ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Pediatr Diabetes 2018; 19: (6) 1124

In this cross-sectional study performed in Haiti, the authors found that 18% of the children and adolescents with diabetes had signs of retinopathy and that 16% had a cataract. This prevalence is clearly much higher than reported in young patients with diabetes living in high-income countries. Importantly, ocular complications occurred early in Haitian patients, 4.9 years after diagnosis of diabetes for retinopathy and 3.0 years for cataract. The prevalence of ocular complications increases with duration of diabetes and poor quality of diabetes management. Not unexpectedly, the management of diabetes is suboptimal in Haiti, one of the poorest countries in the world where healthcare resources are very limited. Indeed, mean HbA1c was 9.8%. Prevalence of retinopathy, but not of cataract, increased with longer duration of diabetes. Whether African ancestry, which is characteristic of Haiti, also predisposes to eye complications, is unknown.

The 2014 ISPAD guidelines recommend retinopathy screening “annually from age 10 or at onset of puberty if this is earlier, after 2 to 5 years’ diabetes duration”. In settings such as Haiti where eye complications seem to develop early, these guidelines may need to be revised and a more intensive and earlier assessment of eye complications may be warranted. Although data are currently not available, it is likely that other micro- and macrovascular complications are also more common in Haitian children with Type 1 diabetes. This study supports the need for capacity building in pediatric endocrinology in Haiti, a task that the authors of this article are presently carrying out through the Pediatric Endocrinology Education Program for Haiti (PEEP-H).