Abstract
Purpose :
To determine the incidence and risk factors for developing treatment-warranted diabetic macular edema (TW-DME) within 5 years after diagnosis of type 2 diabetes (DM2). This may aid identification of patients at increased risk of vision loss who may benefit from additional interventions.
Methods :
We performed a retrospective longitudinal cohort study using the Optum’s de-identified Clinformatics® Data Mart Database from 2007 to 2015. Individuals 18 years of age and older with a diagnosis of DM2 and continuous insurance enrollment of 6 years (1 pre, 5 post-diagnosis) were identified. The cumulative incidence of TW-DME within 5 years was determined using medical claims data. Associations between TW-DME and sociodemographic and clinical factors were tested with multivariable logistic regression. Statistical significance was evaluated with a p-value of 0.05.
Results :
Of 72,067 patients newly diagnosed with DM2, 540 (0.75%) patients had developed TW-DME at 5 years after DM2 diagnosis. Patients who developed TW-DME were more likely to be of older age at diagnosis (age 65-74, OR 1.58, p=0.009) and to have other systemic complications of DM2, including renal disease (OR 2.59, p<0.001), neurological disease (OR 2.40, p<0.001), and peripheral circulatory disorders (OR 2.15, p=0.007). In addition, insulin use (OR 4.11, p<0.001) was more common, and max A1c was higher (9.7 ± 2.5 vs 7.6 ± 2.0, p<0.01) in those developing TW-DME. Young age at diagnosis (age 18-34, OR 0.36, p=0.005), Medicare insurance (OR 0.47, p<0.001), morbid obesity (OR 0.62, p=0.001), smoking (OR 0.77, p=0.046), and dyslipidemia (OR 0.80, p=0.034) were identified as protective factors. African-Americans and Hispanics had a higher incidence of TW-DME, 0.84% and 0.79% respectively, while Asians had a lower incidence of 0.64%.
Conclusions :
Patients with a history of A1c > 9%, insulin use, renal disease, neurologic disease, and peripheral circulatory disease, and advanced age at diagnosis are at a higher risk for early development of TW-DME. These patients may require additional and earlier screening after diagnosis of DM2.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.