Ophthalmic Screening Patterns Among Youths With Diabetes
JAMA Ophthalmology, May 2017
Wang et al. assessed whether youths with diabetes are compliant with screening guidelines for diabetic retinopathy. They found that, despite having health insurance, many young patients do not receive an eye exam within 6 years of their diabetes diagnosis.
The authors’ retrospective longitudinal study included 12,686 patients (≤21 years of age) with type 1 or 2 diabetes who were members of a U.S. managed care network. The time from diabetes diagnosis to first exam by an ophthalmologist or optometrist was estimated by Kaplan-Meier analysis. Multivariate Cox proportional hazards regression models were used to identify factors associated with receiving an ophthalmic exam within 6 years of the diabetes diagnosis.
Among the 5,453 patients with type 1 diabetes (median age at diagnosis, 11 years), 64.9% received an eye exam within 6 years of diagnosis. Of the 7,233 youths with type 2 diabetes (median age at diagnosis, 19 years), only 42.2% had an eye exam in this time frame.
Regression analysis showed that black patients (n = 1,367 [10.8% of study sample]) and Latinos (n = 1,450 [11.4% of study sample]) were 11% and 18% less likely, respectively, than were white youths to have their eyes examined within 6 years of diagnosis (black youths: adjusted hazard ratio [HR], 0.89; Latino youths: adjusted HR, 0.82). Higher household net worth was associated with greater likelihood of having an eye exam within 6 years of diagnosis (net worth ≥$500,000 vs. <$25,000: HR, 1.50). Although lack of health insurance was not found to be a barrier to adherence, insurance copayment requirements may have contributed to the low rates of timely screening.
The authors concluded that more than one-third of children and adolescents with diabetes do not receive an eye exam within 6 years of diagnosis. Adherence to recommended guidelines appears especially challenging for minorities and those who are economically disadvantaged. Efforts should be made to improve the rate of timely ophthalmic screening among youths with diabetes. (Also see related commentary by Seema Garg, MD, in the same issue.)
The original article can be found here.