Underuse of the Health Care System by Persons With Diabetes Mellitus and Diabetic Macular Edema in the United States | Diabetic Retinopathy | JAMA Ophthalmology | JAMA Network
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Original Investigation
Clinical Sciences
February 2014

Underuse of the Health Care System by Persons With Diabetes Mellitus and Diabetic Macular Edema in the United States

Author Affiliations
  • 1Wilmer Eye Institute, Johns Hopkins University School of Medicine and Hospital, Baltimore, Maryland
  • 2Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois College of Medicine, Chicago
  • 3Outcomes Insights, Inc, Westlake Village, California
  • 4Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 5Genentech, Inc, South San Francisco, California
JAMA Ophthalmol. 2014;132(2):168-173. doi:10.1001/jamaophthalmol.2013.6426

Importance  Thickening of the center of the retina, diabetic macular edema (DME), is the most common cause of visual loss due to diabetes mellitus. Treatment of DME has improved dramatically, and the prompt diagnosis of DME and referral of these patients have become more critical. Nonetheless, awareness of and care for DME in the US population is uncharacterized.

Objective  To characterize eye care and awareness of eye disease among persons with DME in the general US population.

Design, Setting, and Participants  Cross-sectional analysis of data from participants in the 2005 to 2008 National Health and Nutrition Examination Survey 40 years or older with diabetes mellitus and fundus photographs.

Main Outcomes and Measures  Among persons with DME, (1) awareness that diabetes has affected their eyes; (2) report on the last time they visited a diabetes specialist; (3) report on their last eye examination with pupil dilation; and (4) prevalence of visual impairment.

Results  In 2010, only 44.7% (95% CI, 27.0%-62.4%) of US adults 40 years or older with DME reported being told by a physician that diabetes had affected their eyes or that they had retinopathy; 46.7% (95% CI, 27.5%-66.0%), that they had visited a diabetes nurse educator, dietician, or nutritionist for their diabetes mellitus more than 1 year ago or never; and 59.7% (95% CI, 43.5%-75.9%), that they had received an eye examination with pupil dilation in the last year. Among persons with DME, 28.7% (95% CI, 12.7%-44.7%) were visually impaired (defined as visual acuity worse than 20/40 in the eye with DME) based on visual acuity at the initial examination and 16.0% (95% CI, 2.5%-29.4%) based on best-corrected visual acuity.

Conclusions and Relevance  Many persons with diabetes mellitus in the United States are not getting care that can prevent visual impairment and blindness. Strategies to increase awareness are warranted, especially given the recent availability of improved therapies for DME.