Format

Send to:

Choose Destination
See comment in PubMed Commons below
Ophthalmology. 2009 Aug;116(8):1515-21, 1521.e1-3. doi: 10.1016/j.ophtha.2009.03.010.

Effects of receipt of guideline-recommended care on onset of diabetic retinopathy and its progression.

Author information

  • 1Center for Health Policy, Duke University, Durham, North Carolina 27708, USA. fsloan@duke.edu

Abstract

OBJECTIVE:

To determine whether persons in a community setting diagnosed with diabetes who received recommended patterns of care experience improved vision outcomes over a 3-year time period.

DESIGN:

Retrospective, longitudinal, cohort analysis.

PARTICIPANTS:

Persons diagnosed with diabetes mellitus (DM), with no prior diagnosis of diabetic retinopathy (DR; n = 5989) from the Medicare Current Beneficiary Survey (1992-2004). Persons diagnosed with DM were followed up to 3 years.

INTERVENTION:

Propensity score matching was used to compare vision outcomes between persons who received guideline-recommended care and those who did not. Receipt of recommended levels of care was defined as receiving each of the following services 0.75 times annually on average: physician examination, ophthalmologist or optometrist examination, hemoglobin A1c level, lipid levels, and urinalysis.

MAIN OUTCOME MEASURES:

Outcome measures were indicators of DR disease progression: no diagnosed DR to diagnosed background DR, proliferative DR, macular edema, proliferative DR complications, and use of a low-vision aid or blindness.

RESULTS:

Persons with diagnosed diabetes receiving guideline-recommended care experienced earlier onset of background DR (average treatment effects on the treated [ATT] at 3 years, 0.118; 95% confidence interval [CI], -0.005 to 0.240). There were no differences between those receiving recommended care and others in time to onset of proliferative DR, macular edema, or proliferative DR complications. However, persons who received care consistent with recommendations experienced much lower rates of onset of low vision/blindness than did others (ATT at 3 years, -0.109; 95% CI, -0.189 to -0.030).

CONCLUSIONS:

Low vision/blindness was substantially reduced over a 3-year period among persons diagnosed with DM who received recommended levels of care.

PMID:
19651311
[PubMed - indexed for MEDLINE]
PMCID:
PMC3616628
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science Icon for PubMed Central
    Loading ...
    Write to the Help Desk