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Data lack support for retinal exams in youth with diabetes
SAN FRANCISCO — Evidence does not support routine retinal screenings of pediatric patients with type 1 diabetes based solely on age and diabetes duration, according to a researcher here.
Although not a retinal specialist, William V. Tamborlane, MD, a professor of pediatrics at Yale University School of Medicine, told attendees at the American Diabetes Association’s 74th Scientific Sessions that he was a primary investigator for the Diabetes Control and Complications Trial (DCCT) and the Epidemiology of Diabetes Interventions and Complications (EDIC) trial.
William V. Tamborlane
Evidence from DCCT/EDIC
“It just so happens that retinopathy was a primary outcome in the DCCT,” Tamborlane said. “There were two separate cohorts: the primary prevention cohort addressed the question of whether intensive therapy prevents the development of retinopathy compared with conventional therapy in patients with relatively short duration who had no retinopathy. The secondary intervention cohort addressed the question of whether intensive therapy could alter the progression of retinopathy.”
Patients’ ages at enrollment were between 13 and 39 years, with a subset of adolescent patients between the ages of 13 and 17 years. Among the 1,441 patients in the study, the subset comprised 195 patients, according to Tamborlane. The primary prevention cohort included patients with a 1- to 5-year duration of no retinopathy or microalbuminuria (n = 726). The secondary intervention cohort included patients with a 1- to 15-year duration of less-severe diabetic proliferative retinopathy (n = 715). Average follow-up was 6.5 years.
Tamborlane and colleagues observed a 76% risk reduction of retinopathy development in patients who did not have retinopathy at the enrollment. Subsequently, those patients were enrolled in the EDIC trial.
“Intensive therapy reduced the relative risk of diabetic retinopathy during the DCCT. Intensive therapy also had a profound reduction in the risk for further progression during EDIC,” Tamborlane said. “EDIC follow-up has demonstrated a consistent beneficial effect on severe eye disease and, even though the risk reduction has decreased over time, the effect is still substantial in the entire DCCT population over 18 years.”
Clinical implications in youth
Tamborlane explained how clinicians can use these data to evaluate the recommendations by the American Diabetes Association in screening for youth with type 1 diabetes.
The organization currently recommends that children who have had type 1 diabetes for 3 to 5 years or more should have an initial dilation and comprehensive eye examination with annual routine follow-up examinations beginning at age 10 years.
“I would suggest that the weight of the current evidence does not support routine retinal screenings of pediatric patients with type 1 diabetes in the U.S. based solely on age and diabetes duration,” Tamborlane said. “The need for annual follow-up examinations in youth free of diabetic retinopathy on initial assessment is even less well-justified.”
Tamborlane suggested that further studies are needed to determine whether routine retinal screening is of benefit to pediatric patients who have a greater risk for developing early-onset diabetic retinopathy due to poor metabolic control, hypertension and microalbuminuria. – by Samantha Costa
Disclosure: Tamborlane has no relevant financial disclosures.
For more information:
Tamborlane WV. Abstract #CT-SY20. Diabetic Retinopathy – From Children to Adults. Presented at: American Diabetes Association’s 74th Scientific Sessions; June 13-17, 2014; San Francisco.