Proliferative Diabetic Retinopathy and Early Intervention Strategies

Goals

To determine the incidence and risk factors for developing proliferative diabetic retinopathy (PDR), traction retinal detachment (TRD), and neovascular glaucoma (NVG) within 5 years of the initial diagnosis of type 2 diabetes.

Methodology

Insured patients aged ≥18 years with newly diagnosed type 2 diabetes and 5 years of continuous enrollment were identified from a nationwide commercial claims database containing data from 2007 to 2015.

The incidences of PDR, TRD, and NVG were calculated at 5 years after the index type 2 diabetes diagnosis.

Associations between these outcomes and demographic, socioeconomic, and medical factors were tested with multivariable logistic regression.

Results

At 5 years after the initial diagnosis of type 2 diabetes, 1.74% (1,249 of 71,817) of patients had developed PDR, 0.25% of patients had developed TRD, and 0.14% of patients they had developed NVG.

Insulin use (odds ratio [OR] 3.59; 95% CI: 3.16-4.08), maximum HbA1c > 9% or > 75 mmol/mol (OR 2.10; 95% CI: 1 .54-2.69), kidney disease (OR 2.68, 95% CI 2.09-3.42), peripheral circulatory disorders (OR 1.88, 95% CI 1.25-2.83), neurological disease (OR 1.62, 95% CI 1.24-2.11) and advanced age (65-74 years) at diagnosis (OR 1.62, 95% CI 1.28-2.03 ) were identified as risk factors for the development of PDR at 5 years.

Young age (18-23 years) at diagnosis (OR 0.46, 95% CI: 0.29-0.74), Medicare insurance (OR 0.60, 95% CI: 0.70) -0.76), morbid obesity (OR 0.72, 95% CI: 0.59-0.87), and smoking (OR 0.84, 95% CI 0.70-1.00) were identified as protective factors.

Comments

Sight-threatening eye disease is a complication of type 2 diabetes that can be prevented through proper glycemic control. This study evaluated the 5-year incidence of severe diabetic eye disease (including proliferative diabetic retinopathy, traction retinal detachment, and neovascular glaucoma) in a large, national, multiethnic cohort of insured persons (>70,000 patients) with type 2 diabetes. newly diagnosed, more than the period 2007 to 2015.

Although <2% of people with newly diagnosed diabetes developed serious eye disease within 5 years of diagnosis, the study identified key risk factors for the development of proliferative diabetic retinopathy. These included insulin use, uncontrolled blood glucose, kidney disease, peripheral circulatory disorders, neurological disease, and advanced age (≥65 years) at diagnosis.

This study has practical implications as it provides useful information on subgroups of people at risk of vision loss in the first 5 years after diagnosis of type 2 diabetes.

The results suggest that these individuals would benefit from intensive and focused preventive efforts, including annual screening for eye diseases and intensive glycemic management early in the disease process.

Overall, the findings highlight the critical importance of screening for eye diseases among people with newly diagnosed type 2 diabetes and its repetition at regular intervals, as well as the need for appropriate clinical treatment to prevent vision loss.