Ophthalmic Screening Patterns Among Youths With Diabetes Enrolled in a Large US Managed Care Network

Abstract

Importance: 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.

Objective: 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.

Main outcomes and measures: 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.

Results: 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).

Conclusions and relevance: 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.

Figure 1. Kaplan-Meier Plot of Time to First Eye Examination After Initial Diabetes Diagnosis

Youths who obtained an eye examination by 6 years after initial diabetes diagnosis are indicated at the vertical line.

Figure 2. Kaplan-Meier Plot of Time to First Eye Examination After Initial Diabetes Diagnosis, Stratified by Race

Youths who obtained an eye examination by 6 years after initial diabetes diagnosis are indicated at the vertical line.

Figure 3. Kaplan-Meier Plot of Time to First Eye Examination After Initial Diabetes Diagnosis, Stratified by Household Net Worth

Youths who obtained an eye examination by 6 years after initial diabetes diagnosis are indicated at the vertical line.