Predictors of eye care utilization in patients with diabetes: A retrospective analysis from a tertiary care center

Diabetic retinopathy (DR) is the leading cause of vision impairment in working age US adults, with increasing prevalence. However, only 50-60% of older diabetics follow eye care recommendations. Increasing DR, combined with poor adherence leads to preventable visual problems and costly public health burden. To evaluate utilization of eye care by patients with diabetes and factors that impact adherence, we conducted a 4-year retrospective analysis integrating electronic billing and chart data from our tertiary eye care center. Patients with diabetes aged ≥40 years seen between 1/1/2007-12/31/2010 were included. Data included evaluation date, diagnosis code(s), DR severity, demographics, insurer(s), diabetes duration, HgbA1C, and recommended follow-up. Neighborhood Deprivation Index (NDI) was calculated based on census track data. We used multivariate analysis to examine adherence to follow-up.Of 1968 charts, the mean age was 59.4 years. The majority of patients were female (54.7%), African American (67.1%), and had annual follow-up recommended (74.6%). Adherence to DR follow-up recommendation was 35.1% for patients in the annual group and increased to 65.4% in the 3-4 month group. Mild DR, smoking, and younger age were independently associated with lower adherence (p <0.0001, p <0.0001, and p=0.0089 respectively). NDI had a weak (p=0.0293) association with severity of DR. Gender, ethnicity, and insurer had no significant impact on DR adherence. In conclusion, patients with mild DR, smokers, and age ≤65 years were the least likely to adhere to follow-up. These findings are being used to develop interventions to improve DR follow-up in the groups with lowest adherence.