Introduction and Objective: Diabetic macular edema (DME) is a leading cause of vision loss in patients with type 2 diabetes mellitus (T2DM) making timely screening and treatment critical. Despite incentives for annual exams, gaps persist from screening to treatment for DME. Methods: This retrospective observational study used medical and pharmacy claims from Carelon Research’s Healthcare Integrated Research Database. Adults aged 18-75 years with T2DM were included for screening analyses during measurement year 2023 and 2024. Compliant screening was defined as a retinal or dilated eye exam performed by an optometrist or ophthalmologist in 2023, 2024. Adjusted multivariable logistic regression (LR) assessed factors associated with screening. A separate cohort of newly diagnosed DME patients was identified using ICD-10 codes (Jan 1, 2022-Dec 31, 2023) and followed for 1 year from index DME diagnosis. Hemoglobin A1c (A1c) results were captured at baseline where available. Results: 1.3 million (2023) and 1.4 million (2024) members with T2DM were eligible for screening, with annual screening rates of 42.9% and 42.4%, respectively. Higher area-level socioeconomic score was associated with a higher likelihood of screenings in 2024 (LR adjusted odds ratio 1.3; 95% CI 1.26 - 1.3, p0.01). Of 12,128 patients newly diagnosed with DME, 68.1% were diagnosed by a specialist (ophthalmologist or retina specialist), while 7.4% had no specialist visit during follow-up. Rural residence was more common among patients without specialist care (22.0% vs 16.3%). Mean (SD) time from DME diagnosis to first anti-VEGF treatment was 54.7 (79.3) days. Of patients with baseline A1c (n=4,640), those visiting a specialist within 1 year often had higher A1c (7%) than those who did not (72.4% vs 65.8%). Conclusion: Despite screening incentives, many patients do not receive timely screening or specialist care, with delays in diagnosis to treatment. Further research is needed to guide interventions that improve care coordination, reduce access barriers, and promote equitable management in DME. Disclosure F. Brodie: Consultant; Current; Genentech, Inc. Consultant; Ended; AbbVie Inc. Consultant; Current; Science Corporation. Other - Founder; Current; Long Bridge Medical. S. Ko: Employee; Current; Genentech, Inc. R.W. Dixon: None. K. Crocker: None. H. Tan: Employee; Current; Carelon Research. A. Ahmed: Employee; Current; Genentech, Inc. A. Warter: Employee; Current; Genentech, Inc. K. Knuth: None. A. Ayati: None. J.E. Kim: Advisory Panel; Ended; Adverum. Consultant; Current; Alcon, Apellis, Astellas Pharma Inc., Bausch + Lomb, Dutch Ophthalmic Research Center, Eyepoint, BVI, Genentech, Inc. Advisory Panel; Ended; Neurotech. Consultant; Current; Regeneron Pharmaceuticals Inc. D. Tabano: Employee; Current; Genentech, Inc.
Brodie et al. (Fri,) studied this question.
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