Trend in Diabetes Care Over 20 Years Shows Risk Reduction

Compared with 2002, the hazard of diabetic retinal disease reached its nadir at 38% lower among patients entering the cohort in 2011 before ending only 13% lower in 2022. Photo: Carolyn Majcher, OD. Click image to enlarge. Despite numerous advances in the systemic care of diabetes mellitus, little is known about the cumulative effect of these advancements on the risk of progression to diabetic retinal disease (DRD) and vision-threatening diabetic retinopathy (VTDR). Researchers recently determined how the yearly rate of progression to diabetic retinal disease, vision-threatening DR and its component disease states, diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR), has changed since 2002. They noted that advancements in systemic diabetes care have not translated to demonstrably better prevention of diabetic retinal disease but do seem to have had a tremendous impact on the risk for progressing to vision-threatening forms of the disease.This study was presented at ARVO 2026 in Denver last week. It comprised members of large commercial and Medicare Advantage health plans. Using ICD-9 and -10 codes, yearly cohorts were created from patients with diabetes mellitus, no history of diabetic retinal disease and at least two years of data to determine the hazard of progression to diabetic retinal disease, vision-threatening DR, DME and PDR from 2003 to 2022. The main outcomes were the hazard of progression to diabetic retinal disease, vision-threatening DR, DME and PDR, stratified by cohort entry year. Among 4,212,578 patients with DM at risk for diabetic retinal disease progression, 234,734 (5.6%) progressed to diabetic retinal disease, 72,508 (1.7%) to vision-threatening DR, 46,230 (1.0%) to DME and 32,107 (0.76%) to PDR over the 20-year observation period.After adjustment, compared with 2002, the hazard of DRD reached its low point at 38% lower among patients entering the cohort in 2011 (hazard ratio; HR=0.62), before ending only 13% lower in 2022 (HR=0.87). The trend in hazards for vision-threatening DR, DME and PDR all tracked similarly, with hazards either being slightly lower or not different for 2003 to 2008 cohorts in each disease state. After 2008, the general trend was for year-over-year reduction in hazards compared with 2002, ending near 20-year lows in 2022 with a 56%, 47% and 67% reduction in hazards for vision-threatening DR, DME and PDR, respectively (2022 vision-threatening DR HR=0.46; DME HR=0.53; PDR HR=0.33).Original abstracts ©2026 Association for Research in Vision and Ophthalmology.  Click here for the source. VanderBeek BL, Yu Y, Cardillo S, Hubbard R. Twenty-year trends in the risk of progressing to diabetic retinal disease in the US. ARVO 2026 annual meeting. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.