Abstract
Purpose :
DR is a common complication of diabetes, and remains a leading cause of vision loss in the US and globally. We aimed to characterize the disease progression and treatment patterns (tx-pats) of DR and DME in children and adults in the US.
Methods :
A retrospective cohort study was conducted with the Truven Health Marketscan data from 2011 to 2019. ICD-9 and ICD-10 were used to identify patients (pts) with index diagnoses of diabetes mellitus (DM), DR by severity, and DME. Pts included had >=12 months medical/pharmacy enrollment, DM pts had >=2 diagnoses at least 30 days apart in outpatients or >=1 diagnosis in an inpatient setting. At least one diagnosis was required for DR/DME. For progression and tx-pats analysis, pts were required to have >=180 days of follow-up (F/U) before and after DR/DME index. We excluded pts with prior history of any type of treatments of interest (tx-I; i.e. anti-VEGF, laser, corticosteroid, vitrectomy).
Results :
In total, 253 children and 165,404 adult DR pts were included and examined for progression and tx-pats longitudinally, and 74 children and 63,639 adult DME pts for tx-pats. The prevalence in children with DM is 0.7% and 0.2% for DR and DME, respectively.
The majority (84%) of pediatric DR pts were initially diagnosed with mild Non-Proliferative DR (NPDR), and 2.4% developed DME in a median of 2.1-year F/U. DR progression, and treatments for DR/DME were rarely observed in children.
Among the adult DR pts, 66.9%, 12.3%, 2.2%, and 18.6% had an initial diagnosis of mild, moderate, severe NPDR and Proliferative DR, respectively; 8.5% of them progressed and 15.3% developed DME in a median of 1.9-year F/U. No significant difference was observed between type-1 and type-2 DM pts. In addition, 14.2% of the DR and 52.6% of DME pts received >=1 type of tx-I, the percentage of pts who received treatment increased by DR severity (Table 1). Treatment with Anti-VEGF, laser, and vitrectomy was more frequently observed than corticosteroid.
Conclusions :
This work provides a deeper understanding of the DR characteristics in pediatric pts, showing rare DR progression and treatments for DR/DME. The majority of adult DR and half of DME pts did not receive any tx-I. Additional research is warranted to understand the drivers of treatment decisions in pts with DR and DME.
This is a 2021 ARVO Annual Meeting abstract.