Incidence of Proliferative Diabetic Retinopathy and Other Neovascular Sequelae at 5 Years Following Diagnosis of Type 2 Diabetes

<b>Objective:</b> To determine the incidence and risk factors for developing proliferative diabetic retinopathy (PDR), tractional retinal detachment (TRD), and neovascular glaucoma (NVG) at 5 years after initial diagnosis of type 2 diabetes. <p><b>Research Design and Methods: </b>Insured patients age 18 or older with newly-diagnosed type 2 diabetes and 5 years of continuous enrollment were identified from a nationwide commercial claims database containing data from 2007-2015.<b> </b>The<b> </b>incidences of PDR, TRD, and NVG were computed at 5 years following index diagnosis of type 2 diabetes.<b> </b>Associations between these outcomes and demographic, socioeconomic, and medical factors were tested with multivariable logistic regression.</p> <p><b>Results:</b> At 5 years following initial diagnosis of type 2 diabetes, 1.74% (1,249/71,817) of patients had developed PDR. Additionally, 0.25% of patients had developed TRD, and 0.14% of patients had developed NVG. Insulin use (OR 3.59, 95% CI 3.16-4.08), maximum HbA1c >9% or 75mmol/mol (OR 2.10, 95% CI 1.54-2.69), renal disease (OR 2.68, 95% CI 2.09-3.42), peripheral circulatory disorders (OR 1.88, 95% CI 1.25-2.83), neurological disease (OR 1.62, 95% CI 1.24-2.11), and older age at diagnosis (age 65-74, OR 1.62, 1.28-2.03) were identified as risk factors for development of PDR at 5 years. Young age at diagnosis (age 18-34, OR 0.46, 95% CI 0.29-0.74), Medicare insurance (OR 0.60, 95% CI 0.70-0.76), morbid obesity (OR 0.72, 95% CI 0.59-0.87), and smoking (OR 0.84, 95% CI 0.70-1.00) were identified as protective factors. </p> <p><b>Conclusions:</b> A subset of patients with type 2 diabetes develop PDR and other neovascular sequelae within the first 5 years following diagnosis with type 2 diabetes. These patients may benefit from increased efforts for screening and early intervention.</p>