Effects of Receipt of Guideline-Recommended Care on Onset of Diabetic Retinopathy and Its Progression

Abstract

Objective To determine whether persons in a community setting diagnosed with diabetes who received recommended patterns of care experience improved vision outcomes over a 3-year time period. Design Retrospective, longitudinal, cohort analysis. Participants Persons diagnosed with diabetes mellitus (DM), with no prior diagnosis of diabetic retinopathy (DR; n = 5989) from the Medicare Current Beneficiary Survey (1992–2004). Persons diagnosed with DM were followed up to 3 years. Intervention Propensity score matching was used to compare vision outcomes between persons who received guideline-recommended care and those who did not. Receipt of recommended levels of care was defined as receiving each of the following services 0.75 times annually on average: physician examination, ophthalmologist or optometrist examination, hemoglobin A1c level, lipid levels, and urinalysis. Main Outcome Measures Outcome measures were indicators of DR disease progression: no diagnosed DR to diagnosed background DR, proliferative DR, macular edema, proliferative DR complications, and use of a low-vision aid or blindness. Results Persons with diagnosed diabetes receiving guideline-recommended care experienced earlier onset of background DR (average treatment effects on the treated [ATT] at 3 years, 0.118; 95% confidence interval [CI], −0.005 to 0.240). There were no differences between those receiving recommended care and others in time to onset of proliferative DR, macular edema, or proliferative DR complications. However, persons who received care consistent with recommendations experienced much lower rates of onset of low vision/blindness than did others (ATT at 3 years, −0.109; 95% CI, −0.189 to −0.030). Conclusions Low vision/blindness was substantially reduced over a 3-year period among persons diagnosed with DM who received recommended levels of care.

Do we have enough ophthalmologists to manage vision-threatening diabetic retinopathy? A global perspective

“…Measures to prevent blindness from DR include effective primary and secondary prevention such as early detection by screening, effective DM management and compliance to recommended DR guidelines [20]. It has been shown that patients who receive consistent care according to guidelines have lower rates of low vision and blindness [21]. The application of deep learning to assist DR screening will potentially play a key role in mass DR screening in years to come [20,22,23].…”

Do we have enough ophthalmologists to manage vision-threatening diabetic retinopathy? A global perspective

“…Measures to prevent blindness from DR include effective primary and secondary prevention such as early detection by screening, effective DM management and compliance to recommended DR guidelines [20]. It has been shown that patients who receive consistent care according to guidelines have lower rates of low vision and blindness [21]. The application of deep learning to assist DR screening will potentially play a key role in mass DR screening in years to come [20,22,23].…”

Six-year prevalence and incidence of diabetic retinopathy and cost-effectiveness of tele-ophthalmology in Manitoba

“…9,14 Screening is known to reduce vision loss associated with diabetes, which can improve the quality of life of affected patients and has significant economic implications. 5,12 Severe vision loss secondary to diabetes has been estimated to cost health care over $3000 per person-year, more than equivalent vision loss from nondiabetic causes. 4 Prompt identification of treatable disease is a primary goal of screening, and may help reduce these visual and economic burdens.…”

Trends of barriers to eye care among adults with diagnosed diabetes in Germany, 1997–2012

“…Diabetes-related eye disease is particularly problematic in those with undiagnosed diabetes and the problem of underdiagnosis is greater within socioeconomically deprived subjects [48]. In the U.S., lack of insurance coverage and low income are established predictors of not receiving eye care [15,19,22,49]. In contrast, given the universal coverage in Germany, it is not surprising that type of insurance did not predict receipt of eye care and that the downward trend in eye care utilization rates was not significantly different in persons with statutory health insurance or a private insurance plan.…”

“…Persons with diagnosed diabetes receiving guideline-recommended eye care do experience much lower onset of low vision and blindness [15]. Evidence from trials has demonstrated that improved glycemic control is associated with decreased risk of retinopathy [12].…”

“…More research is needed to assess whether improved access and compliance with the recommended follow-up examinations result in improved diabetes outcomes, including reduction in vision loss, in Germany [10,50]. Evidence from the U.S. suggests that regular checkups can reduce low vision and blindness [15].…”

Do we have enough ophthalmologists to manage vision-threatening diabetic retinopathy? A global perspective

“…Measures to prevent blindness from DR include effective primary and secondary prevention such as early detection by screening, effective DM management and compliance to recommended DR guidelines [20]. It has been shown that patients who receive consistent care according to guidelines have lower rates of low vision and blindness [21]. The application of deep learning to assist DR screening will potentially play a key role in mass DR screening in years to come [20,22,23].…”

Six-year prevalence and incidence of diabetic retinopathy and cost-effectiveness of tele-ophthalmology in Manitoba

“…9,14 Screening is known to reduce vision loss associated with diabetes, which can improve the quality of life of affected patients and has significant economic implications. 5,12 Severe vision loss secondary to diabetes has been estimated to cost health care over $3000 per person-year, more than equivalent vision loss from nondiabetic causes. 4 Prompt identification of treatable disease is a primary goal of screening, and may help reduce these visual and economic burdens.…”

Trends of barriers to eye care among adults with diagnosed diabetes in Germany, 1997–2012

“…Diabetes-related eye disease is particularly problematic in those with undiagnosed diabetes and the problem of underdiagnosis is greater within socioeconomically deprived subjects [48]. In the U.S., lack of insurance coverage and low income are established predictors of not receiving eye care [15,19,22,49]. In contrast, given the universal coverage in Germany, it is not surprising that type of insurance did not predict receipt of eye care and that the downward trend in eye care utilization rates was not significantly different in persons with statutory health insurance or a private insurance plan.…”

“…Persons with diagnosed diabetes receiving guideline-recommended eye care do experience much lower onset of low vision and blindness [15]. Evidence from trials has demonstrated that improved glycemic control is associated with decreased risk of retinopathy [12].…”

“…More research is needed to assess whether improved access and compliance with the recommended follow-up examinations result in improved diabetes outcomes, including reduction in vision loss, in Germany [10,50]. Evidence from the U.S. suggests that regular checkups can reduce low vision and blindness [15].…”

Do we have enough ophthalmologists to manage vision-threatening diabetic retinopathy? A global perspective

“…Measures to prevent blindness from DR include effective primary and secondary prevention such as early detection by screening, effective DM management and compliance to recommended DR guidelines [20]. It has been shown that patients who receive consistent care according to guidelines have lower rates of low vision and blindness [21]. The application of deep learning to assist DR screening will potentially play a key role in mass DR screening in years to come [20,22,23].…”

Six-year prevalence and incidence of diabetic retinopathy and cost-effectiveness of tele-ophthalmology in Manitoba

“…9,14 Screening is known to reduce vision loss associated with diabetes, which can improve the quality of life of affected patients and has significant economic implications. 5,12 Severe vision loss secondary to diabetes has been estimated to cost health care over $3000 per person-year, more than equivalent vision loss from nondiabetic causes. 4 Prompt identification of treatable disease is a primary goal of screening, and may help reduce these visual and economic burdens.…”

Trends of barriers to eye care among adults with diagnosed diabetes in Germany, 1997–2012

“…Diabetes-related eye disease is particularly problematic in those with undiagnosed diabetes and the problem of underdiagnosis is greater within socioeconomically deprived subjects [48]. In the U.S., lack of insurance coverage and low income are established predictors of not receiving eye care [15,19,22,49]. In contrast, given the universal coverage in Germany, it is not surprising that type of insurance did not predict receipt of eye care and that the downward trend in eye care utilization rates was not significantly different in persons with statutory health insurance or a private insurance plan.…”

“…Persons with diagnosed diabetes receiving guideline-recommended eye care do experience much lower onset of low vision and blindness [15]. Evidence from trials has demonstrated that improved glycemic control is associated with decreased risk of retinopathy [12].…”

“…More research is needed to assess whether improved access and compliance with the recommended follow-up examinations result in improved diabetes outcomes, including reduction in vision loss, in Germany [10,50]. Evidence from the U.S. suggests that regular checkups can reduce low vision and blindness [15].…”