Adherence to the American Diabetes Association retinal screening guidelines for population with diabetes in the United States
Adherence to the American Diabetes Association retinal screening guidelines for population with diabetes in the United States
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DOI：
10.1080/09286586.2018.1424344
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发表时间：
2018-01-01
影响因子：
1.8
通讯作者：
Cheetham, T. Craig
中科院分区：
文献类型：
--
作者：
An, JaeJin;Niu, Fang;Cheetham, T. Craig
目的：(1)评估美国糖尿病患者对美国糖尿病协会指南推荐的视网膜筛查的长期依从性。(2)确定长期坚持常规眼科筛查的相关因素。方法：对2009年1月至2010年12月确诊的成年糖尿病患者进行回顾性队列研究。对患者进行跟踪，直到取消登记、死亡或研究结束日期(2013年12月)。如果有视网膜病变的证据，患者在每12个月期间至少进行一次检查，或者如果没有视网膜病变的证据，则每24个月至少进行一次检查。结果：共确定204,073名患者，平均年龄61岁(13岁)，其中48%为女性。总体而言，在中位数4.8年的随访中，71.1%的人遵守了视网膜筛查指南，其中27.7%的人每年都接受眼科检查。患者的社会经济状况(年龄较小、黑人、低收入/教育程度)、较少的共病、使用胰岛素、较高的专科共同支付计划以及不良患者行为的代用品(较低的口服降血糖药物的依从性、较少的糖尿病教育、较少的血红蛋白A1C>；9%)与不遵守常规眼科筛查检查有关。结论：在近5年的随访中，28.9%的糖尿病患者不遵守视网膜筛查指南。未来的研究应侧重于开发干预措施，以解决与不依从性相关的可修改因素。
Purpose: (1) To assess long-term adherence to American Diabetes Association guideline-recommended retinal screening among population with diabetes in the United States. (2) To determine factors associated with long-term adherence to routine eye screening exams.Methods: A retrospective cohort study was conducted in adult patients with diabetes identified from January 2009 to December 2010. Patients were followed until disenrollment, death, or study end date (December 2013). A patient was defined as adherent when having at least one exam in each 12-month period if there was evidence of retinopathy, or at least one exam in each 24-month period if there was no evidence of retinopathy. Multivariate logistic regressions were used to investigate patient demographics and other baseline characteristics associated with adherence to guidelines.Results: A total of 204,073 patients were identified; the mean age (SD) was 61 (13)years and 48% were female. Overall, 71.1% were adherent to the retinal screening guidelines during a median of 4.8years of follow-up including 27.7% who received an eye exam every year. Patient socioeconomic status (younger age, black race, lower income/education), less comorbidity, insulin use, higher specialist copayment plans, and proxies for poor patient behavior (lower adherence to the oral hypoglycemic agents, less diabetes education, hemoglobin A1C >9%) were associated with nonadherence to routine eye screening exams.Conclusion: During nearly 5years of follow-up, 28.9% of patients with diabetes were nonadherent to the retinal screening guidelines. Future research should focus on the development of interventions to address modifiable factors associated with nonadherence.