Screening for retinopathy in children with type 1 diabetes in Denmark

Abstract

Background: Children with type 1 diabetes (T1D) are screened regularly for retinopathy with fundus photography to prevent visual impairment. According to Danish national guidelines, screening should take place at age 12, 15 and 18 years after minimum 3 years of diabetes. As glycemic control has improved, prevalence of retinopathy is expected to be decreased.Objective: The aim of this study is to investigate the prevalence, degree and progression of retinopathy in children with T1D and to explore if screening at 12 years is currently indicated in Denmark.Subjects and methods: Data on all Danish children with onset of T1D from 2003-2013 (n=2943) were collected from the "DanDiabKids" registry. For children with registered screenings (n=2382), prevalence of retinopathy at 12, 15 and 18 years was determined. In children with retinopathy, subsequent screenings were studied to reveal if retinopathy was persistent or temporary.Results: Prevalence of retinopathy at 12, 15 and 18 years was 0.9 %, 2.3 % and 3.1 %, respectively.Minimal background retinopathy was seen in over 90 % and 100 % at 12 years. In available rescreenings, retinopathy resolved spontaneously in 87.5 % of all cases and 100 % of cases at 12 years.Conclusions: The prevalence of retinopathy in Danish children with T1D was low. At 12 years, prevalence was 0.9 % and exclusively minimal background retinopathy with 100 % remission in rescreenings. Thus, screening at this age does not seem to have significant clinical relevance. We propose more individualized screening selection before the age of 15.

Decreasing prevalence of retinopathy in childhood‐onset type 1 diabetes over the last decade: A comparison of two cohorts diagnosed 10 years apart

“…This study shows that patients with T1D diagnosed in the early 2000s developed less DR than a group of individuals in whom diabetes onset had occurred 10 years earlier, at parity of age at diagnosis, rate of onset in prepubertal stage and duration of disease. Compared with our results, previous studies of populations similar by age at onset reported decreasing prevalence of DR of either lower 18 or higher 16,17 magnitude in recent decades. However, diabetes duration at examination was shorter, 5‐12 years, and one study 18 was based on self‐reported data, which may have led to misclassification.…”

“…10 Finally, studies that considered longer durations of disease, of about 20 years, refer to diagnoses made long ago, in 1965-1990, 6,14,15 while those that considered more recent years of onset and modern glucose-lowering approaches had shorter durations, of around 7-12 years. [16][17][18] In this study, for the prevalence of DR, we compared two cohorts of patients who had been diagnosed with T1D in their childhood 10 years apart, one in the early 2000s and the other in the early 1990s. The cohorts were similar for both duration of disease and age at diagnosis.…”

“…In addition, the effect of diabetes duration may be modified by age at onset 11‐13 and year of diagnosis 10 . Finally, studies that considered longer durations of disease, of about 20 years, refer to diagnoses made long ago, in 1965‐1990, 6,14,15 while those that considered more recent years of onset and modern glucose‐lowering approaches had shorter durations, of around 7‐12 years 16‐18 …”

Differences in retinopathy prevalence and associated risk factors across 11 countries in three continents: A cross‐sectional study of 156,090 children and adolescents with type 1 diabetes

“…14 While there have been many studies in adults, current data regarding the prevalence of DR among children and adolescents with type 1 diabetes are scarce. [15][16][17][18] The aim of this multinational study was to estimate the prevalence of DR in children and adolescents with type 1 diabetes from several large prospective longitudinal registries and to evaluate the risk factors associated with the occurrence of DR in our study population.…”

“…While there have been many studies in adults, current data regarding the prevalence of DR among children and adolescents with type 1 diabetes are scarce. 15 , 16 , 17 , 18 …”