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Diabetic retinopathy screening in incident diabetes mellitus type 2 in Germany between 2004 and 2013 - A prospective cohort study based on health claims data.
PLoS One. 2018; 13(4):e0195426.Plos

Abstract

OBJECTIVE

To assess factors associated with diabetic retinopathy (DR) screening uptake following a diagnosis of type 2 diabetes mellitus (type 2 diabetes) in Germany.

MATERIALS AND METHODS

A nationally representative prospective sample of individual-level health claims data for 250,000 members from Germany's largest public insurance provider in 2004-2013 was assessed. In the sample, 26,560 persons with incident type 2 diabetes were identified. Factors associated with subsequent DR screening were assessed using descriptive statistics, Kaplan-Meier estimator, and Cox regression analysis.

RESULTS

On average 27.6 visits to an ophthalmologist per 100 person-years in persons with incident type 2 diabetes occurred. Half of all incident cases (Kaplan-Meier estimator) had not seen an ophthalmologist after more than two years (2.25 years) following their diabetes diagnosis. In the multivariate analysis, an older age (from hazard ratio HR(70-74) = 0.93 [95%-CI: 0.89-0.97] to HR(90+) = 0.50 [95%-CI: 0.42-0.60] compared to persons aged 50-69 years) and a higher disability level (i.e. HR(disability level 3) = 0.30 [95%-CI: 0.25-0.36]) were associated with a lower likelihood, while female sex (HR = 1.12 [95%-CI: 1.08-1.15]), six or more comorbidities (HR = 1.26 [95%-CI: 1.15-1.37]), moderate (HR = 1.51 [95%-CI: 1.46-1.56]) or severe type 2 diabetes (HR = 1.53 [95%-CI: 1.45-1.61]) as well as being enrolled in a type 2 diabetes disease management program (HR = 1.78 [95%-CI: 1.69-1.87]) were associated with a higher likelihood of DR screening.

CONCLUSIONS

A high proportion of newly diagnosed persons with type 2 diabetes did not follow current German recommendations for DR screening, impeding timely detection and management of potential complications. This was more apparent among persons who were men, older or had a disability. The uptake of screening was considerably greater among those enrolled in a diseases management program. These factors need to be considered when planning DR screening services and/or referrals.

Authors+Show Affiliations

Rostock Center for the Study of Demographic Change, Rostock, Germany. Empirical Methods in Social Sciences and Demography, Institute for Sociology and Demography, University of Rostock, Rostock, Germany.Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia. Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia.Rostock Center for the Study of Demographic Change, Rostock, Germany. Empirical Methods in Social Sciences and Demography, Institute for Sociology and Demography, University of Rostock, Rostock, Germany. German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.Ophthalmic Epidemiology, Department of Ophthalmology, University of Bonn, Bonn, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29621309

Citation

Kreft, Daniel, et al. "Diabetic Retinopathy Screening in Incident Diabetes Mellitus Type 2 in Germany Between 2004 and 2013 - a Prospective Cohort Study Based On Health Claims Data." PloS One, vol. 13, no. 4, 2018, pp. e0195426.
Kreft D, McGuinness MB, Doblhammer G, et al. Diabetic retinopathy screening in incident diabetes mellitus type 2 in Germany between 2004 and 2013 - A prospective cohort study based on health claims data. PLoS One. 2018;13(4):e0195426.
Kreft, D., McGuinness, M. B., Doblhammer, G., & Finger, R. P. (2018). Diabetic retinopathy screening in incident diabetes mellitus type 2 in Germany between 2004 and 2013 - A prospective cohort study based on health claims data. PloS One, 13(4), e0195426. https://doi.org/10.1371/journal.pone.0195426
Kreft D, et al. Diabetic Retinopathy Screening in Incident Diabetes Mellitus Type 2 in Germany Between 2004 and 2013 - a Prospective Cohort Study Based On Health Claims Data. PLoS One. 2018;13(4):e0195426. PubMed PMID: 29621309.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diabetic retinopathy screening in incident diabetes mellitus type 2 in Germany between 2004 and 2013 - A prospective cohort study based on health claims data. AU - Kreft,Daniel, AU - McGuinness,Myra B, AU - Doblhammer,Gabriele, AU - Finger,Robert P, Y1 - 2018/04/05/ PY - 2017/12/08/received PY - 2018/02/26/accepted PY - 2018/4/6/entrez PY - 2018/4/6/pubmed PY - 2018/7/19/medline SP - e0195426 EP - e0195426 JF - PloS one JO - PLoS One VL - 13 IS - 4 N2 - OBJECTIVE: To assess factors associated with diabetic retinopathy (DR) screening uptake following a diagnosis of type 2 diabetes mellitus (type 2 diabetes) in Germany. MATERIALS AND METHODS: A nationally representative prospective sample of individual-level health claims data for 250,000 members from Germany's largest public insurance provider in 2004-2013 was assessed. In the sample, 26,560 persons with incident type 2 diabetes were identified. Factors associated with subsequent DR screening were assessed using descriptive statistics, Kaplan-Meier estimator, and Cox regression analysis. RESULTS: On average 27.6 visits to an ophthalmologist per 100 person-years in persons with incident type 2 diabetes occurred. Half of all incident cases (Kaplan-Meier estimator) had not seen an ophthalmologist after more than two years (2.25 years) following their diabetes diagnosis. In the multivariate analysis, an older age (from hazard ratio HR(70-74) = 0.93 [95%-CI: 0.89-0.97] to HR(90+) = 0.50 [95%-CI: 0.42-0.60] compared to persons aged 50-69 years) and a higher disability level (i.e. HR(disability level 3) = 0.30 [95%-CI: 0.25-0.36]) were associated with a lower likelihood, while female sex (HR = 1.12 [95%-CI: 1.08-1.15]), six or more comorbidities (HR = 1.26 [95%-CI: 1.15-1.37]), moderate (HR = 1.51 [95%-CI: 1.46-1.56]) or severe type 2 diabetes (HR = 1.53 [95%-CI: 1.45-1.61]) as well as being enrolled in a type 2 diabetes disease management program (HR = 1.78 [95%-CI: 1.69-1.87]) were associated with a higher likelihood of DR screening. CONCLUSIONS: A high proportion of newly diagnosed persons with type 2 diabetes did not follow current German recommendations for DR screening, impeding timely detection and management of potential complications. This was more apparent among persons who were men, older or had a disability. The uptake of screening was considerably greater among those enrolled in a diseases management program. These factors need to be considered when planning DR screening services and/or referrals. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/29621309/Diabetic_retinopathy_screening_in_incident_diabetes_mellitus_type_2_in_Germany_between_2004_and_2013___A_prospective_cohort_study_based_on_health_claims_data_ L2 - https://dx.plos.org/10.1371/journal.pone.0195426 DB - PRIME DP - Unbound Medicine ER -