Researchers at the Center for Ophthalmic Bioinformatics Research at the Cole Eye Institute, Cleveland, Ohio, have reported that the prevalence of diabetic retinopathy (DR) changed from 2015 to 2022 – type 1 DR (T1DR) had a 15% increase in prevalence, and type 2 DR (T2DR) had a 7% increase in prevalence. The results of the study suggest that increases of DR among those aged 20 to 39 years had associated with Hispanic and Black race, compared with White race in the US. Their analysis indicated that the prevalence of diabetes “is on the rise and expected to affect nearly 600 million people by the year 2035”, creating an economic burden of diabetes for $327 billion, including $237 billion in direct medical expenses.
Diabetic retinopathy (DR), that arises as a complication of diabetes (DM), is a leading cause of blindness, characterized by retinal ischemia, microaneurysms, hemorrhages, neovascularization or signs of increased vascular permeability. The DR is most commonly observed in individuals with long-term diabetes, highlighted by a higher prevalence in patients with T1DR, compared with patients with T2DR. As a result, effective management of serum glucose levels, early detection and timely treatment can substantially reduce the risk of vision loss secondary to DR. In their current study, researchers followed a cross-sectional epidemiologic evaluation from a research network composed of 56 health care organizations in the US. Patients were stratified by age cohorts (20-29 years, 30-39 years, 40-49 years, 50-59 years, 60-69 years, and 70 years or older), race and ethnicity, and sex and prevalence per 100,000 patients and prevalence odds ratios (ORs) were calculated from a total of 359,126 patients with T1DR or T2DR. Following the analyses, the patient population had a mean [SD] age of 67 [14] years (52% female) with T1DR increasing 1.15-fold affecting 70.4 patients per 100,000 in 2022. T2DR increased 1.07-fold affecting 461.7 patients per 100,000 in 2022. For T1DR, the cohort aged 20 to 39 years had the most substantial increase at 4.7 and 1.96 fold. Overall, White males had the largest prevalence ORs of T1DR at 1.41 (95% CI, 1.36-1.47) compared with White females (reference group). In T2DR, patients aged 20 to 39 years again had a 2.5- and 1.6-fold prevalence increase from 2015 to 2022. Hispanic males demonstrated larger prevalence OR at 4.08 (95% CI, 3.97-4.19) compared with White females followed by Hispanic females at 2.49 (95% CI, 2.42-2.56), Black males at 2.23 (95% CI, 2.17-2.29), and Black females at 2.00 (95% CI, 1.95-2.05).
In conclusion the researchers stated that, “T1DR was found to be associated with greater increases in White males, whereas T2DR was found to be associated with greater increases in Hispanic males. Overall, T2DR appeared to be associated with greater increases in Hispanic and Black communities compared with White communities. Overall, this research suggests DR screening is needed for young adults and for the development of T2DM interventions for Hispanic and Black patients to limit progression to T2DR. Future investigations are warranted to further investigate these trends, especially among young adults”. In addition, the researchers indicated that most of the increases in prevalence of diabetes may likely be attributed to the aging of the US population and possibly longer life expectancy among people with diabetes. Interestingly, the Patient Protection and Affordable Care Act (ACA) (“Obamacare”) and COVID-19 epidemic may have contributed to “observed increases in diagnosed DR prevalence rates through the mechanism of greater health care access for individuals in the US with lower incomes. Greater access to insurance and lower patient coinsurance could have contributed to higher rates of DR diagnosis and treatment within a health system environment”.