The ADA recommends eye exams for patients (Pt) with type 2 diabetes mellitus (T2DM) at diagnosis and annually thereafter, with an option to extend the timeline if the Pt has little to no retinopathy and is in good glycemic control. This retrospective descriptive study utilized the claims and member data from IBM® MarketScan® Commercial Research Database to examine the proportion of members with employer-sponsored insurance with T2DM, aged 18-64 years and in the U.S., who have medical claims for retinal or dilated eye exams in 2017. The dataset consists of 396,396 T2DM members enrolled continuously for 24 months in 2016-2017, with the following attributes: mean age is 54 years; females at 44.3%; ages of 18-44 at 18.1%, and 45-64 at 81.9%; regions of Midwest at 21.8%, Northeast at 16.7%, South at 49.8%, and West at 12.0%. The proportion of T2DM members with medical claims for eye exam is 35.8%. The proportion of T2DM Pts with eye exams by gender, age, and regional attributes are: females at 37.0% (numerator = 65,078), males at 34.8% (76,710); 18-44 at 25.0% (18,241), 45-64 at 38.0% (125,969); Midwest at 36.6% (31,578), Northeast at 43.6% (28,836), South at 33.6% (66,469) and West at 32.2% (15,362). About 2.1% (8,282) of T2DM Pts had a diagnosis of retinopathy, and of those, with eye exams by age group, are: 18-44 at 63.8% (812/1,272) and 45-64 at 72.8% (5,103/7,010). The average total cost per member by CPT codes are: $0.44 (Intermediate New Pt), $11.57 (Comprehensive New Pt), $9.50 (Intermediate Established Pt) and $34.06 (Comprehensive Established Pt). In this study, predominant factors for a higher rate of having a medical claim for an eye exam by members with T2DM are being female, ages 45-64, and from Northeast. There was a higher prevalence of retinopathy in the older age group. In this large sample, the majority of T2DM members did not have an eye exam. Future research should investigate the extent to which members with T2DM defer or obtain ADA recommended eye exams outside of their medical insurance coverage.


E. Scheufele: Employee; Self; IBM. B.L. Rosario: None. F.J. Roberts: None. A.B. Rajmane: None. J. George: Employee; Self; IBM Watson Health. H.J. Feldman: Employee; Self; IBM. K.B. Rhee: Employee; Self; IBM.

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