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Ophthalmic Screening Patterns Among Youths With Diabetes Enrolled in a Large US Managed Care Network.
JAMA Ophthalmol. 2017 05 01; 135(5):432-438.JO

Abstract

Importance

Ophthalmic screening to check for diabetic retinopathy (DR) is important to prevent vision loss in persons with diabetes. The American Academy of Ophthalmology recommends that ophthalmic screening for DR occur beginning at 5 years after initial diabetes diagnosis for youths with type 1 diabetes; the American Diabetes Association recommends screening of youths with type 2 diabetes at the time of initial diagnosis. To our knowledge, it is unknown to what extent youths with diabetes obtain eye examinations in accordance with these guidelines.

Objective

To assess the rate of obtaining ophthalmic examinations and factors associated with receipt of eye examinations for youths with diabetes.

Design, Setting, and Participants

This retrospective, longitudinal cohort study examined youths 21 years or younger with newly diagnosed diabetes enrolled in a US managed care network from January 1, 2001, through December 31, 2014.

Main Outcomes and Measures

Kaplan-Meier survival curves estimated the time from initial diabetes diagnosis to first eye examination by an ophthalmologist or optometrist. Multivariable Cox proportional hazards regression models identified factors associated with receiving an ophthalmic examination after initial diabetes diagnosis.

Results

Among 5453 youths with type 1 diabetes (median age at initial diagnosis, 11 years; interquartile range, 8-15 years; 2972 male [54.5%]; 4505 white [82.6%]) and 7233 youths with type 2 diabetes (median age at initial diagnosis, 19 years; interquartile range, 16-22 years; 1196 male [16.5%]; 5052 white [69.9%]), 64.9% of patients with type 1 diabetes and 42.2% of patients with type 2 diabetes had undergone an eye examination by 6 years after initial diabetes diagnosis. Black youths (1367 [10.8%] of the sample) had an 11% and Latino youths (1450 [11.4%] of the sample) had an 18% decreased hazard of undergoing an eye examination by 6 years compared with white youths (black youths: adjusted hazard ratio [HR], 0.89; 95% CI, 0.79-0.99; Latino youths: HR, 0.82; 95% CI, 0.73-0.92). As household net worth increased, youths were increasingly more likely to undergo an eye examination by 6 years after initial diabetes diagnosis (net worth of ≥$500 000 vs <$25 000: HR, 1.50; 95% CI, 1.34-1.68).

Conclusions and Relevance

Despite possessing health insurance, many youths with diabetes are not receiving eye examinations by 6 years after initial diagnosis to monitor for DR. These data suggest that adherence to clinical practice guidelines is particularly challenging for racial minorities and youths from less affluent families.

Authors+Show Affiliations

Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor.Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor2Center for Eye Policy and Innovation, University of Michigan, Ann Arbor.Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor3Michigan Diabetes Research Center, University of Michigan, Ann Arbor.Division of Endocrinology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor.Division of Endocrinology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor.Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor2Center for Eye Policy and Innovation, University of Michigan, Ann Arbor5Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28334336

Citation

Wang, Sophia Y., et al. "Ophthalmic Screening Patterns Among Youths With Diabetes Enrolled in a Large US Managed Care Network." JAMA Ophthalmology, vol. 135, no. 5, 2017, pp. 432-438.
Wang SY, Andrews CA, Gardner TW, et al. Ophthalmic Screening Patterns Among Youths With Diabetes Enrolled in a Large US Managed Care Network. JAMA Ophthalmol. 2017;135(5):432-438.
Wang, S. Y., Andrews, C. A., Gardner, T. W., Wood, M., Singer, K., & Stein, J. D. (2017). Ophthalmic Screening Patterns Among Youths With Diabetes Enrolled in a Large US Managed Care Network. JAMA Ophthalmology, 135(5), 432-438. https://doi.org/10.1001/jamaophthalmol.2017.0089
Wang SY, et al. Ophthalmic Screening Patterns Among Youths With Diabetes Enrolled in a Large US Managed Care Network. JAMA Ophthalmol. 2017 05 1;135(5):432-438. PubMed PMID: 28334336.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ophthalmic Screening Patterns Among Youths With Diabetes Enrolled in a Large US Managed Care Network. AU - Wang,Sophia Y, AU - Andrews,Chris A, AU - Gardner,Thomas W, AU - Wood,Michael, AU - Singer,Kanakadurga, AU - Stein,Joshua D, PY - 2017/3/24/pubmed PY - 2017/7/20/medline PY - 2017/3/24/entrez SP - 432 EP - 438 JF - JAMA ophthalmology JO - JAMA Ophthalmol VL - 135 IS - 5 N2 - Importance: Ophthalmic screening to check for diabetic retinopathy (DR) is important to prevent vision loss in persons with diabetes. The American Academy of Ophthalmology recommends that ophthalmic screening for DR occur beginning at 5 years after initial diabetes diagnosis for youths with type 1 diabetes; the American Diabetes Association recommends screening of youths with type 2 diabetes at the time of initial diagnosis. To our knowledge, it is unknown to what extent youths with diabetes obtain eye examinations in accordance with these guidelines. Objective: To assess the rate of obtaining ophthalmic examinations and factors associated with receipt of eye examinations for youths with diabetes. Design, Setting, and Participants: This retrospective, longitudinal cohort study examined youths 21 years or younger with newly diagnosed diabetes enrolled in a US managed care network from January 1, 2001, through December 31, 2014. Main Outcomes and Measures: Kaplan-Meier survival curves estimated the time from initial diabetes diagnosis to first eye examination by an ophthalmologist or optometrist. Multivariable Cox proportional hazards regression models identified factors associated with receiving an ophthalmic examination after initial diabetes diagnosis. Results: Among 5453 youths with type 1 diabetes (median age at initial diagnosis, 11 years; interquartile range, 8-15 years; 2972 male [54.5%]; 4505 white [82.6%]) and 7233 youths with type 2 diabetes (median age at initial diagnosis, 19 years; interquartile range, 16-22 years; 1196 male [16.5%]; 5052 white [69.9%]), 64.9% of patients with type 1 diabetes and 42.2% of patients with type 2 diabetes had undergone an eye examination by 6 years after initial diabetes diagnosis. Black youths (1367 [10.8%] of the sample) had an 11% and Latino youths (1450 [11.4%] of the sample) had an 18% decreased hazard of undergoing an eye examination by 6 years compared with white youths (black youths: adjusted hazard ratio [HR], 0.89; 95% CI, 0.79-0.99; Latino youths: HR, 0.82; 95% CI, 0.73-0.92). As household net worth increased, youths were increasingly more likely to undergo an eye examination by 6 years after initial diabetes diagnosis (net worth of ≥$500 000 vs <$25 000: HR, 1.50; 95% CI, 1.34-1.68). Conclusions and Relevance: Despite possessing health insurance, many youths with diabetes are not receiving eye examinations by 6 years after initial diagnosis to monitor for DR. These data suggest that adherence to clinical practice guidelines is particularly challenging for racial minorities and youths from less affluent families. SN - 2168-6173 UR - https://www.unboundmedicine.com/medline/citation/28334336/Ophthalmic_Screening_Patterns_Among_Youths_With_Diabetes_Enrolled_in_a_Large_US_Managed_Care_Network_ L2 - https://jamanetwork.com/journals/jamaophthalmology/fullarticle/10.1001/jamaophthalmol.2017.0089 DB - PRIME DP - Unbound Medicine ER -