Higher BMI in children associated with more rapid progression of diabetic retinopathy

Issue: June 10, 2011

FORT LAUDERDALE, Fla. — Overweight or obese children with type 1 diabetes developed diabetic retinopathy more quickly than their leaner counterparts, according to a poster here.

"These data highlight the potential importance of early weight control in association with glycemic control to reduce [diabetic retinopathy] complications in young patients with type 1 [diabetes]," Meenakashi Gupta, MD, and colleagues said in a poster presentation at the Association for Research in Vision and Ophthalmology meeting.

Dr. Gupta and colleagues conducted a retrospective review of 461 patient charts culled from the Beetham Eye Institute and Joslin Diabetes Center, Boston. All patients were younger than 19 years with type 1 diabetes; 309 (67%) were classified as underweight or normal weight, 103 (22%) as overweight and 49 (11%) as obese. More than half of the subjects (54.5%) were male, and the majority (85.3%) were white.

After three eye examinations over a mean follow-up period of 3.5 years, 9% of subjects developed mild or moderate nonproliferative diabetic retinopathy in at least one eye. Of those patients, 15% were obese, 9% were overweight and 6% were underweight or normal weight.

Dr. Gupta and colleagues found that a higher initial body mass index percentile was associated with faster progression to diabetic retinopathy. Development of diabetic retinopathy was also associated with longer duration of diabetes, longer follow-up and higher average HbA1c. Higher total cholesterol was also a contributor.

Multivariable analysis accounting for age, follow-up duration and HbA1c confirmed the results, the study authors said.

Disclosure: Dr. Gupta has no financial disclosures.

Dr. Gupta and his colleagues presented a retrospective review where a third of the patients were overweight and concluded that a higher BMI was associated with a faster development and progression of diabetic retinopathy in 25% of these patients. Associated factors of longer duration of diabetes, longer follow-up and higher HbA1c contributed.

This study confirms the need for a team approach to the diabetic patient, starting with the pediatrician. A pediatric endocrinologist is essential in those cases when blood sugar is difficult to control and a dietician should be consulted. The pediatric ophthalmologist should communicate the necessity of yearly eye exams in diabetic children, just as it is appropriate in the adult population. It becomes even more crucial when the child is overweight. In this condition, the control of blood sugar through diet, weight control and medications to prevent the complication of diabetic retinopathy to prevent vision loss is essential.

– Robert S. Gold, MD
OSN Pediatrics/Strabismus Section Editor
Disclosure: Dr. Gold has no financial disclosures on this subject.