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Incidence of interventions for diabetic retinopathy and serious lower-limb complications and its related factors in patients with type 2 diabetes using a real-world large claims database

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Abstract

Aims

To examine the incidence of interventions for diabetic retinopathy and serious limb complications and to elucidate the patient attributes related to the incidence of each intervention based on real-world claims data from Japan.

Materials and methods

A retrospective longitudinal study design involving a 9 year (2009–2018) claims database obtained from the JMDC Inc. Patients with type 2 diabetes aged 20–74 years taking antidiabetic medications were divided into two groups: “patients with newly initiated antidiabetic medication” (Group 1, n = 47,201) and “patients with continuing antidiabetic medication” (Group 2, n = 82,332). The incidence rate for each intervention was analyzed. We also divided Group 1 into the former and latter periods and investigated temporal changes.

Results

The incidences of the first retinopathy intervention (laser photocoagulation, vitrectomy, or intraocular injection), vitrectomy, and lower-limb amputations in Group 1 were 7.46, 2.37, and 0.31 /1000 person-years, respectively. Those in Group 2 were about 1.2–1.5 times higher. Older age, insulin use, and being dependents rather than insured persons were associated with a higher incidence in both groups after adjustment. While the incidence of the interventions for retinopathy hardly changed during the observation period, that of lower-limb amputations decreased by 40%, with less statistical significance (p = 0.11).

Conclusions

We showed the incidences of the first retinopathy interventions and lower-limb amputations and their secular trends in patients with diabetes, stratified by whether the antidiabetic medication was newly initiated or not. Older age, insulin use, and being dependents were risk factors of these interventions for diabetic complications.

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Acknowledgements

This study was supported by the Grant of National Center or Global Health and Medicine (26-D-002) and JSPS KAKENHI Grant Number JP19K19451. The JMDC Claims Database was accessible through the contract with the JMDC Inc. The authors complied with the RECORD Statement (Supporting file 8). TS received his salary from University of Tsukuba in FY2018 and FY2019 based on the collaborative research fund between University of Tsukuba and the JMDC Inc (NT was a PI of the research fund), although the present study was not related to the joint research project. The authors instead paid for the database use. The JMDC Inc. did not involve in any of the study design, analysis, and interpretation of data, writing of the report, or any restrictions regarding the submission of the report for publication, while the JMDC Inc. involved in generic data collection (not specific to the present study purpose). UK was at an advisory role at Poxel SA and ERX Pharmaceuticals, received honoraria from Abbott Japan, Novo Nordisk Pharma Ltd., Ono, MSD K.K., Dainihon-Sumitomo, Mitsubishi-Tanabe, Takeda, Kyowa-Kirin, and Daiichi-Sankyo, received research funding from Novo Nordisk Pharam Ltd., Eli Lilly Japan, Nippon Boehringer Ingelheim Co., Ltd, MSD K.K., Abbott Japan, Astellas, Kyowa-Kirin, Dainihon-Sumitomo, Sanofi K.K., and Mitsubishi-Tanabe, and received subsidies or donations from Novo Nordisk Pharma Ltd., Eli Lilly Japan, Astellas, Takeda, and Ono. MO received honoraria from Novartis Pharma, Sanofi K.K., Eli Lilly Japan, and Novo Nordisk Pharma Ltd., received research funding from Novo Nordisk Pharma Ltd, Nippon Boehringer Ingelheim Co., Ltd, Eli Lilly Japan, MSD K.K., Kyowa Kirin, Abbott Japan, and Sanofi K.K., and received subsidies from Sumintomo Dainippon Pharma Co., Ltd., Novartis Pharma, and Mitsubishi Tanabe Pharma Co. TN received research funding from JMDC Inc. (described above) and SMS CO.

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Authors and Affiliations

  1. Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan

    Ayako Yanagisawa-Sugita, Takehiro Sugiyama, Noriko Ihana-Sugiyama, Hirokazu Tanaka, Kenjiro Imai & Mitsuru Ohsugi

  2. Department of Public Health/Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan

    Ayako Yanagisawa-Sugita, Hirokazu Tanaka & Yasuki Kobayashi

  3. Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, 305-8575, Japan

    Takehiro Sugiyama & Nanako Tamiya

  4. Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan

    Takehiro Sugiyama & Kohjiro Ueki

  5. Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan

    Noriko Ihana-Sugiyama & Mitsuru Ohsugi

  6. Department of Public Health and Occupational Medicine, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan

    Hirokazu Tanaka

  7. Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan

    Kohjiro Ueki

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  1. Ayako Yanagisawa-Sugita
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  2. Takehiro Sugiyama
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Correspondence to Takehiro Sugiyama.

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Yanagisawa-Sugita, A., Sugiyama, T., Ihana-Sugiyama, N. et al. Incidence of interventions for diabetic retinopathy and serious lower-limb complications and its related factors in patients with type 2 diabetes using a real-world large claims database. Diabetol Int 13, 548–560 (2022). https://doi.org/10.1007/s13340-021-00566-7

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