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Original Investigation |

Prevalence of and Risk Factors for Diabetic Macular Edema in the United States ONLINE FIRST

Rohit Varma, MD, MPH1; Neil M. Bressler, MD2,3; Quan V. Doan, PharmD4; Michelle Gleeson, PhD4; Mark Danese, PhD4; Julie K. Bower, PhD5; Elizabeth Selvin, PhD2; Chantal Dolan, PhD6; Jennifer Fine, PhD6; Shoshana Colman, PhD6; Adam Turpcu, PhD6
[+] Author Affiliations
1USC Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles
2Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
3Editor, JAMA Ophthalmology
4Outcomes Insights, Inc, Westlake Village, California
5Division of Epidemiology, The Ohio State University College of Public Health, Columbus
6Genentech, Inc, South San Francisco, California
JAMA Ophthalmol. Published online August 14, 2014. doi:10.1001/jamaophthalmol.2014.2854
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Importance  Diabetic macular edema (DME) is a leading cause of vision loss in persons with diabetes mellitus. Although there are national estimates for the prevalence of diabetic retinopathy and its risk factors among persons with diabetes, to our knowledge, no comparable estimates are available for DME specifically.

Objectives  To estimate the prevalence of DME in the US population and to identify associated risk factors.

Design, Setting, and Participants  A cross-sectional analysis of 1038 participants aged 40 years or older with diabetes and valid fundus photographs in the 2005 to 2008 National Health and Nutrition Examination Survey.

Main Outcomes and Measures  The overall prevalence of DME and its prevalence according to age, race/ethnicity, and sex.

Results  Of the 1038 persons with diabetes analyzed for this study, 55 had DME, for an overall weighted prevalence of 3.8% (95% CI, 2.7%-4.9%) or approximately 746 000 persons in the US 2010 population aged 40 years or older. We identified no differences in the prevalence of DME by age or sex. Multivariable logistic regression analysis showed that the odds of having DME were higher for non-Hispanic blacks than for non-Hispanic whites (odds ratio [OR], 2.64; 95% CI, 1.19-5.84; P = .02). Elevated levels of glycosylated hemoglobin A1c (OR, 1.47; 95% CI, 1.26-1.71 for each 1%; P < .001) and longer duration of diabetes (OR, 8.51; 95% CI, 3.70-19.54 for ≥10 vs <10 years; P < .001) were also associated with DME prevalence.

Conclusions and Relevance  These results suggest a greater burden of DME among non-Hispanic blacks, individuals with high levels of hemoglobin A1c, and those with longer duration of diabetes. Given recent treatment advances in reducing vision loss and preserving vision in persons with DME, it is imperative that all persons with diabetes receive early screening; this recommendation is even more important for those at higher risk for DME.

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Figure 1.
Prevalence of Diabetic Macular Edema (DME) Stratified by Race/Ethnicity in the US Population Aged 40 Years or Older in the National Health and Nutrition Examination Survey (NHANES)

Error bars represent 95% CIs. Hispanics included both Mexican American and non–Mexican American Hispanics.

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Figure 2.
Estimated Prevalence of Diabetic Macular Edema (DME) by Glycosylated Hemoglobin A1c (HbA1c) Levels, Stratified by Diabetes Duration for All Persons With Diabetes Mellitus in the National Health and Nutrition Examination Survey (NHANES)

The glycemia-specific prevalence data for all persons by each 0.5% difference were plotted to show the independent relationship of glycemia with prevalence of DME. Margin plots were obtained with a logistic regression model that included HbA1c and the quadratic and cubic terms for HbA1c (P < .01) and adjusted for all other covariates. Probabilities of DME prevalence were estimated using individual HbA1c values for each subject along with the means of all other covariates. Shading represents 95% CIs for the predicted probabilities.

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