The Role of Urban Residence, Race and Ethnicity, and Glycemic Control in Receiving Standards of Care and Progression to Vision Threatening Diabetic Retinopathy
Among patients with diabetes from the United States with newly detected mild or moderate non-proliferative 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).
Research Design and Methods
Electronic health records of patients newly detected with NPDR without DME between 2015 and 2023 were analyzed using the Epic Cosmos Research Platform. We characterized the adjusted associations of urban versus rural residence, race/ethnicity (Hispanic, Non-Hispanic [NH] White, NH Black, Other), and glycemic control (HbA1c: <7%, 7-8.9%, ≥9%, unavailable) separately with guideline-recommended care (two out of three: Ophthalmology visit, Primary Care visit, measurement of HbA1c, blood pressure and LDL cholesterol) in the two years after diagnosis and progression to VTDR.
Results
The analytic sample (n=102,919) were on average 63 years [SD: 13.5], 51% female, 59% NH- White and 7% rural residents. Only 40% received guideline recommended care and 14% progressed to vision threatening diabetic retinopathy (follow-up: 35 months [IQR: 18-63]). Urban residence was associated with receiving standards of care in both years (RR: 1.08 [95%CI: 1.05-1.12]) and progression to VTDR (HR: 1.07 [95%CI: 0.99-1.15]). Racial/ethnic minorities 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.
Conclusions
Understanding the management and progression of newly detected NPDR will require disentangling the independent and interdependent contributions of geography, race/ethnicity, and glycemia.