{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T06:52:29Z","timestamp":1788504749774,"version":"build-2803163510"},"reference-count":39,"publisher":"American Diabetes Association","issue":"1","license":[{"start":{"date-parts":[[2024,10,10]],"date-time":"2024-10-10T00:00:00Z","timestamp":1728518400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["(P30DK111024)"],"award-info":[{"award-number":["(P30DK111024)"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,1,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Among patients with diabetes living in the U.S. with newly detected mild or moderate nonproliferative diabetic retinopathy (NPDR) without diabetic macular edema (DME), we aimed to characterize determinants for receiving standards of care and progression to vision-threatening diabetic retinopathy (VTDR) (severe NPDR, proliferative diabetic retinopathy, DME).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>Electronic health records of patients newly detected with NPDR without DME between 2015 and 2023 were analyzed with use of the Epic Cosmos research platform. We characterized the adjusted associations of urban versus rural residence, race and ethnicity (Hispanic, non-Hispanic [NH] White, NH Black, other), and glycemic control (HbA1c &amp;lt;7.0%, 7.0%\u20138.9%, \u22659%, unavailable) separately with guideline-recommended care (two of three: ophthalmology visit, primary care visit, and measurement of HbA1c, blood pressure, and LDL cholesterol) in the 2 years after diagnosis and with progression to VTDR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Average (SD) age for the analytic sample (n = 102,919) was 63 (13.5) years, and 51% were female, 59% NH White, and 7% rural residents. Only 40% received guideline-recommended care, and 14% progressed to VTDR (median follow-up 35 months [interquartile range 18\u201363]). Urban residence was associated with receiving standards of care in both years (risk ratio 1.08 [95% CI 1.05\u20131.12]) and progression to VTDR (hazard ratio 1.07 [95% CI 0.99\u20131.15]). Racial and ethnic minority individulas were more likely to progress to VTDR. Individuals with poor or unknown glycemic control were less likely to receive standards of care and more likely to progress to VTDR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Understanding the management and progression of newly detected NPDR will require disentangling the independent and interdependent contributions of geography, race and ethnicity, and glycemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title\/>\n                  <\/jats:sec>","DOI":"10.2337\/dci24-0024","type":"journal-article","created":{"date-parts":[[2024,10,10]],"date-time":"2024-10-10T13:10:41Z","timestamp":1728565841000},"page":"29-37","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":12,"title":["The Role of Urban Residence, Race and Ethnicity, and Glycemic Control in Receiving Standards of Care and Progression to Vision-Threatening Diabetic Retinopathy"],"prefix":"10.2337","volume":"48","author":[{"given":"Jithin Sam","family":"Varghese","sequence":"first","affiliation":[{"name":"1Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA"},{"name":"2Emory Global Diabetes Research Center, Robert W. Woodruff Health Sciences Center, Emory University, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishnu","family":"Ravi Kumar","sequence":"additional","affiliation":[{"name":"3Office of Information Technology, Emory University, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jackson","family":"Bartelt","sequence":"additional","affiliation":[{"name":"4Emory College of Arts and Sciences, Emory University, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew M.","family":"Hendrick","sequence":"additional","affiliation":[{"name":"5Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3845-6703","authenticated-orcid":false,"given":"Francisco J.","family":"Pasquel","sequence":"additional","affiliation":[{"name":"1Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA"},{"name":"2Emory Global Diabetes Research Center, Robert W. Woodruff Health Sciences Center, Emory University, Atlanta, GA"},{"name":"6Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2024,10,10]]},"reference":[{"key":"2024122019513177200_B1","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1001\/jamaophthalmol.2023.2289","article-title":"Prevalence of diabetic retinopathy in the US in 2021","volume":"141","author":"Lundeen","year":"2023","journal-title":"JAMA Ophthalmol"},{"key":"2024122019513177200_B2","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1001\/jamaophthalmol.2022.0052","article-title":"Trends in prevalence and treatment of diabetic macular edema and vision-threatening diabetic retinopathy among Medicare Part B fee-for-service beneficiaries","volume":"140","author":"Lundeen","year":"2022","journal-title":"JAMA Ophthalmol"},{"key":"2024122019513177200_B3","doi-asserted-by":"crossref","first-page":"S231","DOI":"10.2337\/dc24-S012","article-title":"12. 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