Optimization of Diabetic Macular Edema Management in the Real World: A Model of Excellence in Retina Units: The EMUREX Initiative

Abstract

To define and develop a model of excellence for the clinical management of diabetic macular edema (DME) patients in a real-world setting. Methods: A multidisciplinary joint commission (5 ophthalmologists, 1 nurse, and 1 pharmaceutic) established a series of preliminary recommendations based on clinical guidelines and DME activity results from 8 Pilot Hospitals (PH). These were validated by members of each PH and a group of DME patients in discussion workshops. Thus, the validated guideline (VG) took into consideration different aspects, namely, main core points (ranging 0-100), criteria, and indicators. Finally, each PH own setting was compared to the VG in order to settle down a starting point to clinical excellence. Results: Mean PH score was 51.5 (range 30-65). As compared to their maximum, main points that showed best scores were Clinical Guidelines and Protocols (78%) and Portfolio of Services (73%). Topics reaching close to 50% scoring included Resources (55%), Innovation (54%), Care Process (53%), Organization (52%), and Leadership (50%). Lowest scores were observed in the Strategic Alliances (46%) and Staff (37%) points. Conclusions: Analysis of each PH by the VG delivered a global vision of the starting situation, especially focused in the identification of the different improvement areas. In order to further extend this model into the Public Health System, the effect of implementing it in different hospitals should be assessed to analyze its impact on daily clinical practice and health economics.

Are visual disturbances (excluding diabetic retinopathy) more common in geriatric DM patients? Are they risks factor for the progression of disability?

“…In fact, these intravitreal treatments have been able to dramatically improve patients' visual prognosis, either by increasing their central vision or by preventing further visual loss. Repeated intravitreal administrations of long-acting corticosteroid drugs for treating geriatric patients with chronic diabetic macular edema should be recommended considering that i) the most common comorbidities for DM include microangiopathic disorders (retinopathy, neuropathy, and nephropathy) and macroangiopathic disorders (myocardial infarction, cerebrovascular stroke, and other severe thromboembolic events); ii) the latest guidelines suggest the use of corticosteroids and, in particular, dexamethasone implants, as first-line treatment in diabetic macular edema patients with high cardiovascular risk, and iii) there is insufficient evidence to definitively exclude an increased mortality risk or cardiovascular and cerebrovascular incidents among patients treated with anti-VEGF drugs because affected by diabetic macular edema [23][24][25][26][27][28][29][30][31] . DM is associated with an increased risk of falls due to frailty.…”