Adherence to the American Diabetes Association retinal screening guidelines for population with diabetes in the United States

Ophthalmic Epidemiol. 2018 Jun;25(3):257-265. doi: 10.1080/09286586.2018.1424344. Epub 2018 Jan 15.

Abstract

Purpose: (1) To assess long-term adherence to American Diabetes Association guideline-recommended retinal screening among population with diabetes in the United States. (2) To determine factors associated with long-term adherence to routine eye screening exams.

Methods: A retrospective cohort study was conducted in adult patients with diabetes identified from January 2009 to December 2010. Patients were followed until disenrollment, death, or study end date (December 2013). A patient was defined as adherent when having at least one exam in each 12-month period if there was evidence of retinopathy, or at least one exam in each 24-month period if there was no evidence of retinopathy. Multivariate logistic regressions were used to investigate patient demographics and other baseline characteristics associated with adherence to guidelines.

Results: A total of 204,073 patients were identified; the mean age (SD) was 61 (13) years and 48% were female. Overall, 71.1% were adherent to the retinal screening guidelines during a median of 4.8 years of follow-up including 27.7% who received an eye exam every year. Patient socioeconomic status (younger age, black race, lower income/education), less comorbidity, insulin use, higher specialist copayment plans, and proxies for poor patient behavior (lower adherence to the oral hypoglycemic agents, less diabetes education, hemoglobin A1C >9%) were associated with nonadherence to routine eye screening exams.

Conclusion: During nearly 5 years of follow-up, 28.9% of patients with diabetes were nonadherent to the retinal screening guidelines. Future research should focus on the development of interventions to address modifiable factors associated with nonadherence.

Keywords: NCQA/HEDIS; diabetes; ophthalmology; practice guidelines/patterns; quality of care; retinal screening.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Diabetes Mellitus / epidemiology*
  • Diabetic Retinopathy / diagnosis
  • Diabetic Retinopathy / epidemiology*
  • Female
  • Follow-Up Studies
  • Guideline Adherence*
  • Humans
  • Incidence
  • Male
  • Mass Screening / standards*
  • Middle Aged
  • Prevalence
  • Retrospective Studies
  • Societies, Medical*
  • Time Factors
  • United States / epidemiology