'Stunning' increase in diabetic retinopathy since 2015

An analysis of a large electronic database finds that the prevalence of vision-threatening retinopathy in people with diabetes has increased sharply over the past decade, especially among younger adults and among Hispanics and blacks.

The cross-sectional analysis, published online June 13, 2024, included 359,126 patients with type 1 and type 2 diabetes. JAMA OphthalmologyThey found that the prevalence of diabetic retinopathy (DR) increased by 15% in the former and 7% in the latter between 2015 and 2022. The increase was more pronounced in type 1 diabetes patients aged 20-29 years, increasing almost five-fold from 6.5 cases per 100,000 people in 2015 to 30.7 cases per 100,000 people in 2022, the researchers found. In type 1 disease patients aged 30-39 years, the prevalence nearly doubled. In other age groups, the increase was more modest, ranging from 6% to 17%, and in those aged 70 years and older, the prevalence fell by 28%.

Rishi Singh, MD, executive vice president and chief medical officer at Cleveland Clinic Florida Martin North and South Hospital and a professor at the Cleveland Clinic Larner College of Medicine in Cleveland, said he and his colleagues expect an increase in cases.

“We know that diabetes is increasing exponentially. We expected that the rate of diabetic retinopathy would increase as well,” Singh said. Medscape Medical NewsBut the scale of the surge in certain groups was “staggering,” he added.

The study collected data from the U.S. Collaborative Network within the TriNetX Analytics platform, a healthcare research network that stores de-identified electronic medical record data from more than 95 million patients from 56 U.S. healthcare institutions.

Once vision loss occurs due to DR, it cannot be restored. Treatment with anti-vascular endothelial growth factor agents can preserve existing vision and prevent worsening of vision loss, but it cannot restore lost vision.

Who is most affected?

Among those with type 1 diabetes, the 20- to 29-year-old cohort saw a steep increase in prevalence in the three major ethnic and racial groups: a 3.8-fold increase in the black population, a 7.6-fold increase in the Hispanic population, and a 5.1-fold increase in the white population.

The increase in men was greater than in women, with white men having the highest incidence rate in 2022, at 38.6 cases per 100,000.

Among patients with type 2 diabetes, the prevalence of DR increased 2.5-fold in the 20-29 age group and 60% in the 30-39 age group.

Singh and his colleagues also observed “significant racial and ethnic trends” across age groups, especially among younger people: Hispanic men aged 20 to 29 years had a 5.1-fold increase in the prevalence of DR, whereas men aged 30 to 39 years had a 2.5-fold increase in the prevalence of DR.

“Above the age of 30 years, prevalence rates began to vary by racial and ethnic group, with Hispanic men and women having the highest prevalence, followed by black men and women,” the researchers wrote.

Singh called the increase in Hispanics and blacks “very worrying” and said it shows the impact of health care disparities. “Many patients of this ethnicity or race don't necessarily always seek health care,” he said.

The findings show the importance of screening for retinopathy when diabetes is diagnosed, Dr Singh said. “Screening should start from the very beginning, but unfortunately most of the studies done so far have shown that there is a lack of screening among the population.”

Even those who have insurance The inspection rate is only 50% to 70%“Even if you have the best insurance, you don't have the highest testing rates,” he says. “We hope that as the quality of testing improves, we'll improve this patient population's ability to maintain their vision, but so far that hasn't happened.” At least three glucagon-like peptide 1 receptor agonists were approved to treat diabetes patients during the study period, but their effect on DR propensity is hard to measure, Singh says. “They were for patients who were having trouble maintaining their overall diabetic status,” he says of the drugs.

Calling for more attention to DR

“Doctors and caregivers of people with diabetes should always be concerned about diabetic retinopathy, and these results suggest we may need to worry even more about it,” said Dr. Invited Commentary He spoke about his research. Medscape Medical News.

The commentary noted that the Patient Protection and Affordable Care Act of 2014 and the COVID-19 pandemic, which provided health insurance to people who would otherwise be unable to obtain insurance due to the public health emergency, may have influenced the increased diagnosis of DR in this study.

“The emergency declaration may have been a catalyst for people to maintain their insurance, not only among those on Medicaid but perhaps among others who would not have been able to get insurance otherwise,” Rhine said. “Also, the implementation of the Affordable Care Act increased the number of people in the country who had insurance, which led to more doctor visits and screening for diabetic retinopathy for people who perhaps would not have been able to do so before.”

The COVID-19 pandemic may have contributed in other ways, he said. “Rates of all preventive care declined during the pandemic, particularly in 2020, which may have led to delays in routine eye exams, delays in potential treatment for diabetic retinopathy, and delays in seeking medical attention for diabetes care, which could have led to worsening of diabetes over time and contributed to an increase in diabetic retinopathy.”

Lane added that the study also demonstrated the power of leveraging data from large administrative databases and electronic health record data sources. “What we really need to address the issue of potentially increasing rates of diabetic retinopathy is better population-based studies of people in care and people not in care,” he said.

The study was funded by the Cleveland Clinical and Translational Science Collaborative, Research to Prevent Blindness, and the National Eye Institute. Singh disclosed financial ties to Genentech/Roche, Alcon, Novartis, Regeneron Pharmaceuticals, Asclepix, Gyroscope, Bausch + Lomb, and Apelis Pharmaceuticals. Lyne disclosed funding from the Centers for Disease Control and Prevention.

Richard M. Kirchner is a medical journalist based in the Philadelphia area.