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Nidhi Talwar, Mehnaz Khan, Thomas Gardner, Joshua Stein; Risk Factors Associated with Diabetic Macular Edema: A Longitudinal Analysis of 447,407 Persons with Diabetes in a U.S. Managed Care Network. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1540.
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To determine risk factors associated with development of a diabetic macular edema (DME) among a large group of enrollees in a large managed care network throughout the United States.
All beneficiaries with a diagnosis of diabetes, age ≥30 years, who were continuously enrolled for ≥3 years in a nationwide managed care network from 2001-2011, and with ≥1 visit to an eye-care provider during that time were identified. Non-incident cases of DME were excluded. Multivariable Cox regression analyses were performed to identify socio-demographic factors, ocular and non-ocular conditions that were associated with the development of a DME.
Of the 447407 enrollees who met the inclusion criteria, 6473 (1.45%) developed DME over 5.3 ± 2.0 years. After adjustment for confounding factors, blacks (adjusted hazard ratio (HR)=1.14, 95% confidence interval (CI) 1.04-1.26, p=0.0074) and Latinos (HR=1.28, 95% CI 1.16-1.42, p<0.0001) had an increased hazard of developing DME relative to whites. Individuals with diabetic neuropathy (HR=1.59, 95% CI 1.50-1.69, p<0.0001) or diabetic nephropathy (HR=1.41, 95% CI 1.32-1.50, p<0.0001) were also more likely to develop DME compared to those without these conditions. Compared to those with no hypertension, persons with uncomplicated hypertension had a 25% increased hazard of DME (HR=1.25, 95% CI 1.11-1.40, p=0.0002), and those with end-organ damage caused by hypertension had a 45% increased hazard of developing DME (HR=1.45, 95% CI 1.28-1.64, p<0.0001). Those with hyperlipidemia had a reduced risk for DME (HR=0.81, 95% CI 0.73-0.91, p=0.0002). The hazard of DME was almost doubled for those with type I diabetes (HR=1.97, 95% CI 1.85-2.09, p<0.0001). The baseline value of HbA1c lab test was also a significant predictor, with each unit increase in the measured value associated with a 16% increase in the hazard for DME (HR=1.16, 95% CI 1.09-1.24, p<0.0001).
Our study has identified several risk factors that are associated with development of DME. These risk factors can be incorporated into a risk calculator to educate patients of their risk of DME and the impact of modifiable risk factors on risk of DME.
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