Trends in the Prevalence and Treatment of Diabetic Macular Edema and Vision-Threatening Diabetic Retinopathy Among Commercially Insured Adults Aged <65 Years

Objective: Examine the ten-year trend in the prevalence and treatment of diabetic macular edema (DME) and vision-threatening diabetic retinopathy (VTDR) among commercially insured adults with diabetes.

Research Design and Methods: We analyzed the ten-year trend (2009–2018) in healthcare claims for adults 18–64 years using the IBM® MarketScan® Database, a national convenience sample of employer-sponsored health insurance. We included patients continuously enrolled in commercial fee-for-service health insurance for 24 months who had a diabetes ICD-9/10-CM code on ≥1 inpatient or ≥2 different day outpatient claims in the index year or previous calendar year. We used diagnosis and procedure codes to calculate the annual prevalence of patients with ≥1 claims for: 1) any DME, 2) either DME/VTDR, and 3) anti-vascular endothelial growth factor injections [anti-VEGF] and laser photocoagulation treatment, stratified by any DME, VTDR with DME, and VTDR without DME. We calculated Average Annual Percent Change (AAPC).

Results: From 2009–2018, there was an increase in the annual prevalence of patients with DME/VTDR (2.1% to 3.4%; AAPC=7.5%; p<0.001) and any DME (0.7% to 2.6%; AAPC=19.8%; p<0.001). There were sex differences in the annual prevalence of DME/VTDR and any DME, with males having a higher prevalence than females. Annual claims for anti-VEGF increased among those with any DME (327%) and VTDR with DME (206%); laser photocoagulation decreased among patients with any DME (-68%), VTDR with DME (-54%), and VTDR without DME (-62%). 

Conclusions: Annual claims for DME/VTDR and anti-VEGF injections increased while laser photocoagulation decreased among commercially insured adults with diabetes.