Effects of receipt of guideline-recommended care on onset of diabetic retinopathy and its progression.
Effects of receipt of guideline-recommended care on onset of diabetic retinopathy and its progression.
复制标题
接受指南推荐的护理对糖尿病视网膜病变发病及其进展的影响。
DOI：
10.1016/j.ophtha.2009.03.010
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发表时间：
2009
期刊：
影响因子：
13.7
通讯作者：
Lee,PaulP
中科院分区：
文献类型：
--
作者：
Sloan,FrankA;Grossman,DanielS;Lee,PaulP
目的确定在社区环境中被诊断为糖尿病的人接受推荐的护理模式是否在3年的时间内改善了视力结果。方法回顾性、纵向、队列分析。参与者被诊断为糖尿病（DM）的人，既往未被诊断为糖尿病视网膜病变（DR; n = 5989），来自医疗保险当前受益人调查（1992-2004）。诊断为糖尿病的患者随访3年。干预倾向评分匹配用于比较接受指南推荐护理和未接受指南推荐护理的患者的视力结果。接受推荐水平的护理被定义为平均每年接受以下服务0.75次：内科医生检查、眼科医生或验光师检查、血红蛋白A1 c水平、脂质水平和尿液分析。主要结局指标结局指标是DR疾病进展的指标：无诊断DR至诊断背景DR、增殖性DR、黄斑水肿、增殖性DR并发症，和使用低视力辅助器或失明。接受指南推荐护理的诊断为糖尿病的患者发生背景DR的时间较早（3年时对接受治疗的[ATT]的平均治疗效果，0.118; 95%置信区间[CI]，-0.005至0.240）。在增殖性DR、黄斑水肿或增殖性DR并发症发生的时间方面，接受推荐治疗的患者与其他患者之间没有差异。然而，接受与建议一致的护理的人比其他人的低视力/失明发病率低得多（ATT在3年，-0.109; 95%CI，-0.189到-0.030）。结论在接受建议水平护理的诊断为DM的人中，低视力/失明在3年内大幅减少。财务披露：作者对本文中讨论的任何材料都没有专有或商业利益。
OBJECTIVETo determine whether persons in a community setting diagnosed with diabetes who received recommended patterns of care experience improved vision outcomes over a 3-year time period.DESIGNRetrospective, longitudinal, cohort analysis.PARTICIPANTSPersons diagnosed with diabetes mellitus (DM), with no prior diagnosis of diabetic retinopathy (DR; n = 5989) from the Medicare Current Beneficiary Survey (1992–2004). Persons diagnosed with DM were followed up to 3 years.INTERVENTIONPropensity score matching was used to compare vision outcomes between persons who received guideline-recommended care and those who did not. Receipt of recommended levels of care was defined as receiving each of the following services 0.75 times annually on average: physician examination, ophthalmologist or optometrist examination, hemoglobin A1c level, lipid levels, and urinalysis.MAIN OUTCOME MEASURESOutcome measures were indicators of DR disease progression: no diagnosed DR to diagnosed background DR, proliferative DR, macular edema, proliferative DR complications, and use of a low-vision aid or blindness.RESULTSPersons with diagnosed diabetes receiving guideline-recommended care experienced earlier onset of background DR (average treatment effects on the treated [ATT] at 3 years, 0.118; 95% confidence interval [CI], −0.005 to 0.240). There were no differences between those receiving recommended care and others in time to onset of proliferative DR, macular edema, or proliferative DR complications. However, persons who received care consistent with recommendations experienced much lower rates of onset of low vision/blindness than did others (ATT at 3 years, −0.109; 95% CI, −0.189 to −0.030).CONCLUSIONSLow vision/blindness was substantially reduced over a 3-year period among persons diagnosed with DM who received recommended levels of care. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.