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William S Gange, Khristina Lung, Benjamin Xu, Seth Seabury, Brian C Toy; Risk Factors for Severe Diabetic Eye Disease in a Large Sample of Patients Newly-Diagnosed with Type 2 Diabetes. Invest. Ophthalmol. Vis. Sci. 2020;61(7):1898.
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Diabetic eye disease is the leading cause of blindness in working-age adults in the United States. As rates of diabetes continue to rise in the United States, adequately screening all patients for diabetic retinopathy at guideline-recommended intervals remains a public health challenge. We performed a retrospective study of medical claims data for patients newly-diagnosed with type 2 diabetes (DM2), in order to better identify high risk populations who may benefit most from improved rates of screening.
Patients age 18 or older with newly-diagnosed DM2 from 2007-2015 were recruited from a commercial claims database. All patients were required to have continuous enrollment for 6 years: 1 year prior to and 5 years after the index diabetes diagnosis. 72,067 patients with newly-diagnosed DM2 were identified. Demographic data were collected. Patients were identified as having severe diabetic eye disease if they had an ICD-9 diagnosis code for proliferative diabetic retinopathy, vitreous hemorrhage, neovascular glaucoma, rubeosis iridis, tractional retinal detachment, or blindness, or a CPT code for pars plana vitrectomy, glaucoma drainage device, or panretinal photocoagulation within 5 years of diagnosis. Multivariable logistic regression was used to test associations between demographic factors and identification of severe disease.
At 5 years following diagnosis with diabetes, 3.97% of patients had severe diabetic eye disease. Black patients were more likely than white patients to have severe disease (OR 1.26, p<.001). Age at diagnosis was positively correlated with severe diabetic eye disease, with patients diagnosed at ages 18-34 having the lowest risk (OR 0.75, p<.01) and those diagnosed after age 75 having the highest risk of severe disease (OR 1.63, p<.001). Smokers were more likely to have severe disease than non-smokers (OR 1.15, p<.02). Income and education level were not associated with early development of severe diabetic eye disease in this insured population.
A subset of patients with DM2 develop severe diabetic eye disease within the first 5 years after diagnosis. Black patients, older patients, and smokers were more likely to have severe diabetic eye disease, which suggests either a longer duration of undiagnosed disease, or poorer control of disease. These patients may require increased screening efforts.
This is a 2020 ARVO Annual Meeting abstract.
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