ESPE Yearbook of Paediatric Endocrinology

Diabetes Care. 2022 May 20:dc211652. https://pubmed.ncbi.nlm.nih.gov/35594057/

Brief Summary: This longitudinal study reports trends in diabetic retinopathy (DR) and macular edema (DME) across 3 decades: 1990-1999, 2000-2009, 2010-2019, in a large Australian cohort of 2404 adolescents with type 1 diabetes (T1D). The prevalence of DR decreased between 1990-1999 and 2000-2009, from 40 to 21%, and remained stable thereafter (20%), whereas the prevalence of DME remained low across the three decades 1.4, 0.5, and 0.9%.

Diabetic retinopathy is the most common eye diseases and a main cause of blindness among people with T1D, therefore contributed to the overall morbidity associated with this condition. The early identification and treatment of this complication is of paramount importance (1). Understanding the contemporary prevalence and severity of DR in the adolescent population is important to inform screening guidelines (2).

The study showed an important decrease in the prevalence of DR between 1999 and 2009 but a static trend during the last decade when, however, still one in five adolescents had DR.

The main risk factors included some known ones such as high HbA1c, longer diabetes duration, and some emerging factors such as overweight/obesity, diastolic blood pressure. Of note, the use of insulin pump therapy (CSII), which increased during the first two decades, was associated with 38% lower risk of DR than MDI, independently of HbA1c, likely reflecting more physiological insulin delivery or less glycemic variability with CSII.

This study was based on a long follow up and standardized protocols to grade DR in one of the main centres with expertise in diabetic retinopathy. However, the findings might be country specific and not generalizable. Nevertheless, these findings are important and support current recommendations to lower glycemic targets, increase CSII use, and target modifiable risk factors including blood pressure, cholesterol, and overweight/obesity, to prevent DR and other vascular complications (2).

References: 1. Antonetti DA, Klein R, Gardner TW. Diabetic retinopathy. N Engl J Med 2012;366:1227–399. 2. Draznin B, Aroda VR, Bakris G, Benson G, Brown FM, Freeman R, et al. Children and Adolescents: Standards of Medical Care in Diabetes-2022. Diabetes Care 2022;45:S208-s231.