In children, risk of diabetic retinopathy is higher in type 2 disease than type 1

A retrospective, population-based review conducted over 50 years in a single county in the United States evaluated the risk of developing diabetes-associated ocular complications in children diagnosed with either type 1 diabetes (T1D) or type 2 diabetes (T2D).

Study design

The records of 606 patients aged ≤22 years were reviewed; of this group, 525 had at least one eye examination performed after their diabetes diagnosis. The associated ocular complications assessed by investigators included nonproliferative and proliferative diabetic retinopathy, visually significant cataract, diabetic macular edema, and the need for pars plana vitrectomy.

Outcomes

Overall, the rate of ocular complication development was 31.9% in children with T1D and 26.6% in children with T2D. However, the children with T2D developed retinopathy after a shorter diabetes duration and at a higher rate than children with T1D (hazard ratios: 1.88 for nonproliferative diabetic retinopathy and 2.33 for proliferative diabetic retinopathy). The T2D group was also at a much greater risk of needing pars plana vitrectomy after 15 years.

Limitations

The study is retrospective with incomplete data. Children with T2D are more likely to have undetected disease compared with children with T1D. This may account for the shortened timeframe from diabetes diagnosis to ocular disease.

Clinical significance

Children with T2D show ocular complications after a shorter duration of diabetes compared with children with T1D, and therefore should be monitored carefully for diabetic retinopathy.