An JaeJin, Niu Fang, Turpcu Adam, Rajput Yamina, Cheetham T Craig
a Department of Pharmacy Practice & Administration , Western University of Health Sciences , Pomona , CA , USA.
b Drug Information Services, Kaiser Permanente Southern California, Downey , CA , USA.
Ophthalmic Epidemiol. 2018 Jun;25(3):257-265. doi: 10.1080/09286586.2018.1424344. Epub 2018 Jan 15.
(1) To assess long-term adherence to American Diabetes Association guideline-recommended retinal screening among population with diabetes in the United States. (2) To determine factors associated with long-term adherence to routine eye screening exams.
A retrospective cohort study was conducted in adult patients with diabetes identified from January 2009 to December 2010. Patients were followed until disenrollment, death, or study end date (December 2013). A patient was defined as adherent when having at least one exam in each 12-month period if there was evidence of retinopathy, or at least one exam in each 24-month period if there was no evidence of retinopathy. Multivariate logistic regressions were used to investigate patient demographics and other baseline characteristics associated with adherence to guidelines.
A total of 204,073 patients were identified; the mean age (SD) was 61 (13) years and 48% were female. Overall, 71.1% were adherent to the retinal screening guidelines during a median of 4.8 years of follow-up including 27.7% who received an eye exam every year. Patient socioeconomic status (younger age, black race, lower income/education), less comorbidity, insulin use, higher specialist copayment plans, and proxies for poor patient behavior (lower adherence to the oral hypoglycemic agents, less diabetes education, hemoglobin A1C >9%) were associated with nonadherence to routine eye screening exams.
During nearly 5 years of follow-up, 28.9% of patients with diabetes were nonadherent to the retinal screening guidelines. Future research should focus on the development of interventions to address modifiable factors associated with nonadherence.
（1）评估美国糖尿病患者对美国糖尿病协会指南推荐的视网膜筛查的长期依从性。（2）确定与长期坚持常规眼部筛查检查相关的因素。
对2009年1月至2010年12月期间确诊的成年糖尿病患者进行回顾性队列研究。对患者进行随访，直至退出研究、死亡或研究结束日期（2013年12月）。如果有视网膜病变的证据，患者在每12个月期间至少进行一次检查，则定义为依从；如果没有视网膜病变的证据，患者在每24个月期间至少进行一次检查，则定义为依从。使用多变量逻辑回归来研究与指南依从性相关的患者人口统计学和其他基线特征。
共确定了204,073名患者；平均年龄（标准差）为61（13）岁，48%为女性。总体而言，在中位随访4.8年期间，71.1%的患者遵守了视网膜筛查指南，其中27.7%的患者每年接受一次眼部检查。患者的社会经济状况（年龄较小、黑人种族、收入/教育程度较低）、合并症较少、使用胰岛素、较高的专科共付计划以及患者不良行为的代理指标（口服降糖药依从性较低、糖尿病教育较少、糖化血红蛋白>9%）与未遵守常规眼部筛查检查相关。
在近5年的随访中，28.9%的糖尿病患者未遵守视网膜筛查指南。未来的研究应侧重于开发干预措施，以解决与不依从相关的可改变因素。
