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OBJECTIVE Examine the 10-year trend in the prevalence and treatment of diabetic macular edema (DME) and vision-threatening diabetic retinopathy (VTDR) among commercially insured adults with diabetes. RESEARCH DESIGN AND METHODS We analyzed the 10-year trend (2009–2018) in health care claims for adults aged 18–64 years using the IBM MarketScan Database, a national convenience sample of employer-sponsored health insurance. We included patients continuously enrolled in commercial fee-for-service health insurance for 24 months who had a diabetes ICD-9/10-CM code on one or more inpatient or two or more different-day outpatient claims in the index year or previous calendar year. We used diagnosis and procedure codes to calculate the annual prevalence of patients with one or more claims for 1) any DME, 2) either DME or VTDR, and 3) antivascular endothelial growth factor (anti-VEGF) injections and laser photocoagulation treatment, stratified by any DME, VTDR with DME, and VTDR without DME. We calculated the average annual percent change (AAPC). RESULTS From 2009 to 2018, there was an increase in the annual prevalence of patients with DME or VTDR (2.1% to 3.4%; AAPC 7.5%; P < 0.001) and any DME (0.7% to 2.6%; AAPC 19.8%; P < 0.001). There were sex differences in the annual prevalence of DME or VTDR and any DME, with men having a higher prevalence than women. Annual claims for anti-VEGF injections increased among patients with any DME (327%) and VTDR with DME (206%); laser photocoagulation decreased among patients with any DME (−68%), VTDR with DME (−54%), and VTDR without DME (−62%). CONCLUSIONS Annual claims for DME or VTDR and anti-VEGF injections increased whereas those for laser photocoagulation decreased among commercially insured adults with diabetes.

Objective: Examine the ten-year trend in the prevalence and treatment of diabetic macular edema (DME) and vision-threatening diabetic retinopathy (VTDR) among commercially insured adults with diabetes. Research Design and Methods: We analyzed the ten-year trend (2009–2018) in healthcare claims for adults 18–64 years using the IBM® MarketScan® Database, a national convenience sample of employer-sponsored health insurance. We included patients continuously enrolled in commercial fee-for-service health insurance for 24 months who had a diabetes ICD-9/10-CM code on ≥1 inpatient or ≥2 different day outpatient claims in the index year or previous calendar year. We used diagnosis and procedure codes to calculate the annual prevalence of patients with ≥1 claims for: 1) any DME, 2) either DME/VTDR, and 3) anti-vascular endothelial growth factor injections [anti-VEGF] and laser photocoagulation treatment, stratified by any DME, VTDR with DME, and VTDR without DME. We calculated Average Annual Percent Change (AAPC). Results: From 2009–2018, there was an increase in the annual prevalence of patients with DME/VTDR (2.1% to 3.4%; AAPC=7.5%; pany DME (0.7% to 2.6%; AAPC=19.8%; pDME/VTDR and any DME, with males having a higher prevalence than females. Annual claims for anti-VEGF increased among those with any DME (327%) and VTDR with DME (206%); laser photocoagulation decreased among patients with any DME (-68%), VTDR with DME (-54%), and VTDR without DME (-62%). Conclusions: Annual claims for DME/VTDR and anti-VEGF injections increased while laser photocoagulation decreased among commercially insured adults with diabetes.

Persons with low socioeconomic status are disproportionately affected by diabetes and among people with diabetes, those with lower incomes tend to have poorer health status than those with higher incomes. Few studies have examined whether policies to improve the financial status of low-income populations can improve health outcomes among people with diabetes. Using data on state earned income tax credit (EITC) policies from the National Bureau of Economic Research and self-reported health status from the 2000-2016 Behavioral Risk Factor Surveillance System (BRFSS) , we examined the association of state EITC with poor health status among United States (US) adults with self-reported diagnosed diabetes. Poor overall health was defined as self-reported general health status of “fair” or “poor” in BRFSS. Poor mental and physical health were defined as having at least 14 self-reported days in poor mental or poor physical health in the past 30 days, respectively. State EITC was defined as the state’s EITC amount as a percentage of the federal EITC. We used weighted logistic regression to model the effect of EITC variation across states and over years and calculated the marginal effects of state EITC on health status, controlling for poverty, race, education, unemployment, state gross domestic product (GDP) , state Medicaid expansion, and state minimum wage policy. Poisson regression models were conducted as a sensitivity analysis. A 10-percentage point increase in the state EITC was associated with a 3% lower rate of poor mental health status (-2,759 per 100,000, 95% CI = -5,494, -25) . The associations of the state EITC with physical health and overall health status were not statistically significant. The results were robust to choice of model based on the sensitivity analysis. Policies that increase income retained may help to improve self-reported mental health status of US adults with diabetes. Disclosure S.Tang: None. Y.Chen: None. D.B.Rolka: None. G.Imperatore: None. C.S.Holliday: None. P.Zhang: None.

In 2021, the US Preventive Services Task Force (USPSTF) expanded the recommended age range for prediabetes and diabetes screening among those with overweight/obesity to 35-70 years. Using 2017 to pre-pandemic March 2020 National Health and Nutrition Examination Survey data, we applied these screening criteria to assess their performance in a nationally representative sample. We included 3243 non-pregnant adults aged ≥18 years without diagnosed diabetes. Screening eligibility was determined based on participants' age and measured body mass index (BMI) [≥23kg/m2 for non-Hispanic (NH) Asian adults and ≥25kg/m2 for other ethnic groups]. Dysglycemia was defined based on A1c ≥5.7% or fasting plasma glucose ≥100mg/dL. We compared participant characteristics by USPSTF eligibility. We also assessed performance [sensitivity, specificity, positive predictive value (PPV) , and negative predictive value (NPV) ] of the screening criteria for detecting dysglycemia overall and by ethnicity. During 2017-2020, 44.4% of US adults aged 35-70 years were eligible for screening, representing 95.9 million US adults. Relative to adults who were ineligible, those who were eligible had a higher burden of diabetes risk factors, as well as greater proportions of some racial ethnic groups, higher proportion of those with less than a high school education, and more likely to be living in poverty. The performance characteristics of the USPSTF screening criteria were: sensitivity 59.4% (95% CI: 56.4-62.4) ; specificity 68.6% (65.1-71.9) ; PPV 62.4% (59.2-65.6) ; and NPV 65.8% (61.9-69.5) . The sensitivity by ethnicity was as follows: NH White adults 59.1% (55.4-62.7) ; NH Black adults 63.6% (57.8-68.9) ; Hispanic adults 62.0% (55.0-68.5) ; and NH Asian adults 57.3% (46.6-67.3) . Screening based on the 2021 USPSTF criteria will detect approximately 60% of US adults with dysglycemia, which was similar across ethnic groups. Disclosure M.J.O'brien: None. K.M.Bullard: None. Y.Zhang: n/a. S.Bailey: Consultant; Lundbeck, Luto, Pfizer Inc., Sanofi, Research Support; Eli Lilly and Company, Gordon and Betty Moore Foundation, Lundbeck, Merck & Co., Inc., Pfizer Inc., Retirement Research Foundation for Aging. S.Khan: None. R.T.Ackermann: Consultant; UnitedHealth Group. M.K.Ali: Advisory Panel; Bayer AG, Research Support; Merck & Co., Inc. S.R.Benoit: None. G.Imperatore: None. C.S.Holliday: None.

Relatively little is known about diabetes-related medical costs across income groups, yet such information can assist efforts to reduce income-related diabetes disparities. Using data from the 2017-20 Medical Expenditure Panel Survey, we estimated medical expenditures (total and by service category [inpatient, outpatient, and drug]) in adults with diabetes, overall and by income level ( Disclosure Y.Wang: None. H.Shao: Board Member; BRAVO4HEALTH, LLC. G.Imperatore: None. C.S.Holliday: None. P.Zhang: None.

To identify prediabetes/diabetes, the US Preventive Services Task Force (USPSTF) has recommended glucose testing in 40-70 year olds (2015) and now 35-70 year olds (2021) with overweight/obesity. Since 2002, the American Diabetes Association (ADA) has recommended prediabetes/diabetes screening based on a larger set of diabetes risk factors. We analyzed cross-sectional National Health and Nutrition Examination Survey data from 6,0non-pregnant US adults aged ≥18 years without diagnosed diabetes. For USPSTF 2015 and 2021, and ADA guidelines, we described which adults were eligible and ineligible for glucose testing, and proportions reporting receiving testing. We assessed sensitivity and specificity in identifying prediabetes (fasting plasma glucose [FPG] 100-125mg/dL or A1c 5.7-6.4% or both) or undiagnosed diabetes (FPG≥126mg/dL or A1c≥6.5% or both) . During 2013-2018, an estimated 76.7 million, 90.4 million, and 157.7 million US adults met eligibility for glucose testing by the USPSTF 2015, 2021, and ADA guidelines, respectively. Eligibility and proportions receiving testing varied by guideline (Figure 1) . Across definitions of prediabetes/diabetes, ADA recommendations were most sensitive (range: 91.0-99.1%) and least specific (24.1-35.3%) ; 2015 (sensitivity: 51.9-59.4%; specificity: 63.2-74.5%) and 2021 USPSTF (sensitivity: 57.5-66.6%; specificity: 56.6-67.1%) guideline sensitivity and specificity were comparable. Disclosure M.K.Ali: Advisory Panel; Bayer AG, Research Support; Merck & Co., Inc. G.Imperatore: None. S.R.Benoit: None. C.S.Holliday: None. M.J.O'brien: None. J.B.Echouffo tcheugui: None. K.M.Bullard: None. Funding MKA was partially supported by the Georgia Center for Diabetes Translation Research funded by the National Institute of Diabetes and Digestive and Kidney Diseases (P30DK111024)

To report the national proportions and trends of adult hospitalizations with diabetes in the United States during 2000-2018.We used the 2000-2018 National Inpatient Sample to identify hospital discharges with any listed and primary diagnoses for diabetes, based on International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) and ICD-10-CM codes. We calculated proportions and trends of adult hospitalizations with diabetes, overall and by subpopulations. We used the Nationwide Readmissions Database to assess calendar-year and 30-day readmission rates.From 2000 to 2018, the proportion of hospitalizations among adults ≥18 years increased from 17.1% to 27.3% (average annual percentage change [AAPC] 2.5%; P 0.001) for any listed diabetes codes and from 1.5% to 2.1% (AAPC 2.2%; P 0.001) for primary diagnosis of diabetes. Men, non-Hispanic Black patients, and those from poorer zip codes had higher proportions of hospitalizations with diabetes codes.In recent years, approximately one-quarter of adult hospitalizations in the United States had a listed diabetes code, increasing about 2.5% per year from 2000 to 2018. These data are important for benchmarking purposes, especially due to disruptions in health care utilization from the COVID-19 pandemic.

Data suggest that more men than women are dying of coronavirus disease 2019 (COVID-19) worldwide, but it is unclear why. A biopsychosocial approach is critical for understanding the disproportionate death rate among men. Biological, psychological, behavioral, and social factors may put men at disproportionate risk of death. We propose a stepwise approach to clinical, public health, and policy interventions to reduce COVID-19-associated morbidity and mortality among men. We also review what health professionals and policy makers can do, and are doing, to address the unique COVID-19-associated needs of men.

Purpose and objectives Community programs to prevent or delay the onset of type 2 diabetes are effective, but implementing these programs to maximize their reach and impact remains a challenge. The American Medical Association (AMA) partnered with the YMCA of the USA, as part of a Centers for Medicare and Medicaid Innovation demonstration project, to develop, implement, and evaluate innovative quality improvement strategies to increase routine screening, testing, and referral of Medicare patients with prediabetes to diabetes prevention programs (DPPs) at local YMCAs. Intervention approach AMA recruited 26 primary care practices and health systems in 17 US communities to implement point-of-care and retrospective methods (or a combination of both) for screening, testing, and referral of Medicare patients with prediabetes. Evaluation methods We assessed changes in rates of referral and enrollment of patients among participating practices. We used a mixed-methods pretest-posttest evaluation design to determine if use of certain tools and resources, coupled with systems changes, led to increased screening and referrals. Results Practices referred a total of 5,640 patients, of whom 1,050 enrolled in a YMCA DPP (19%; range, 2%-98%). Practices (n = 12) that used retrospective (ie, electronic medical record [EMR]) systems to identify eligible Medicare patients via a registry referred more people (n = 4,601) to the YMCA DPP than practices (n = 10) that used a point-of-care method alone (n = 437 patients) or practices (n = 4) that used a combination of these approaches (n = 602 patients). All approaches showed increased enrollment with point-of-care methods being most successful. Implications for public health Lessons learned from this intervention can be used to increase diabetes prevention in the United States and support the Centers for Medicare and Medicaid Services (CMS) decision to expand Medicare coverage to include the DPP for all Medicare beneficiaries.