OBJECTIVE Among patients with diabetes living in the U.S. with newly detected mild or moderate nonproliferative diabetic retinopathy (NPDR) without diabetic macular edema (DME), we aimed to characterize determinants for receiving standards of care and progression to vision-threatening diabetic retinopathy (VTDR) (severe NPDR, proliferative diabetic retinopathy, DME). RESEARCH DESIGN AND METHODS Electronic health records of patients newly detected with NPDR without DME between 2015 and 2023 were analyzed with use of the Epic Cosmos research platform. We characterized the adjusted associations of urban versus rural residence, race and ethnicity (Hispanic, non-Hispanic [NH] White, NH Black, other), and glycemic control (HbA1c <7.0%, 7.0%–8.9%, ≥9%, unavailable) separately with guideline-recommended care (two of three: ophthalmology visit, primary care visit, and measurement of HbA1c, blood pressure, and LDL cholesterol) in the 2 years after diagnosis and with progression to VTDR. RESULTS Average (SD) age for the analytic sample (n = 102,919) was 63 (13.5) years, and 51% were female, 59% NH White, and 7% rural residents. Only 40% received guideline-recommended care, and 14% progressed to VTDR (median follow-up 35 months [interquartile range 18–63]). Urban residence was associated with receiving standards of care in both years (risk ratio 1.08 [95% CI 1.05–1.12]) and progression to VTDR (hazard ratio 1.07 [95% CI 0.99–1.15]). Racial and ethnic minority individulas were more likely to progress to VTDR. Individuals with poor or unknown glycemic control were less likely to receive standards of care and more likely to progress to VTDR. CONCLUSIONS Understanding the management and progression of newly detected NPDR will require disentangling the independent and interdependent contributions of geography, race and ethnicity, and glycemia.

中文翻译：

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城市居住、种族和民族以及血糖控制在接受护理标准和进展为威胁视力的糖尿病视网膜病变中的作用


目的 在居住在美国的新发现的轻度或中度非增殖性糖尿病视网膜病变 （NPDR） 且无糖尿病性黄斑水肿 （DME） 的糖尿病患者中，我们旨在描述接受护理标准和进展为威胁视力的糖尿病视网膜病变 （VTDR） 的决定因素 （严重 NPDR，增殖性糖尿病视网膜病变，DME）。研究设计和方法 使用 Epic Cosmos 研究平台分析 2015 年至 2023 年间新发现的无 DME 的 NPDR 患者的电子健康记录。我们表征了城市与农村居住地、种族和民族 （西班牙裔、非西班牙裔 [NH] 白人、NH 黑人等）和血糖控制 （HbA1c <7.0%， 7.0%–8.9%， ≥9%， 不可用） 与指南推荐护理 （三项中的两项：眼科就诊、初级保健就诊和 HbA1c、血压和低密度脂蛋白胆固醇测量） 的调整关联在诊断后 2 年内与进展为 VTDR。结果 分析样本 （n = 102,919） 的平均 （SD） 年龄为 63 （13.5） 岁，其中 51% 为女性，59% 为 NH 白人，7% 为农村居民。只有 40% 接受了指南推荐的护理，14% 进展为 VTDR （中位随访 35 个月 [四分位距 18-63]）。城市居住与两年接受护理标准 （风险比 1.08 [95% CI 1.05-1.12]）和进展为 VTDR （风险比 1.07 [95% CI 0.99-1.15]）相关。少数种族和少数民族更有可能进展为 VTDR。血糖控制不佳或未知的个体不太可能接受标准护理，并且更有可能进展为 VTDR。 结论 了解新检测到的 NPDR 的管理和进展需要解开地理、种族和民族以及血糖的独立和相互依存的贡献。