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Influence of comorbidities on the implementation of the fundus examination in patients with newly diagnosed type 2 diabetes

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Abstract

Aims

To investigate the influence of comorbidities on undergoing a diabetic eye examination in patients with newly diagnosed type 2 diabetes mellitus (T2DM).

Design

Retrospective cohort study

Methods

This was a retrospective cohort study using data from health insurance claims made between January 2005 and March 2013 in Japan. The primary outcome was implementation of the fundus examination that includes fundus photography, ophthalmoscopy and optical coherence tomography by a doctor within one year of initial drug therapy for Type2 Diabetes Mellitus (T2DM). We used multivariable logistic regression models with adjustment for demographic parameters to investigate the influence of comorbidities (hypertension and/or hyperlipidemia) on patients with T2DM receiving fundus examinations. We conducted an additional analysis to investigate whether the site of treatment might influence the performance of fundus examinations in patients with T2DM.

Results

A total of 6,492 patients were eligible for this analysis, of which 1,044 (16.1%) had comorbidities and 2,212 (34.1%) received the fundus examination. In the multivariable analysis, there was a significant association between comorbidities and a lower proportion of examination implementation (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.48−0.68; P<0.001). The implementation proportion for patients treated for comorbidities and T2DM in the same facility was also low (OR, 0.52; 95% CI, 0.43−0.63; P<0.001).

Conclusions

These results suggest that the proportion of taking fundus examination is low among patients with comorbidities, especially in patients treated at the same facility for comorbidities and T2DM. This may help to increase the proportion of T2DM patients receiving fundus examinations.

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References

  1. Wako R, Yasukawa T, Kato A, Omori T, Ishida S, Ishibashi T, et al. Causes and prevalence of visual impairment in Japan. Nippon Ganka Gakkai zasshi. 2014;118:495–501 (in Japanese).

    PubMed  Google Scholar 

  2. Stratton IM, Kohner EM, Aldington SJ, Turner RC, Holman RR, Manley SE, et al. UKPDS 50: risk factors for incidence and progression of retinopathy in Type II diabetes over 6 years from diagnosis. Diabetologia. 2001;44:156–63.

    Article  CAS  PubMed  Google Scholar 

  3. Fenwick EK, Pesudovs K, Rees G, Dirani M, Kawasaki R, Wong TY, et al. The impact of diabetic retinopathy: understanding the patient’s perspective. Br J Ophthalmol. 2011;95:774–82.

    Article  CAS  PubMed  Google Scholar 

  4. Fenwick E, Rees G, Pesudovs K, Dirani M, Kawasaki R, Wong TY, et al. Social and emotional impact of diabetic retinopathy: a review. Clin Exp Ophthalmol. 2012;40:27–38.

    Article  PubMed  Google Scholar 

  5. Mohamed Q, Gillies MC, Wong TY. Management of diabetic retinopathy: a systematic review. JAMA. 2007;298:902–16.

    Article  CAS  PubMed  Google Scholar 

  6. Focal photocoagulation treatment of diabetic macular edema. Relationship of treatment effect to fluorescein angiographic and other retinal characteristics at baseline: ETDRS report no. 19. Early Treatment Diabetic Retinopathy Study Research Group. Arch Ophthalmol. 1995;113:1144–55.

    Article  Google Scholar 

  7. Aiello LM. Perspectives on diabetic retinopathy. Am J Ophthalmol. 2003;136:122–35.

    Article  PubMed  Google Scholar 

  8. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33. Lancet. 1998;352:837–53.

    Article  Google Scholar 

  9. Chen HS, Wu TE, Jap TS, Hsiao LC, Lee SH, Lin HD. Beneficial effects of insulin on glycemic control and beta-cell function in newly diagnosed type 2 diabetes with severe hyperglycemia after short-term intensive insulin therapy. Diabetes Care. 2008;31:1927–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Chon S, Oh S, Kim SW, Kim JW, Kim YS, Woo JT. The effect of early insulin therapy on pancreatic beta-cell function and long-term glycemic control in newly diagnosed type 2 diabetic patients. Korean J Intern Med. 2010;25:273–81.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Diabetes Control and Complications Trial Research Group. Early worsening of diabetic retinopathy in the Diabetes Control and Complications Trial. Arch Ophthalmol. 1998;116:874–86.

    Article  Google Scholar 

  12. Kawasaki R, Tanaka S, Tanaka S, Yamamoto T, Sone H, Ohashi Y, et al. Incidence and progression of diabetic retinopathy in Japanese adults with type 2 diabetes: 8 year follow-up study of the Japan Diabetes Complications Study (JDCS). Diabetologia. 2011;54:2288–94.

    Article  CAS  PubMed  Google Scholar 

  13. Keech AC, Mitchell P, Summanen PA, O’Day J, Davis TM, Moffitt MS, et al. Effect of fenofibrate on the need for laser treatment for diabetic retinopathy (FIELD study): a randomised controlled trial. Lancet. 2007;370:1687–97.

    Article  CAS  PubMed  Google Scholar 

  14. Matthews DR, Stratton IM, Aldington SJ, Holman RR, Kohner EM. Risks of progression of retinopathy and vision loss related to tight blood pressure control in type 2 diabetes mellitus: UKPDS 69. Arch Ophthalmol. 2004;122:1631–40.

    Article  PubMed  Google Scholar 

  15. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ. 1998;317:703–13.

    Article  PubMed Central  Google Scholar 

  16. Sjolie AK, Klein R, Porta M, Orchard T, Fuller J, Parving HH, et al. Effect of candesartan on progression and regression of retinopathy in type 2 diabetes (DIRECT-Protect 2): a randomised placebo-controlled trial. Lancet. 2008;372:1385–93.

    Article  PubMed  Google Scholar 

  17. Chew EY, Ambrosius WT, Davis MD, Danis RP, Gangaputra S, Greven CM, et al. Effects of medical therapies on retinopathy progression in type 2 diabetes. N Engl J Med. 2010;363:233–44.

    Article  PubMed  Google Scholar 

  18. World Health Organization. Global Initiative for the Elimination of Avoidable Blindness—Action Plan 2006–2011. In: Vision 2020 The right to sight. 2007. http://apps.who.int/iris/bitstream/10665/43754/1/9789241595889_eng.pdf. Accessed 30 Jun 2017.

  19. Ting DS, Cheung GC, Wong TY. Diabetic retinopathy: global prevalence, major risk factors, screening practices and public health challenges: a review. Clin Exp Ophthalmol. 2016;44:260–77.

    Article  PubMed  Google Scholar 

  20. Treatment of Diabetic Retinopathy. In: Evidence-based Practice Guideline for the Treatment for Diabetes in Japan 2013. http://www.jds.or.jp/modules/en/index.php?content_id=44. Accessed 30 Jun 2017.

  21. Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada 2008. Can J Diabetes 2008;32:Supplement 1.

  22. Boyle S. United Kingdom (England). Health Syst Rev. 2011;13:1–483.

    Google Scholar 

  23. Papavasileiou E, Dereklis D, Oikonomidis P, Grixti A, Vineeth Kumar B, Prasad S. An effective programme to systematic diabetic retinopathy screening in order to reduce diabetic retinopathy blindness. Hell J Nucl Med. 2014;17:30–4.

    PubMed  Google Scholar 

  24. Rice T, Rosenau P, Unruh LY, Barnes AJ, Saltman RB, van Ginneken E. United States of America: health system review. Health Syst Trans. 2013;15:1–431.

    Google Scholar 

  25. https://www.aao.org/eyecare-america. Accessed 30 Jun 2017.

  26. Hatanaka T, Eguchi N, Deguchi M, Yazawa M, Ishii M. Study of Global Health Strategy Based on International Trends: Promoting Universal Health Coverage Globally and Ensuring the Sustainability of Japan’s Universal Coverage of Health Insurance System: Problems and Proposals. Jpn Med Assoc J. 2015;58:78–101.

    Google Scholar 

  27. Funatsu H, Hori S, Fukuda T, Miyakawa T, Yamaguchis N. Five years of changes in diabetic eye notebooks. Nippon Ganka Gakkai zasshi. 2010;114:96–104 (in Japanese).

    PubMed  Google Scholar 

  28. Tomio J, Toyokawa S, Tanihara S, Inoue K, Kobayashi Y. Quality of care for diabetes patients using National Health Insurance claims data in Japan. J Eval Clin Pract. 2010;16:1164–9.

    Article  PubMed  Google Scholar 

  29. Tanaka H, Tomio J, Sugiyama T, Kobayashi Y. Process quality of diabetes care under favorable access to healthcare: a 2-year longitudinal study using claims data in Japan. BMJ Open Diabetes Res Care. 2016;. https://doi.org/10.1136/bmjdrc-2016-000291.

    Google Scholar 

  30. Goh PP, Omar MA, Yusoff AF. Diabetic eye screening in Malaysia: findings from the National Health and Morbidity Survey 2006. Singapore Med J. 2010;51:631–4.

    CAS  PubMed  Google Scholar 

  31. Saadine JB, Fong DS, Yao J. Factors associated with follow-up eye examinations among persons with diabetes. Retina. 2008;28:195–200.

    Article  PubMed  Google Scholar 

  32. Sloan FA, Yashkin AP, Chen Y. Gaps in receipt of regular eye examinations among medicare beneficiaries diagnosed with diabetes or chronic eye diseases. Ophthalmology. 2014;121:2452–60.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Saaddine JB, Engelgau MM, Beckles GL, Gregg EW, Thompson TJ, Narayan KM. A diabetes report card for the United States: quality of care in the 1990s. Ann Intern Med. 2002;136:565–74.

    Article  PubMed  Google Scholar 

  34. Moss SE, Klein R, Klein BE. Factors associated with having eye examinations in persons with diabetes. Arch Fam Med. 1995;4:529–34.

    Article  CAS  PubMed  Google Scholar 

  35. Schoenfeld ER, Greene JM, Wu SY, Leske MC. Patterns of adherence to diabetes vision care guidelines: baseline findings from the Diabetic Retinopathy Awareness Program. Ophthalmology. 2001;108:563–71.

    Article  CAS  PubMed  Google Scholar 

  36. Funatsu H, Hori S, Shimizu E, Nakamura S. Questionnaire survey on periodic ocular examination in Japanese diabetic patients. Am J Ophthalmol. 2003;136:955–7.

    Article  PubMed  Google Scholar 

  37. Chou CF, Sherrod CE, Zhang X, Barker LE, Bullard KM, Crews JE, et al. Barriers to eye care among people aged 40 years and older with diagnosed diabetes, 2006–2010. Diabetes Care. 2014;37:180–8.

    Article  PubMed  Google Scholar 

  38. Sheppler CR, Lambert WE, Gardiner SK, Becker TM, Mansberger SL. Predicting adherence to diabetic eye examinations: development of the compliance with Annual Diabetic Eye Exams Survey. Ophthalmology. 2014;121:1212–9.

    Article  PubMed  Google Scholar 

  39. Mamtani R, Haynes K, Finkelman BS, Scott FI, Lewis JD. Distinguishing incident and prevalent diabetes in an electronic medical records database. Pharmacoepidemiol Drug Saf. 2014;23:111–8.

    Article  PubMed  Google Scholar 

  40. Jacques CH, Jones RL, Houts P, Bauer LC, Dwyer KM, Lynch JC, et al. Reported practice behaviors for medical care of patients with diabetes mellitus by primary-care physicians in Pennsylvania. Diabetes Care. 1991;14:712–7.

    Article  CAS  PubMed  Google Scholar 

  41. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012;35:1364–79.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Ismail-Beigi F. Clinical practice. Glycemic management of type 2 diabetes mellitus. N Engl J Med. 2012;366:1319–27.

    Article  CAS  PubMed  Google Scholar 

  43. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–86.

    Article  Google Scholar 

  44. Polonsky WH, Fisher L, Guzman S, Villa-Caballero L, Edelman SV. Psychological insulin resistance in patients with type 2 diabetes: the scope of the problem. Diabetes Care. 2005;28:2543–5.

    Article  PubMed  Google Scholar 

  45. Kunt T, Snoek FJ. Barriers to insulin initiation and intensification and how to overcome them. Int J Clin Pract Suppl. 2009;164:6–10.

    Article  Google Scholar 

  46. Yau JW, Rogers SL, Kawasaki R, Lamoureux EL, Kowalski JW, Bek T, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012;35:556–64.

    Article  PubMed  PubMed Central  Google Scholar 

  47. American Academy of Ophthalmology Retina/Vitreous panel. Preferred Practice Pattern GUidelines. Diabetic Retinopathy. San Francisco, CA: American Academy of Ophthalmology; 2016. www.aao.org/ppp.

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Acknowledgements

We are grateful to JMDC for allowing us to access their claims data. We would like to thank Editage (www.editage.jp) for English language editing.

Author information

Authors and Affiliations

  1. Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan

    Taichi Kawamura, Izumi Sato & Koji Kawakami

  2. Senju Pharmaceutical Co., Ltd., Osaka, Japan

    Taichi Kawamura

  3. Keihanshin Consortium for Fostering the Next Generation of Global Leaders in Research (K-CONNEX), Kyoto, Japan

    Izumi Sato

  4. Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Hiroshi Tamura

  5. Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Hiroshi Tamura

  6. Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan

    Yoko M. Nakao

  7. Center for Innovative Research and Education in Data Science, Institute for Liberal Arts and Sciences, Kyoto University, Yoshida Nihonmatsu-cho, Sakyo-ku, Kyoto, 606-8501, Japan

    Hiroshi Tamura

Authors
  1. Taichi Kawamura
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  2. Izumi Sato
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Corresponding author

Correspondence to Koji Kawakami.

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Conflicts of interest

T. Kawamura, Employee (Senju Pharmaceutical); I. Sato, Grant (K-CONNEX), Yearly Pay (K-CONNEX); H. Tamura, Grant (Findex), Lecture fees (Findex, Novartis, RIAM NPO); Y. M. Nakao, None; K. Kawakami, Honorarium (Behringer Ingelheim Japan, Daiichi Sankyo, Eisai, Mitsubishi Tanabe Pharma, Novartis Pharmaceutical, Sanofi, Shionogi Pharmaceuticals, Takeda Pharmaceutical), Consultant fees (Kaken Pharmaceutical, Kyowa Hakko Kirin, Olympus, Otsuka Pharmaceuticals) and K. Kawakami is responsible for data acquisition from Japan Medical Data Center Ltd.

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Kawamura, T., Sato, I., Tamura, H. et al. Influence of comorbidities on the implementation of the fundus examination in patients with newly diagnosed type 2 diabetes. Jpn J Ophthalmol 62, 68–76 (2018). https://doi.org/10.1007/s10384-017-0551-8

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  • DOI: https://doi.org/10.1007/s10384-017-0551-8

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