Low-Income Diabetes Patients Face Worse DR Outcomes Despite Treatment Adherence

The poorer DR outcomes seen in individuals affected by social determinants of health were independent of care access and treatment adherence. This indicates that reducing these persistent disparities will require systemic changes extending beyond improved access and appointment attendance. Photo: Julie Torbit, OD. Click image to enlarge. While poor glycemic control, longer diabetes duration and microvascular complications are known risk factors for diabetic retinopathy (DR), emerging evidence suggests that social determinants of health (SDOH) significantly affect DR incidence and treatment access. A new study published in the journal Eye found that socially deprived individuals, such as those facing food insecurity and low income, tend to present with more advanced DR and higher risks of complications—even those who adhere to treatment.The study, which aimed to evaluate the long-term effects of social deprivation on DR incidence and complications in patients with type 2 diabetes, analyzed data from the TriNetX national EHR network. A total of 125,572 adults diagnosed with T2DM were categorized into socially deprived and non-deprived cohorts based on ICD-10 codes related to housing instability, food insecurity and financial hardship. Propensity score matching balanced the two groups across various factors such as demographics, comorbidities, laboratory values and ophthalmic care use. The mean age of participants was 54 years, with 42% being female and a racial composition of 49% white, 27% Black and 14% Hispanic.Over the 10-year follow-up period, social deprivation was linked to an increased risk of developing any form of DR (hazard ratio, HR: 1.40) and higher rates of sight-threatening complications, including blindness. By 10 years, the incidence of DR was 7.5% in the socially deprived group compared to 4.9% in non-deprived individuals. Compared to housing instability and low health literacy, financial hardship was the social deprivation domain most consistently associated with incident DR and sight-threatening complications.While documented nonadherence was significantly more prevalent among the socially deprived cohort (HR 3.57), social deprivation correlated with heightened DR risk even for treatment-adherent individuals; this trend was especially prevalent among males, Hispanic individuals and younger adults aged 18 to 39. Socially deprived patients also received ophthalmic interventions and diagnostic screenings at rates comparable to or greater than that of non-deprived individuals. Together, these findings suggest that access and adherence to treatment are not sufficient to bridge existing healthcare gaps.“While prior studies often attribute disparities to lower healthcare utilization amongst racial and ethnic minorities, our findings indicate that social deprivation itself—independent of care access—drives worse outcomes across all racial and ethnic groups,” the researchers wrote in their paper. The reason why socially deprived patients still experienced higher risks of progression to sight-threatening complications despite greater use of intravitreal anti-VEGF injections, panretinal photocoagulation, pars plana vitrectomy and diagnostic imaging could be that these individuals demonstrate more advanced disease at presentation. “This suggests,” the researchers noted, “that higher intervention rates in these groups stem from delayed diagnoses and more severe baseline pathology, not enhanced disease control.” Moreover, they explained that “social deprivation more than doubles the risk of missed screenings, contributing to late-stage presentation,” and that even after diagnosis, “barriers such as delayed treatment escalation, inconsistent care intensity and fragmented healthcare delivery may further compound disease progression.” The authors noted that these disparities are particularly concerning since early treatment for DR can prevent as much as 90% of severe vision loss. In their conclusion, the researchers suggested several strategies to address these systemic gaps beyond access to care. For one, they emphasized equitable, evidence-based care with consistent monitoring regardless of socioeconomic status. They also suggested integrating SDOH screening into ophthalmology and primary care, using EHRs to flag high-risk patients and implementing automated referrals for earlier intervention. Moreover, teleophthalmology and AI-assisted screening may enhance early detection and access, while interdisciplinary collaboration and strong patient education can help bridge care gaps and reduce preventable vision loss.Click here for the journal source. Hong AT, Chwa JS, Humayun L, Ameri H. Persistent disparities in DR outcomes among socially deprived individuals despite treatment adherence. Eye. October 8, 2025. [Epub ahead of print]. 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.