The risk of diabetic-associated ocular problems was found is higher in children with type 2 rather than type 1 disease over the first 15 years of their diagnosis
Rates of diabetic-associated ocular problems in children have been found to be much higher in children diagnosed with type 2 compared with those with type 1 disease over the first 15 years after their diagnosis. This was the finding of a retrospective analysis by a team from the Department of Ophthalmology, Mayo Clinic, Rochester, US.
Diabetes is a common childhood condition, with a recent UK study finding that in 2019, there were around 36,000 children with diabetes under the age of 19, an increase from from 31,500 in 2015. Although in children, type 1 disease accounts for around 90% of all cases, there is evidence to suggest that the prevalence of type 2 diabetes has increased between 2001 and 2009, in 10 – 19-year-olds. Diabetes is associated with the development of micro-vascular complications including retinopathy, which remains the most common cause of blindness in working-age adults in the developed world. Nevertheless, while sight loss in children due to diabetic retinopathy is far less common, guidance does recommend retinopathy screening of children with type 1 diabetes. However, far less is known about the development and progression of diabetic retinopathy among children with type 2 diabetes.
In the present study, the US researchers wanted to compare diabetic ocular problem rates in children with both forms of the disease. They turned to the medical records of children newly diagnosed with diabetes between 1970 and 2019 in Minnesota. They collected demographic and clinical data such as HbA1C and whether the individuals had undergone an eye examination and followed-up on these examinations. The researchers catalogued diabetic-associated ocular complications including non-proliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), diabetic macular oedema (DME), a visually significant cataract (VSC) and the need for pars plana vitrectomy (PPV).
A total of 606 children were diagnosed with diabetes during the 50-year period, of whom, 525 (87.8%) had undergone at least one eye examination and were diagnosed with either type 1 (461) or type 2 (64) diabetes. The mean age of diagnosis among those with type 1 disease was 10.8 years (53.4% male) and 17.3 years (28.1% male) for type 2 disease. A DAOC occurred in 147 (31.9%) of those with type 1 disease,14 years after diagnosis and in 17 (26.6%) of those with type 2 disease. The hazard ratio, HR for developing any diabetic retinopathy between type 2 and type 1 disease was 1.88 (95% CI 1.13 – 3.12, p = 0.02).
Overall, 30.6% of those with type 1 disease developed an ocular problem within 15 years compared to 52.7% of those with type 2 disease. While the risk of developing any of the other retinopathy complications included in the analysis was numerically higher among those with type 2 disease, the only statistically significant effect was the need for pars plana vitrectomy (HR = 4.06, 95% CI 1.34 – 12.33, p = 0.07), 15 years after the initial diagnosis.
The authors concluded that children with type 2 diabetes developed vision-threatening retinopathy a shorter time after diagnosis than those with type 1 disease, and suggested that such children should have ophthalmoscopy evaluations at least as frequently, or even more frequently, than those with type 1 disease.
Bai P et al. Ocular Sequelae in a Population-Based Cohort of Youth Diagnosed With Diabetes During a 50-Year Period. JAMA Ophthalmol 2021