Diabetes is a common chronic disease of childhood characterized by chronic hyperglycemia with end-organ damage that often results in the microvascular triad of nephropathy, neuropathy, and retinopathy.
Although the ocular sequelae of type 1 diabetes (T1D) and adult onset type 2 diabetes (T2D) have been well described, little is known concerning the progression of diabetic retinopathy among children with T2D, despite its increasing prevalence in recent year.
Children with T2D have a higher risk of developing retinopathy than those with T1D, finds a new study.The study has appeared in JAMA ophthalmology.
The purpose of this study carried by Patricia Bai et al was to assess the risk of developing diabetes-associated ocular complications (DAOC) among a population-based cohort of children diagnosed with either T1D or T2D during a 50-year period.
This retrospective, population-based medical record review included all residents of Olmsted County, Minnesota, diagnosed with diabetes at younger than 22 years from January 1, 1970, through December 31, 2019. Main outcomes and measures included Risk of developing ocular complications over time.
Among 1362 individuals with a diagnostic code of diabetes, medical record reviews confirmed a diagnosis of T1D or T2D in 606 children, of whom 525 (86.6%) underwent at least 1 eye examination.
Diabetes-associated ocular complications occurred in 147 of the 461 children (31.2%) with T1D and in 17 of the 64 children (26.6%) with T2D. The hazard ratio illustrating the risk between T2D and T1D rates was 1.88 (P = .02) for developing any diabetic retinopathy (nonproliferative or greater), 2.33 (P = .048) for proliferative diabetic retinopathy, 1.49 (P = .50) for diabetic macular edema, 2.43 (P = .24) for a visually significant cataract, and 4.06 (P = .007) for requiring pars plana vitrectomy by 15 years after the diagnosis of diabetes.
In this 50-year population-based cohort, children diagnosed with T2D had a higher risk of developing diabetic retinopathy, developing PDR, and requiring PPV compared with those diagnosed with T1D. The duration between the diagnosis of diabetes and the development of diabetic retinopathy was shorter in the T2D cohort compared with the T1D cohort, and patients with T2D developed vision-threatening retinopathy at a higher rate than those with T1D. This suggests that the natural history of retinopathy development among youth diagnosed with T2D may differ from that in youth diagnosed with T1D, where patients with T2D may be more susceptible to developing retinopathy than those with T1D despite controlling for diabetes disease duration
In this population-based cohort of children diagnosed with diabetes during a 50-year period, patients with T2D developed vision-threatening retinopathy after a shorter diabetes duration and at a higher rate than children with T1D. These findings suggest that to prevent serious ocular complications, children with T2D may require ophthalmoscopic evaluations at least as frequently as or more frequently than children with T1D.
doi:10.1001/jamaophthalmol.2021.5052