The Role of Urban Residence, Race and Ethnicity, and Glycemic Control in Receiving Standards of Care and Progression to Vision-Threatening Diabetic Retinopathy
Authors' conclusion
Understanding the management and progression of newly detected NPDR will require disentangling the independent and interdependent contributions of geography, race and ethnicity, and glycemia.
Study context
- Population
- US patients with diabetes and newly detected mild or moderate nonproliferative diabetic retinopathy (NPDR) without diabetic macular edema (DME), 2015–2023; mean age 63 years, 51% female, 59% NH White, 7% rural
- Participants
- 102,919 patients
- Exposure
- Urban vs rural residence; race and ethnicity; glycemic control
- Outcome
- Guideline-recommended care (two of three: ophthalmology visit, primary care visit, and measurement of HbA1c, blood pressure and LDL-C) and progression to VTDR (severe NPDR, proliferative DR, DME)
- Follow-up
- 2 years after diagnosis (care)
Methodological detailselectronic health records, Epic Cosmos research platform
- Electronic health records
- Epic Cosmos research platform
Main finding
As reported in the abstract
Urban vs RuralEstimate (95% CI)
Standards of care in both years
RR 1.08(1.05–1.12)
Progression to VTDR
HR 1.07(0.99–1.15)
- Received guideline-recommended care (whole sample)
- 40%
- Progressed to vision-threatening diabetic retinopathy (VTDR) (whole sample; median follow-up 35 months, IQR 18-63)
- 14%
Observational data: associations, not effects.
Further findings
Race and ethnicity
- Racial and ethnic minority individuals were more likely to progress to VTDR
Glycemic control
- Poor or unknown glycemic control: less likely to receive standards of care and more likely to progress to VTDR
Original publication
The Role of Urban Residence, Race and Ethnicity, and Glycemic Control in Receiving Standards of Care and Progression to Vision-Threatening Diabetic Retinopathy. Diabetes Care. Published 10 October 2024. doi:10.
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