Incidence and Risk Factors for Developing Diabetic Retinopathy among Youths with Type 1 or Type 2 Diabetes throughout the United States

Abstract

Objectives Despite the increasing prevalence of Type 2 diabetes mellitus (T2DM) among children and adolescents, little is known about their risk of developing diabetic retinopathy (DR). We sought to identify risk factors for DR in youth with DM, to compare DR rates for youth with Type 1 diabetes mellitus (T1DM) and T2DM, and to assess whether adherence to DR screening guidelines promoted by the American Academy of Ophthalmology, American Academy of Pediatrics, and American Diabetes Association adequately capture youth with DR. Design Retrospective observational longitudinal cohort study. Participants Youth aged ≤ 21 years with newly diagnosed T1DM or T2DM enrolled in a large U.S. managed care network. Main Outcome Measure Hazard ratios (HR) with 95% confidence intervals (CIs) for developing DR. Methods In this study of youth aged ≤ 21 years with newly diagnosed T1DM or T2DM enrolled in a large U.S. managed care network who were under ophthalmic surveillance, we identified the incidence and timing of DR onset for youth with T1DM and T2DM. Kaplan-Meier survival curves assessed the timing of initial diagnosis of DR for youth with each type of diabetes. Multivariable Cox proportional hazard regression modeling identified factors associated with the hazard of developing DR. Model predictors were age and calendar year at initial diabetes mellitus diagnosis, sex, race/ethnicity, net worth, and glycosylated hemoglobin (HbA1c). Results Among the 2240 youth with T1DM and 1768 youth with T2DM, 20.1% and 7.2% developed DR, over a median follow-up of 3.2 and 3.1 years, respectively. Survival curves demonstrated that youth with T1DM developed DR faster than youth with T2DM (P<0.0001). For every one-point increase in HbA1c, the hazard for DR increased by 20% (HR=1.20, CI 1.06–1.35) and 30% (HR=1.30, CI 1.08–1.56) among youth with T1DM and T2DM, respectively. Current guidelines suggest ophthalmic screening begin 3–5 years after initial DM diagnosis, at which point in our study, over 18% of youth with T1DM had already had received ≥1 DR diagnosis. Conclusions Youth with T1DM or T2DM exhibit a considerable risk for DR and should undergo regular screenings by eye-care professionals to ensure timely DR diagnosis and limit progression to vision-threatening disease.

ISPAD Clinical Practice Consensus Guidelines 2018: Microvascular and macrovascular complications in children and adolescents

“…Severe retinopathy or macular oedema was present in 2% and the youngest patient with PDR was age 6 years. Lower rates of screening uptake were found in those with lower family income and this group had higher rates of retinopathy, suggesting that the actual rate may be even higher …”

“…84,85 In the T1D Exchange Registry in the United States, less than 1% of 12 235 patients reported treatment for retinopathy 86 were found in those with lower family income and this group had higher rates of retinopathy, suggesting that the actual rate may be even higher. 87,88 Initial worsening of diabetic retinopathy can occur with the initiation of improvement in glycemic control as occurred in the DCCT but such worsening did not result in clinically significant visual loss and over time, intensive therapy continued to be superior to standard therapy. This initial worsening of diabetic retinopathy with improvement of glycemic control also occurred in patients with growth failure due to severe under-insulinization.…”

Serum CA 19–9 Level is Correlated to the Clinical Characteristics and Chronic Complications of Patients Newly Diagnosed with Type 2 Diabetes Mellitus

“…Some studies in Denmark and Germany showed that the prevalence of DR were 21.2 and 25.8 % in patients with T2DM [22,23]. The prevalence of DR patients was 7.2 and 13.1 % , in which young patients newly diagnosed with T2DM aged ≤ 21 years were enrolled in a large US managed-care network and a new diagnosis of T2DM in China, respectively [24,25]. In our study, the prevalence of DR was 7.8 % in the adult patients newly diagnosed with T2DM.…”

Gastrodin inhibits high glucose‑induced human retinal endothelial cell apoptosis by regulating the SIRT1/TLR4/NF‑κBp65 signaling pathway

“…Diabetic retinopathy (DR) is one of the main microvascular complications of diabetes mellitus and one of the leading causes of blindness worldwide (17). A large body of evidences showed that inhibition of HRECs apoptosis may have protective effects against DR (18,19).…”