Varghese Jithin Sam, Ravi Kumar Vishnu, Bartelt Jackson, Hendrick Andrew M, Pasquel Francisco J
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA.
Emory Global Diabetes Research Center, Robert W. Woodruff Health Sciences Center, Emory University, Atlanta, GA.
Diabetes Care. 2025 Jan 1;48(1):29-37. doi: 10.2337/dci24-0024.
Among patients with diabetes living in the U.S. with newly detected mild or moderate nonproliferative diabetic retinopathy (NPDR) without diabetic macular edema (DME), we aimed to characterize determinants for receiving standards of care and progression to vision-threatening diabetic retinopathy (VTDR) (severe NPDR, proliferative diabetic retinopathy, DME).
Electronic health records of patients newly detected with NPDR without DME between 2015 and 2023 were analyzed with use of the Epic Cosmos research platform. We characterized the adjusted associations of urban versus rural residence, race and ethnicity (Hispanic, non-Hispanic [NH] White, NH Black, other), and glycemic control (HbA1c <7.0%, 7.0%-8.9%, ≥9%, unavailable) separately with guideline-recommended care (two of three: ophthalmology visit, primary care visit, and measurement of HbA1c, blood pressure, and LDL cholesterol) in the 2 years after diagnosis and with progression to VTDR.
Average (SD) age for the analytic sample (n = 102,919) was 63 (13.5) years, and 51% were female, 59% NH White, and 7% rural residents. Only 40% received guideline-recommended care, and 14% progressed to VTDR (median follow-up 35 months [interquartile range 18-63]). Urban residence was associated with receiving standards of care in both years (risk ratio 1.08 [95% CI 1.05-1.12]) and progression to VTDR (hazard ratio 1.07 [95% CI 0.99-1.15]). Racial and ethnic minority individulas were more likely to progress to VTDR. Individuals with poor or unknown glycemic control were less likely to receive standards of care and more likely to progress to VTDR.
Understanding the management and progression of newly detected NPDR will require disentangling the independent and interdependent contributions of geography, race and ethnicity, and glycemia.
在美国患有新诊断出的轻度或中度非增殖性糖尿病视网膜病变（NPDR）且无糖尿病性黄斑水肿（DME）的糖尿病患者中，我们旨在确定接受标准治疗以及进展为威胁视力的糖尿病视网膜病变（VTDR，即重度NPDR、增殖性糖尿病视网膜病变、DME）的决定因素。
利用Epic Cosmos研究平台分析了2015年至2023年间新诊断出患有NPDR且无DME的患者的电子健康记录。我们分别描述了城市与农村居住情况、种族和族裔（西班牙裔、非西班牙裔[NH]白人、NH黑人、其他）以及血糖控制情况（糖化血红蛋白<7.0%、7.0%-8.9%、≥9%、数据缺失）与诊断后2年内指南推荐治疗（三项中的两项：眼科就诊、初级保健就诊以及糖化血红蛋白、血压和低密度脂蛋白胆固醇测量）以及进展为VTDR之间的校正关联。
分析样本（n = 102,919）的平均（标准差）年龄为63（13.5）岁，51%为女性，59%为NH白人，7%为农村居民。仅40%的患者接受了指南推荐治疗，14%进展为VTDR（中位随访35个月[四分位间距18 - 63]）。城市居住情况在两年内均与接受标准治疗相关（风险比1.08[95%置信区间1.05 - 1.12]）以及进展为VTDR相关（风险比1.07[95%置信区间0.99 - 1.15]）。少数种族和族裔个体更有可能进展为VTDR。血糖控制不佳或情况不明的个体接受标准治疗的可能性较小，进展为VTDR的可能性更大。
了解新诊断出的NPDR的管理和进展情况需要厘清地理、种族和族裔以及血糖的独立和相互依存的影响。
