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.


E. A. Lundeen: None. M. Kim: None. D. B. Rein: None. J. Wittenborn: None. C. Cai: None. J. B. Saaddine: None.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.