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

Overview

Journal Ophthalmology

Publisher Elsevier

Specialty Ophthalmology

Date 2009 Aug 5

PMID 19651311

Citations 17

Authors

Frank A Sloan

Daniel S Grossman

Paul P Lee

Affiliations

Soon will be listed here.

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.

Citing Articles

Disparities Between Teleretinal Imaging Findings and Patient-Reported Diabetic Retinopathy Status and Follow-up Eye Care Interval: A 10-Year Prospective Study.

Silva P, Cavallerano J, Sun J, Tolson A, Tolls D, Abrahamson M Diabetes Care. 2024; 47(6):970-977.

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Identifying the mechanism of missingness for unspecified diabetic retinopathy disease severity in the electronic health record: an IRIS® Registry analysis.

Hatfield M, Nguyen T, Chapman R, Myrick A, Leng T, Mbagwu M J Am Med Inform Assoc. 2023; 30(6):1199-1204.

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Incidence of Proliferative Diabetic Retinopathy and Other Neovascular Sequelae at 5 Years Following Diagnosis of Type 2 Diabetes.

Gange W, Lopez J, Xu B, Lung K, Seabury S, Toy B Diabetes Care. 2021; 44(11):2518-2526.

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Rates of Eye Care and Diabetic Eye Disease among Insured Patients with Newly Diagnosed Type 2 Diabetes.

Gange W, Xu B, Lung K, Toy B, Seabury S Ophthalmol Retina. 2020; 5(2):160-168.

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The War on Diabetic Retinopathy: Where Are We Now?.

Wong T, Sabanayagam C Asia Pac J Ophthalmol (Phila). 2019; 8(6):448-456.

PMID: 31789647 PMC: 6903323. DOI: 10.1097/APO.0000000000000267.

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