Prevalence of diabetic retinopathy in children and adolescents with IDDM

Abstract

Summary Vision-threatening diabetic retinopathy can be prevented if it is diagnosed before becoming too advanced. Since diabetic retinopathy has been reported to occur only rarely before the end of pubertal development, children and adolescents are seldom included in screening programmes. We invited 780 children and adolescents with insulin-dependent diabetes mellitus diagnosed before the age of 15.0 years (disease duration of < 12 years) and who were older than 9.0 years at the time of examination from eight regions of Sweden. Retinal examination was performed with stereoscopic fundus photograph. The photograph were rated according to a modified Airlie House classification. The dropouts (223/780, 28.6 %) were significantly older and with a longer duration of diabetes than the examined children (p < 0.001 and 0.001, respectively). Photographs from 557 patients aged (median [interquartile range]:14.6 [12.4-17.0]) years and with a diabetes duration of 8.0 (5.5-9.9) years were evaluated. Retinopathy was demonstrated in 81 patients (14.5 %):66 with background retinopathy, 2 with microaneurysms and hard exudates, 12 with preproliferative retinopathy, 1 with proliferative retinopathy. Preproliferative retinopathy was diagnosed in a 12.8-year-old girl in pubertal stage 3 and an 11.8-year-old boy in pubertal stage 2, and proliferative retinopathy was found in a 21.5-year-old girl. Retinopathy was demonstrated in 6 % and 18 % of patients in pubertal stages 1 and 5, respectively. The overall prevalence of retinopathy in this population may even be higher since the dropouts were older and had a longer duration of diabetes. Since background and preproliferative retinopathy were found in children before puberty, we recommend including children and adolescents in screening programmes for diabetic retinopathy from the age of 10 years. [Diabetologia (1997) 40: 307-310]

Diabetic retinopathy

“…Although not normally present during the first 5 years of Type I diabetes [7], STDR may rarely develop in pre-pubertal patients if they are extremely poorly controlled [8]. PDR is not likely to develop within the first 10 years of diabetes but its incidence reaches about 30 out of 1000 patients per year rapidly afterwards [9,10].…”

Low cumulative incidence of proliferative retinopathy in childhood-onset type 1 diabetes: a 24-year follow-up study

“…2). Mean age at diagnosis of PDR was 27 years (range: 17-41), and mean diabetes duration was 19 years (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). Thirty-two patients (10.9%) had no retinopathy at follow-up.…”

“…Numerous studies [8,[11][12][13][14][15][16][17][18][19][20] have described the prevalence and incidence of DR in type 1 diabetes and its relationship to various characteristics. However, only a few population-based studies of retinopathy in subjects with childhood-onset type 1 diabetes are available [13,15,19,20].…”

“…However, only a few population-based studies of retinopathy in subjects with childhood-onset type 1 diabetes are available [13,15,19,20]. Observational studies from dedicated centres [12,13] have argued that the individual risk of developing microvascular complications has declined in recent years as a consequence of improvement in diabetes management.…”

Diagnosis of retinopathy in children younger than 12 years of age: implications for the diabetic eye screening guidelines in the UK

“…This age was defined at the start of the programme in 2005 by a report which found that the youngest person to have STDR was 11.9 years old. 9 Previous studies have been carried out to assess DR prevalence in young patients. The majority of these studies showed that a small percentage of patients younger than 12 years developed DR. 7,10,11 The main aim of the audit was to assess whether the current starting age is appropriate in relation to identification of STDR.…”