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Sophia Wang, Chris A Andrews, Thomas W Gardner, Michael Wood, Kanakadurga Singer, Joshua D Stein; Ophthalmic Screening Patterns Among Youth with Type 1 and Type 2 Diabetes Enrolled in a Large U.S. Managed Care Network. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5561. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
The American Academy of Ophthalmology recommends that ophthalmic screening for diabetic retinopathy (DR) occur by 5 years after initial diabetes mellitus (DM) diagnosis among youth with Type 1 DM (T1DM); the American Diabetes Association recommends that youth with Type 2 DM (T2DM) be screened at the time of initial DM diagnosis. It is unknown to what extent youth with DM obtain eye examinations in accordance with these guidelines. We investigated the rate of screening for DR and its associated factors in a large cohort of youth with T1DM and T2DM in a nationwide U.S. managed care network.
We reviewed health care claims database records to identify all youth age ≤21 years who were newly diagnosed with DM from 2001 to 2014. A previously validated algorithm characterized each youth with T1DM or T2DM. We identified the proportion of youth who underwent ≥1 eye examinations by an ophthalmologist or optometrist based on healthcare encounter records. Kaplan-Meier survival curves estimated the time from first DM diagnosis to initial eye exam. Multivariate Cox proportional hazard regression models identified sociodemographic factors associated with undergoing an eye exam following DM diagnosis.
Among the 5515 eligible youth with T1DM and 7304 youth with T2DM, Kaplan-Meier survival analysis estimated that 60% and 38% had undergone an eye exam by 5 years after DM diagnosis, respectively. Children and adolescents with T1DM had 116% increased hazard of undergoing an eye exam by 5 years compared to youth with T2DM (HR 2.16, 95% CI 1.98-2.35). Blacks and Latinos had 11% and 18% decreased hazard of undergoing an eye exam by 5 years compared to Whites, respectively (Blacks HR 0.89, 95% CI 0.79-0.92; Latinos HR 0.82, 95% CI 0.73-0.92). As household net worth increased, youth were increasingly more likely to undergo an eye exam by 5 years (HR 1.46, 95% CI 1.30-1.62 for net worth ≥$500,000 vs <$25,000).
Youth with T2DM are significantly less likely to undergo ophthalmic screening than youth with T1DM. Blacks, Latinos, and youth from less affluent families are significantly less likely to undergo a timely eye exam to check for DR than whites and youth from more affluent families. These groups are an underserved population that should be targeted in efforts to increase adherence to ophthalmic screening guidelines to prevent sight-threatening complications from DR.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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