Global Prevalence of Diabetic Retinopathy in Pediatric Type 2 Diabetes

Abstract

ImportanceType 2 diabetes (T2D) is increasing globally. Diabetic retinopathy (DR) is a leading cause of blindness in adults with T2D; however, the global burden of DR in pediatric T2D is unknown. This knowledge can inform retinopathy screening and treatments to preserve vision in this population.ObjectiveTo estimate the global prevalence of DR in pediatric T2D.Data SourcesMEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, the Web of Science, and the gray literature (ie, literature containing information that is not available through traditional publishing and distribution channels) were searched for relevant records from the date of database inception to April 4, 2021, with updated searches conducted on May 17, 2022. Searches were limited to human studies. No language restrictions were applied. Search terms included diabetic retinopathy; diabetes mellitus, type 2; prevalence studies; and child, adolescent, teenage, youth, and pediatric.Study SelectionThree teams, each with 2 reviewers, independently screened for observational studies with 10 or more participants that reported the prevalence of DR. Among 1989 screened articles, 27 studies met the inclusion criteria for the pooled analysis.Data Extraction and SynthesisThis systematic review and meta-analysis followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines for systematic reviews and meta-analyses. Two independent reviewers performed the risk of bias and level of evidence analyses. The results were pooled using a random-effects model, and heterogeneity was reported using χ2 and I2 statistics.Main Outcomes and MeasuresThe main outcome was the estimated pooled global prevalence of DR in pediatric T2D. Other outcomes included DR severity and current DR assessment methods. The association of diabetes duration, sex, race, age, and obesity with DR prevalence was also assessed.ResultsAmong the 27 studies included in the pooled analysis (5924 unique patients; age range at T2D diagnosis, 6.5-21.0 years), the global prevalence of DR in pediatric T2D was 6.99% (95% CI, 3.75%-11.00%; I2 = 95%; 615 patients). Fundoscopy was less sensitive than 7-field stereoscopic fundus photography in detecting retinopathy (0.47% [95% CI, 0%-3.30%; I2 = 0%] vs 13.55% [95% CI, 5.43%-24.29%; I2 = 92%]). The prevalence of DR increased over time and was 1.11% (95% CI, 0.04%-3.06%; I2 = 5%) at less than 2.5 years after T2D diagnosis, 9.04% (95% CI, 2.24%-19.55%; I2 = 88%) at 2.5 to 5.0 years after T2D diagnosis, and 28.14% (95% CI, 12.84%-46.45%; I2 = 96%) at more than 5 years after T2D diagnosis. The prevalence of DR increased with age, and no differences were noted based on sex, race, or obesity. Heterogeneity was high among studies.Conclusions and RelevanceIn this study, DR prevalence in pediatric T2D increased significantly at more than 5 years after diagnosis. These findings suggest that retinal microvasculature is an early target of T2D in children and adolescents, and annual screening with fundus photography beginning at diagnosis offers the best assessment method for early detection of DR in pediatric patients.

Malnutrition Is Associated with Diabetic Retinopathy in Patients with Type 2 Diabetes

“…The proportion of malnourished patients assessed by GLIM, PNI, and CONUT was higher in males. In the current study, gender differences in DR and malnutrition are inconclusive [31][32][33]. In our study, patients with DR had a lower BMI, which was contrary to the Yin et al's study [30].…”

“…In our study, patients with DR had a lower BMI, which was contrary to the Yin et al's study [30]. However, the current meta-analysis showed that there was no difference in the prevalence of DR between obese and nonobese diabetic patients [31]. In our study, malnourished patients had lower BMI, which is consistent with most previous studies.…”

Type 2 diabetes in children and adolescents: Exploring the disease heterogeneity and research gaps to optimum management

“…However, in another study on Pima Indian people, retinopathy was relatively lower in patients with young- rather than later-onset T2DM[ 50 ]. In a recent meta-analysis, the most significant increase in the prevalence of T2DM was observed at more than 5 years after diagnosis[ 51 ]. Overall, available studies suggest that having younger onset T2DM increases the risk of retinopathy more than having T1DM of same duration, but the differences in risk between young-onset and usual onset T2DM remain unclear.…”

Effectiveness and safety of early lens extraction during par plana vitrectomy for proliferative diabetes retinopathy with mild cataract: a randomized clinical trial

“…D iabetic retinopathy (DR), one of the leading causes of irreversible blindness worldwide, is frequently accompanied by lens opacities [1][2][3][4] . Pars plana vitrectomy PPV combined phacoemulsification for PDR patients Int J Ophthalmol, Vol.…”