Diabetic retinopathy prevalence increases over time in pediatric type 2 diabetes
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Key takeaways:
- About 7% of youths with type 2 diabetes have diabetic retinopathy.
- Diabetic retinopathy prevalence increases sharply with diabetes duration.
- More studies are needed to analyze sex and race subgroups.
The prevalence of diabetic retinopathy among children and adolescents with type 2 diabetes greatly increases 5 years after diabetes diagnosis, according to findings from a systematic review and meta-analysis.
“These findings indicate that the retina is an early target of type 2 diabetes in children in the early years after diagnosis,” M. Constantine Samaan, MD, MSc, staff physician in the division of pediatric endocrinology at McMaster Children’s Hospital and associate professor in the department of pediatrics at McMaster University in Hamilton, Ontario, Canada, told Healio. “This finding has implications for retinopathy screening and ophthalmic care, and personalized diabetes treatment to protect vision.”
Samaan and colleagues conducted a systematic review and meta-analysis of studies that analyzed the prevalence of diabetic retinopathy among children and adolescents with type 2 diabetes. Studies that included people diagnosed with type 2 diabetes at age 21 years or younger, had a study population of at least 10 participants, had an observational design and reported diabetic retinopathy prevalence were included. The MEDLINE, Embase, CINAHL, CENTRAL, Cochrane Database of Systematic Reviews, and Web of Science databases were searched from April 4, 2021, until May 17, 2022.
The findings were published in JAMA Network Open.
There were 29 studies meeting the inclusion criteria, of which six were cross-sectional studies, 13 were retrospective cohort studies and 10 were prospective studies. Data from 27 of the 29 studies were used in the pooled analysis.
The global prevalence of diabetic retinopathy among 5,924 children and adolescents was 6.99%. Of nine studies that reported diabetic retinopathy classification using Early Treatment Diabetic Retinopathy Study criteria or modified Airlie House criteria, minimal to moderate nonproliferative diabetic retinopathy was reported in 11.16% of participants, severe nonproliferative diabetic retinopathy was observed in 2.57%, proliferative diabetic retinopathy was found in 2.43% and the prevalence of macular edema was 3.09%.
Five studies reported the prevalence of diabetic retinopathy when a fundoscopy was used for diagnosis was 0.47%. In four studies where 7-field stereoscopic fundus photography was used to assess diabetic retinopathy, the prevalence was 13.55%.
When all studies were pooled together, the prevalence of diabetic retinopathy less than 2.5 years after diabetes diagnosis was 1.78%. Diabetic retinopathy prevalence more than doubled between 2.5 and 5 years post-diagnosis to 5.08%, and increased dramatically more than 5 years after diabetes diagnosis to 28.83%.
The researchers were unable to determine sex differences in the prevalence of diabetic retinopathy due to a low confidence interval. When prevalence was analyzed based on race, 24.07% of Middle Eastern or white children and adolescents had diabetic retinopathy. The prevalence rate was lower among Asian youth (13.31%). Insufficient data were available to analyze other subgroups.
“We were surprised that there was very limited evidence to understand the sex and race differences in retinopathy risk in youth with type 2 diabetes,” Samaan said. “Further research is warranted considering that more girls develop type 2 diabetes than boys, and the risk of type 2 diabetes cases is higher in some racial groups.”
Older age, longer diabetes duration and higher hypertension prevalence were associated with higher diabetic retinopathy prevalence. There was no association between glycemic control and diabetic retinopathy prevalence. However, patients who developed diabetic retinopathy had a 1.37% higher mean HbA1c than those without retinopathy.
Eight of the 29 studies had a low risk of bias, 20 had a moderate risk of bias, and one study had a high risk of bias.
“There is a need to ensure that screening for diabetic retinopathy in these youth follow current guidelines,” Samaan said. “While guidelines advocate for retinopathy screening at diabetes diagnosis and annually, these recommendations are not always implemented, especially in racial minority groups. Equitable and consistent access to eye care and implementation of screening guidelines in this population are needed.”
For more information:
M. Constantine Samaan, MD, MSc, can be reached at samaanc@mcmaster.ca.
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Cioana M, et al. JAMA Netw Open. 2023;doi:10.1001/jamanetworkopen.2023.1887.
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