Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Feb;132(2):168-73.
doi: 10.1001/jamaophthalmol.2013.6426.

Underuse of the health care system by persons with diabetes mellitus and diabetic macular edema in the United States

Neil M Bressler  1 , Rohit Varma  2 , Quan V Doan  3 , Michelle Gleeson  3 , Mark Danese  3 , Julie K Bower  4 , Elizabeth Selvin  4 , Chantal Dolan  5 , Jennifer Fine  5 , Shoshana Colman  5 , Adam Turpcu  5
Affiliations

Underuse of the health care system by persons with diabetes mellitus and diabetic macular edema in the United States

Neil M Bressler et al. JAMA Ophthalmol. 2014 Feb.

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: N. Bressler is principal investigator of grants at The Johns Hopkins University sponsored by the following entities (not including the National Institutes of Health): Bausch & Lomb Incorporated; ForSight Labs, LLC; Genentech, Inc.; Genzyme Corporation; Lumenis Inc.; Notal Vision; Novartis Pharma AG; Optovue, Inc.; Regeneron Pharmaceuticals, Inc. R. Varma is a consultant for Allergan, Aquesys, Genentech, Merck, and Replenish and has received research funding from Genentech, and Replenish. Q. Doan, M. Gleeson, and M. Danese are employees of Outcomes Insights, Inc. and paid consultants for Genentech. J. Bower and E. Selvin are co-investigators of Dr Bressler's grant at The Johns Hopkins University sponsored by Genentech. C. Dolan is a paid consultant for Genentech. A. Turpcu, J. Fine, and S. Colman are employees of Genentech.

Figures

Figure 1
Figure 1
Awareness of eye diseases among U.S. adults aged ≥40 years with self-reported diabetes. Participants were asked “Have you been told by a doctor that diabetes has affected your eyes or that you had retinopathy?” Unknown category not reported. Error bars represent 95% confidence intervals. DME, diabetic macular edema; DR, diabetic retinopathy.
Figure 2
Figure 2
Self-reported last visit to a diabetes specialist among U.S. adults aged ≥40 years with diabetes. Participants were asked “When was the last time you saw a diabetes nurse educator, or dietitian or nutritionist for your diabetes?” The total for each cohort equals 100%. If not, the difference represents subject who responded as “don't know” to this question (not shown). Error bars represent 95% confidence intervals. DME, diabetic macular edema; DR, diabetic retinopathy.
Figure 3
Figure 3
Self-reported last pupil dilation exam among U.S. adults ≥40 years with diabetes. Participants were asked “When was the last time you had an eye exam in which the pupils were dilated?” The total for each cohort equals 100%. If not, the difference represents subject who responded as “don't know” to this question (not shown). Error bars represent 95% confidence intervals. DME, diabetic macular edema; DR, diabetic retinopathy.
Figure 4
Figure 4
Percentage of U.S. adults aged ≥40 years with diabetes, diabetes and diabetic retinopathy (DR) without diabetic macular edema (DME), or diabetes with DME, with presenting or best-corrected visual acuity (VA) worse than 20/40. Unknown category not reported. Error bars represent 95% confidence intervals. aStandard error is >30% of the estimate; estimate may be unreliable.
See this image and copyright information in PMC

Comment in

References

    1. Centers for Disease Control and Prevention. National diabetes fact sheet. [Accessed April 30, 2013];2011 http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf.
    1. Roy MS, Klein R, O'Colmain BJ, Klein BE, Moss SE, Kempen JH. The prevalence of diabetic retinopathy among adult type 1 diabetic persons in the United States. Arch Ophthalmol. 2004;122(4):546–551. - PubMed
    1. Congdon N, O'Colmain B, Klaver CC, et al. Eye Diseases Prevalence Research Group. Causes and prevalence of visual impairment among adults in the United States. Arch Ophthalmol. 2004;122(4):477–485. - PubMed
    1. Prevent Blindness America. Vision problems in the U.S.: prevalence of adult visioni Impairment and age-related eye disease in America [2008] [Accessed April 30, 2013]; http://www.preventblindness.net/site/DocServer/VPUS_2008_update.pdf.
    1. Klein R, Lee KE, Gangnon RE, Klein BE. The 25-year incidence of visual impairment in type 1 diabetes mellitus the wisconsin epidemiologic study of diabetic retinopathy. Ophthalmology. 2010;117(1):63–70. - PMC - PubMed

Publication types