有新诊断 2 型糖尿病的参保患者的眼科保健和糖尿病眼病发生率。
Rates of Eye Care and Diabetic Eye Disease among Insured Patients with Newly Diagnosed Type 2 Diabetes.
机构信息
Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California.
Keck-Shaeffer Initiative for Population Health Policy, Keck School of Medicine, University of Southern California, Los Angeles, California.
出版信息
Ophthalmol Retina. 2021 Feb;5(2):160-168. doi: 10.1016/j.oret.2020.07.004. Epub 2020 Jul 9.
PURPOSE
To determine rates of eye examinations and diabetic eye disease in the first 5 years after diagnosis of type 2 diabetes (DM2) among continuously insured adults.
DESIGN
Retrospective, longitudinal cohort study.
PARTICIPANTS
Insured patients aged 40 years or older with newly diagnosed DM2 (n = 42 684), and control patients without diabetes matched on age, sex, and race were identified from a nationwide commercial claims database containing data from 2007 to 2015.
METHODS
All patients were tracked for 6 years: 1 year before and 5 years after the index diabetes diagnosis. Receipt of eye care for individual patients was identified using International Classification of Diseases 9th edition (ICD-9) procedure codes or Current Procedural Terminology (CPT) codes indicating an eye examination, as well as encounters indicating the patient was seen by an ophthalmologist. A diagnosis of diabetic eye disease was determined by using ICD-9 codes.
MAIN OUTCOME MEASURES
Outcome measures included annual receipt of eye care and development of diabetic eye disease, namely, diabetic retinopathy (DR). Associations between these outcomes and demographic factors were tested with multivariable logistic regression.
RESULTS
Diabetic patients received more eye examinations than controls in each year, but no more than 40.4% of diabetic patients received an examination in any given year. Patients with Medicare Advantage received fewer eye examinations at 5 years (odds ratio [OR], 0.79; P < 0.01) than those with private insurance but were less likely to develop DR (OR, 0.71; P < 0.01). Hispanic patients had higher rates of DR (OR, 1.60; P < 0.01) and received fewer eye examinations (OR, 0.75; P < 0.01) at 5 years compared with White patients. Men received fewer eye examinations (OR, 0.84; P < 0.01) and were more likely to develop DR at 5 years (OR, 1.17; P < 0.01) than women. Patients with higher education were more likely to receive an eye examination and less likely to develop DR.
CONCLUSIONS
The majority of diabetic patients do not receive adequate eye care within the 5 years after initial diabetes diagnosis despite having insurance. Efforts should be made to improve adherence to screening guidelines, especially for vulnerable populations.
目的
在诊断出 2 型糖尿病（DM2）后的 5 年内，确定连续参保成年人的眼部检查和糖尿病眼病的发生率。
设计
回顾性纵向队列研究。
参与者
从一个全国性的商业索赔数据库中确定了年龄在 40 岁或以上的新诊断为 2 型糖尿病（DM2）的参保患者（n=42684），并匹配了年龄、性别和种族相同的无糖尿病对照患者。该数据库包含了 2007 年至 2015 年的数据。
方法
所有患者都进行了 6 年的跟踪：糖尿病诊断前 1 年和诊断后 5 年。通过使用国际疾病分类第 9 版（ICD-9）程序代码或当前程序术语（CPT）代码来识别个别患者的眼科护理情况，这些代码表明进行了眼部检查，以及表明患者接受眼科医生检查的就诊情况来确定糖尿病眼病的诊断。
主要观察指标
观察指标包括每年接受眼部护理和发生糖尿病眼病的情况，即糖尿病视网膜病变（DR）。使用多变量逻辑回归测试这些结果与人口统计学因素之间的关系。
结果
与对照组相比，糖尿病患者在每年都接受了更多的眼部检查，但在任何给定年份，接受检查的糖尿病患者都不超过 40.4%。与私人保险相比，拥有医疗保险优势的患者在 5 年内接受的眼部检查较少（比值比[OR]，0.79；P<0.01），但发生 DR 的可能性较小（OR，0.71；P<0.01）。与白人患者相比，西班牙裔患者在 5 年内发生 DR 的比例更高（OR，1.60；P<0.01），接受的眼部检查也较少（OR，0.75；P<0.01）。男性接受的眼部检查较少（OR，0.84；P<0.01），且在 5 年内发生 DR 的可能性更大（OR，1.17；P<0.01），而女性则较少。受教育程度较高的患者更有可能接受眼部检查，且发生 DR 的可能性较小。
结论
尽管有保险，但大多数糖尿病患者在初始糖尿病诊断后的 5 年内并未接受足够的眼部护理。应努力提高对筛查指南的依从性，尤其是对弱势群体。
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