life expectancy (≤ 12 months) or need for dialysis
* Hearing impairment that precludes research participation

Pt. 2

Inclusion Criteria:

* Glaucoma (physician diagnosis)
* Scheduled for a follow-up appointment that meets the American Academy of Ophthalmology (AAO) follow-up guidelines
* Attended the Wills Eye Glaucoma Clinic from September 1, 2012 to October 31, 2013
* Age ≥ 21 years old
* Able to understand and speak English

Exclusion Criteria:

* Diagnosed with a pre-existing medical condition that would preclude the subject from providing reliable and valid data
* Individual was asked to follow-up in less than a month.
B: Inclusion Criteria:

* Prevalent Type 2-diabetes as confirmed by Primary Care Physician.
* Patient alive throughout the intervention period.
* GP actively working throughout the intervention period (not retired).

Exclusion criteria:

* death during intervention
* moved out of geographic area during intervention
* GP retired during intervention
C: Inclusion Criteria:

1. Clinical Diagnosis of Type 2 diabetes mellitus
2. Glycosylated Hemoglobin (HbA1c) \> 7.0 = Uncontrolled
3. Positive score on diabetes related distress 2 question screener and/or
4. Positive score on Patient Health Questionnaire (PHQ-2) 2 question screener

Exclusion Criteria: a diagnosis \[from billing records using International Classification of Disease, 9th Edition (ICD-9) codes\] of:

1. advanced disease (e.g., end stage renal disease, advanced heart failure, blindness, metastatic cancer and including those who are in active treatment for cancer), or
2. alcoholism or
3. cognitive impairment, or
4. major psychiatric disease or
5. any type of physical or mental impairment that would preclude active participation
D: Inclusion Criteria:

* Initiating long-acting insulin treatment or initiating the titration of long-acting insulin treatment
* Speaks English or Spanish
* Hemoglobin A1c \> or = 8%
* Able and willing to inject insulin
* Able and willing to provide informed consent

Exclusion Criteria:

* Short-acting insulin treatment
* Systemic glucocorticoids
* Sustained elevated serum creatinine \> or = 1.5 mg/dL for men and \> or = 1.4 mg/dL for women
* Hypoglycemia unawareness
* Type 1 diabetes

Answer: A