Abstract：
OBJECTIVE: To describe the management of diabetic macular oedema (DME) patients from the entire French population between 2012 and 2018.
METHODS: In this retrospective longitudinal study, we identified adults treated for DME from the French population using the exhaustive French National Health Information database (SNDS), and an algorithm based on diagnosis and procedure codes, and reimbursed treatments.
RESULTS: Between 2012 and 2018, we identified 53 584 treated DME patients, who were followed for up to 7 years from DME treatment initiation. Optical coherence tomography (OCT) became the predominant imaging tool to diagnose DME. Only 14% of patients consulted a diabetologist or endocrinologist in the 3 months prior to initiating DME treatment, whereas 84% consulted a general practitioner. The percentage of patients consulting an ophthalmologist declined over time, from 97% of patients in Year 1 (median of 9 consultations), to 46% in Year 7 (median of 7 consultations). The median DME treatment duration with an anti-VEGF and/or dexamethasone implant treatment was 9 months; 54% of patients had a treatment duration less than 1 year. First-line treatment was more common with ranibizumab (55% of patients) than with aflibercept (30%), or dexamethasone implant (15%). About 25% of patients who initiated anti-VEGF treatment switched treatment at least once, while 30% of patients who initiated dexamethasone implant switched to anti-VEGF treatment at least once.
CONCLUSIONS: French DME patients seem well-monitored by their ophthalmologist, but median DME treatment duration was just 9 months. These results emphasise the challenge to manage and treat patients with DME over the long term.
METHODS: In this retrospective longitudinal study, we identified adults treated for DME from the French population using the exhaustive French National Health Information database (SNDS), and an algorithm based on diagnosis and procedure codes, and reimbursed treatments.
RESULTS: Between 2012 and 2018, we identified 53 584 treated DME patients, who were followed for up to 7 years from DME treatment initiation. Optical coherence tomography (OCT) became the predominant imaging tool to diagnose DME. Only 14% of patients consulted a diabetologist or endocrinologist in the 3 months prior to initiating DME treatment, whereas 84% consulted a general practitioner. The percentage of patients consulting an ophthalmologist declined over time, from 97% of patients in Year 1 (median of 9 consultations), to 46% in Year 7 (median of 7 consultations). The median DME treatment duration with an anti-VEGF and/or dexamethasone implant treatment was 9 months; 54% of patients had a treatment duration less than 1 year. First-line treatment was more common with ranibizumab (55% of patients) than with aflibercept (30%), or dexamethasone implant (15%). About 25% of patients who initiated anti-VEGF treatment switched treatment at least once, while 30% of patients who initiated dexamethasone implant switched to anti-VEGF treatment at least once.
CONCLUSIONS: French DME patients seem well-monitored by their ophthalmologist, but median DME treatment duration was just 9 months. These results emphasise the challenge to manage and treat patients with DME over the long term.
摘要：
目的：描述2012年至2018年整个法国人群糖尿病性黄斑水肿（DME）患者的治疗。
方法：在这项回顾性纵向研究中，我们使用详尽的法国国家健康信息数据库（SNDS）从法国人群中确定了接受DME治疗的成年人，以及基于诊断和程序代码的算法，和报销治疗。
结果：在2012年至2018年之间，我们确定了53584名接受治疗的DME患者，从DME治疗开始后随访长达7年。光学相干断层扫描（OCT）成为诊断DME的主要成像工具。只有14%的患者在开始DME治疗前3个月咨询过糖尿病专家或内分泌专家。而84%的人咨询了全科医生。咨询眼科医生的患者比例随着时间的推移而下降，从第1年的97%的患者（中位数为9次咨询），到第7年的46%（7次咨询的中位数）。使用抗VEGF和/或地塞米松植入治疗的DME治疗的中位持续时间为9个月；54％的患者的治疗持续时间少于1年。一线治疗更常见的是雷珠单抗（55％的患者）比阿柏西普（30％），或地塞米松植入物（15%）。约25%开始抗VEGF治疗的患者至少切换过一次治疗，而30%开始使用地塞米松植入的患者至少一次改用抗VEGF治疗。
结论：法国DME患者似乎受到眼科医生的良好监测，但中位DME治疗持续时间仅为9个月.这些结果强调了长期管理和治疗DME患者的挑战。
方法：在这项回顾性纵向研究中，我们使用详尽的法国国家健康信息数据库（SNDS）从法国人群中确定了接受DME治疗的成年人，以及基于诊断和程序代码的算法，和报销治疗。
结果：在2012年至2018年之间，我们确定了53584名接受治疗的DME患者，从DME治疗开始后随访长达7年。光学相干断层扫描（OCT）成为诊断DME的主要成像工具。只有14%的患者在开始DME治疗前3个月咨询过糖尿病专家或内分泌专家。而84%的人咨询了全科医生。咨询眼科医生的患者比例随着时间的推移而下降，从第1年的97%的患者（中位数为9次咨询），到第7年的46%（7次咨询的中位数）。使用抗VEGF和/或地塞米松植入治疗的DME治疗的中位持续时间为9个月；54％的患者的治疗持续时间少于1年。一线治疗更常见的是雷珠单抗（55％的患者）比阿柏西普（30％），或地塞米松植入物（15%）。约25%开始抗VEGF治疗的患者至少切换过一次治疗，而30%开始使用地塞米松植入的患者至少一次改用抗VEGF治疗。
结论：法国DME患者似乎受到眼科医生的良好监测，但中位DME治疗持续时间仅为9个月.这些结果强调了长期管理和治疗DME患者的挑战。
