Influence of comorbidities on the implementation of the fundus examination in patients with newly diagnosed type 2 diabetes
Influence of comorbidities on the implementation of the fundus examination in patients with newly diagnosed type 2 diabetes
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DOI：
10.1007/s10384-017-0551-8
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发表时间：
2018-01-01
影响因子：
2.4
通讯作者：
Kawakami, Koji
中科院分区：
文献类型：
--
作者：
Kawamura, Taichi;Sato, Izumi;Kawakami, Koji
探讨合并症对新诊断2型糖尿病（T2 DM）患者进行糖尿病眼科检查的影响。回顾性队列研究这是一项回顾性队列研究，使用2005年1月至2013年3月在日本进行的健康保险索赔数据。主要结局是在2型糖尿病（T2 DM）初始药物治疗后1年内由医生进行眼底检查，包括眼底照相、检眼镜检查和光学相干断层扫描。我们使用多变量logistic回归模型，调整人口统计学参数，以研究合并症（高血压和/或高脂血症）对接受眼底检查的T2 DM患者的影响。我们进行了一项额外的分析，以调查治疗部位是否会影响T2 DM患者的眼底检查。共有6，492例患者符合此分析的条件，其中1，044例（16.1%）患有合并症，2，212例（34.1%）接受了眼底检查。在多变量分析中，合并症与较低比例的检查实施之间存在显著相关性（比值比[OR]，0.57; 95%置信区间[CI]，0.48-0.68; P < 0.001）。合并症与T2 DM在同一机构治疗的患者实施眼底检查的比例也较低（OR，0.52; 95%CI，0.43-0.63; P < 0.001），提示合并症患者中眼底检查的比例较低，尤其是合并症与T2 DM在同一机构治疗的患者。这可能有助于增加接受眼底检查的T2 DM患者比例。
To investigate the influence of comorbidities on undergoing a diabetic eye examination in patients with newly diagnosed type 2 diabetes mellitus (T2DM).Retrospective cohort studyThis 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.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).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.