• Diabetic Retinopathy Outcomes in Young Patients

    By Jean Shaw
    Selected and Reviewed by Neil M. Bressler, MD, and Deputy Editors

    Journal Highlights

    JAMA Ophthalmology, January 2022

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    Bai et al. set out to assess the risk of developing diabetes-associated ocular complications among young people with type 1 and type 2 diabetes. They found that those with type 2 diabetes were more likely to develop diabetic retinopathy (DR) after a shorter dura­tion of disease—and to do so at a higher rate than those with type 1 diabetes.

    For this retrospective population-based study, the researchers reviewed the medical records of children and teenagers who were diagnosed with diabetes from Jan. 1, 1970, through Dec. 31, 2019. All were younger than 22 years of age and lived in Olmstead County, Minnesota, at time of diagno­sis. The main outcome measure was the risk of developing ocular sequelae over time.

    A diagnosis of diabetes was con­firmed via ophthalmic examination in 525 children and teenagers during this 50-year period, with 461 diagnosed with type 1 disease and 64 with type 2. The mean age at diagnosis was 12.1 (range, 73 days to 21.8 years). The majority (83.3%) of those with type 1 diabetes were White. In contrast, the ethnicity of those with type 2 disease was more varied, as 54.7% were White, 18.7% were Black, and 14.1% were Asian.

    Diabetes-associated complications occurred in 147 (31.8%) of those with type 1 diabetes during a mean follow-up of 14 years (range, 1 day to 37 years) and in 17 (26.6%) of those with type 2 disease during a mean follow-up of nine years (range, 18 days to 24 years). All told, the prevalence of DR, includ­ing both proliferative and nonprolif­erative disease, was 30.6% for type 1 and 52.7% for type 2 disease. Other outcomes for type 1 and type 2 were as follows: diabetic macular edema, 5% versus 4%; a visually significant cata­ract, 1% versus 9%; and the need for pars plana vitrectomy by 15 years after diabetes diagnosis, 2% versus 8%.

    These findings suggest that the natural history of DR among young people diagnosed with type 2 diabetes may differ from that observed in those with type 1 disease, the authors said. As a result, they noted, children with type 2 diabetes may require ophthalmic examinations as frequently—or perhaps more frequently—than those with type 1 disease. (Also see related commentary by Jennifer K. Sun, MD, MPH, in the same issue.)

    The original article can be found here.