Wang Sophia Y, Andrews Chris A, Gardner Thomas W, Wood Michael, Singer Kanakadurga, Stein Joshua D
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.
JAMA Ophthalmol. 2017 May 1;135(5):432-438. doi: 10.1001/jamaophthalmol.2017.0089.
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.
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.
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.
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).
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.
眼科筛查以检查糖尿病视网膜病变（DR）对于预防糖尿病患者视力丧失至关重要。美国眼科学会建议，1型糖尿病青少年在首次诊断糖尿病后5年开始进行DR的眼科筛查；美国糖尿病协会建议对2型糖尿病青少年在初次诊断时进行筛查。据我们所知，尚不清楚糖尿病青少年在多大程度上按照这些指南进行眼部检查。
评估糖尿病青少年进行眼科检查的比例以及与接受眼部检查相关的因素。
设计、设置和参与者：这项回顾性纵向队列研究对2001年1月1日至2014年12月31日在美国管理式医疗网络中登记的21岁及以下新诊断糖尿病青少年进行了检查。
Kaplan-Meier生存曲线估计了从初次糖尿病诊断到眼科医生或验光师首次眼部检查的时间。多变量Cox比例风险回归模型确定了初次糖尿病诊断后接受眼科检查的相关因素。
在5453名1型糖尿病青少年（初次诊断时的中位年龄为11岁；四分位间距为8 - 15岁；2972名男性[54.5%]；4505名白人[82.6%]）和7233名2型糖尿病青少年（初次诊断时的中位年龄为19岁；四分位间距为16 - 22岁；1196名男性[16.5%]；5052名白人[69.9%]）中，64.9%的1型糖尿病患者和42.2%的2型糖尿病患者在初次糖尿病诊断后6年内接受了眼部检查。黑人青少年（样本中的1367名[10.8%]）与白人青少年相比，在6年内接受眼部检查的风险降低了11%，拉丁裔青少年（样本中的1450名[11.4%]）降低了18%（黑人青少年：调整后的风险比[HR]为0.89；95%置信区间为0.79 - 0.99；拉丁裔青少年：HR为0.82；95%置信区间为0.73 - 0.92）。随着家庭净资产增加，青少年在初次糖尿病诊断后6年内接受眼部检查的可能性越来越大（净资产≥50万美元与＜2.5万美元相比：HR为1.50；95%置信区间为1.34 - 1.68）。
尽管拥有医疗保险，但许多糖尿病青少年在初次诊断后6年内未接受眼部检查以监测DR。这些数据表明，对于少数族裔和来自不太富裕家庭的青少年来说，遵守临床实践指南尤其具有挑战性。
