427-P: Prevalence and Treatment of Diabetic Macular Edema and Vision-Threatening Diabetic Retinopathy among Commercially Insured Adults Aged <65 Years

While diabetes prevalence in U.S. adults has increased in the last three decades, less is known about trends in ocular complications of diabetes, particularly in adults aged <65 years. We examined trends in prevalence and treatment of diabetic macular edema (DME) or vision-threatening diabetic retinopathy (DR) among commercially insured adults with diabetes. We analyzed claims from 2012 to 2018 using the IBM^® MarketScan^® Database, a national convenience sample of employer-sponsored health insurance. Analyses for each cross-sectional year included adults (18-64 years) with type 1 or 2 diabetes continuously enrolled for the calendar year (range: n=980,705 to n=1,715,815). Outcomes included the annual prevalence of those with ≥1 claim for: 1) DME or vision-threatening DR (severe non-proliferative DR or proliferative DR), 2) DME of any type, alone or with any stage of DR, and 3) treatment (anti-vascular endothelial growth factor [VEGF] injection, laser surgery/photocoagulation, vitrectomy, or retinal detachment repair). From 2012 to 2018, annual diabetes prevalence ranged from 7.3% to 7.8%. Annual prevalence of adults with diabetes who had ≥1 claim for DME or vision-threatening DR increased from 1.9% to 3.1% (Annual percent change [APC]: 0.23); any type of DME increased from 0.9% to 2.4% (APC: 0.29). Among those with DME or vision-threatening DR, annual prevalence of having ≥1 claim for treatment increased for anti-VEGF injection (21.9% to 31.2%; APC: 1.81) and decreased for laser surgery/photocoagulation (33.6% to 18.9%; APC: -2.65), vitrectomy (6.5% to 3.8%; APC: -0.48), and retinal detachment repair (3.9% to 2.9%; APC: -0.15). P-values for all trends were <0.01. From 2012 to 2018, among commercially insured adults aged <65 years, the annual prevalence of those with claims for DME or vision-threatening DR and DME of any type increased, coinciding with an increase in the use of anti-VEGF injection, a contemporary first-line treatment.