Eye Care Utilization Among Insured People With Diabetes in the U.S., 2010–2014
Abstract
OBJECTIVE: Diabetic retinopathy (DR) is the leading cause of blindness among working-age adults, and although screening with eye exams is effective, screening rates are low. We evaluated eye exam visits over a 5-year period in a large population of insured patients 10–64 years of age with diabetes. RESEARCH DESIGN AND METHODS: We used claims data from IBM Watson Health to identify patients with diabetes and continuous insurance coverage from 2010 to 2014. Diabetes and DR were defined using ICD-9 Clinical Modification codes. We calculated eye exam visit frequency by diabetes type over a 5-year period and estimated period prevalence and cumulative incidence of DR among those receiving an eye exam. RESULTS: Among the 298,383 insured patients with type 2 diabetes and no diagnosed DR, almost half had no eye exam visits over the 5-year period and only 15.3% met the American Diabetes Association (ADA) recommendations for annual or biennial eye exams. For the 2,949 patients with type 1 diabetes, one-third had no eye exam visits and 26.3% met ADA recommendations. The 5-year period prevalence and cumulative incidence of DR were 24.4% and 15.8%, respectively, for patients with type 2 diabetes and 54.0% and 33.4% for patients with type 1 diabetes. CONCLUSIONS: The frequency of eye exams was alarmingly low, adding to the abundant literature that systemic changes in health care may be needed to detect and prevent vision-threatening eye disease among people with diabetes.
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This care gap is a major source of health disparity, with racial and ethnic minorities, and under-resourced communities, having worse outcomes, and a disproportionately higher prevalence of DED.
“This care gap is a major source of health disparity, with racial and ethnic minorities, and under-resourced communities, having worse outcomes, and a disproportionately higher prevalence of DED2,5–9.”
From Autonomous artificial intelligence increases screening and follow-up for diabetic retinopathy in youth: the ACCESS randomized control trial (2024) · cites this paper as [7]
The adherence rate to diabetic eye exam recommendations in the U.S. is as low as 20%.
“However, studies have found the adherence rate to diabetic eye exam recommendations in the U.S. to be as low as 20%3.”
From Autonomous AI-assisted diabetic retinopathy screening at primary care is associated with increased presentation to eye care by at risk patients (2026) · cites this paper as [3]
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- Authors
- Benoit, S. R., Swenor, B., Geiss, L. S., Gregg, E. W., & Saaddine, J. B.
- Affiliations
- Centers for Disease Control and Prevention (US)
- Johns Hopkins University (US)
- Corresponding author
- Benoit, Stephen R.
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2019-01-24
- Volume
- 42
- Issue
- 3
- Pages
- 427-433
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2914931135
- Cited by
- 97
- References
- 2
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 12 · 2023: 19 · 2022: 14 · 2021: 21 · 2020: 16 · 2019: 5
- FWCI
- 13.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
- Keywords
- diabetic retinopathy, diabetes screening, type 1 diabetes, type 2 diabetes, insured patients, period prevalence, cumulative incidence, vision-threatening eye disease, health care utilization
- MeSH terms
- Adolescent, Adult, Child, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Diabetic Retinopathy, Female, Health Resources, Humans, Male, Mass Screening, Middle Aged, Ophthalmology, Physical Examination, United States, Incidence, Prevalence, Insurance Coverage, Young Adult
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