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Youths with diabetes at higher risk for retinopathy
Higher levels of glycosylated hemoglobin may also increase risk for diabetic retinopathy.
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Youths with type 1 or type 2 diabetes are at a higher risk of being diagnosed with diabetic retinopathy later in life and should undergo early ophthalmic examinations.
These at-risk youths are at a higher risk to be diagnosed with diabetic retinopathy (DR) and should periodically undergo screening by an eye care professional, Sophia Y. Wang, MD, told Ocular Surgery News.
“One of the main results for our investigation of risk factors for diabetic retinopathy was that youth with type 1 diabetes were more likely than youth with type 2 diabetes to be diagnosed with DR. We also found that higher levels of glycosylated hemoglobin (HbA1c) conferred increased risk for diabetic retinopathy,” she said.
Risk factors for DR
The retrospective, observational, longitudinal cohort study included patients aged 21 years or younger who were newly diagnosed with type 1 or type 2 diabetes. The researchers examined the incidence and timing of the patients diagnosed with DR.
The study cohort included 2,240 patients with type 1 diabetes and 1,768 with type 2 diabetes. Overall, 14.4% of the study participants received a DR diagnosis.
Of those diagnosed with type 1 diabetes, 20.1% developed DR after a median follow-up time of 3.2 years, compared with 7.2% with type 2 diabetes who developed DR after a median follow-up time of 3.1 years.
“There is a perception that diabetic retinopathy is very uncommon in youth with [diabetes mellitus]. We were surprised to find that overall, more than one in five of the youth with type 1 DM and 7% of the youth with type 2 DM in our cohort received a diagnosis of diabetic retinopathy during the time they were monitored in the health plan. For example, in our survival analysis, by 8 years of follow-up, over 30% of youth with type 1 DM and over 10% of youth with type 2 DM had been diagnosed with diabetic retinopathy. These results suggest that diabetic retinopathy may not be so uncommon among youth with DM,” Wang said.
HbA1c also a risk factor
Researchers also found that a higher median level of HbA1c was a direct risk factor for DR. Patients in the cohort with type 1 diabetes were found to have higher median levels of HbA1c than those with type 2 diabetes. Also, those with DR were found to have higher median levels of HbA1c than those without DR, Wang noted.
“For every 1-point increase in the HbA1c, DR hazard increased by 20% among those with type 1 diabetes and by 30% among those with type 2 diabetes,” she said.
Additional ophthalmic screening
Wang said American Academy of Ophthalmology guidelines recommend that ophthalmic screenings should begin at the time of diagnosis of type 2 diabetes. The guidelines also suggest that screenings for patients with type 1 diabetes should start at 5 years after the initial diabetes diagnosis.
However, due to the results of the study, Wang said additional research is needed to better understand when patients with type 1 or 2 diabetes should begin having ophthalmic screenings for DR.
“Researchers have studied how well adults and youth with DM adhere to these current guidelines, and most studies have found that adherence is far from ideal. Based on our study results, we believe that additional research is needed to help better understand the ideal timing of screening for DR and that there may be groups of patients with high-risk features (ie, worse glycemic control) who may benefit from earlier screening than other patients who have fewer risk factors. The present guidelines only consider the type of DM, the age of onset and the duration of disease,” she said.
The subgroup of patients who are at an elevated risk for DR might benefit from being seen earlier than the average patient, Wang said.
“We hope that our study will help inform pediatricians and other health care providers who care for youth with DM about the importance of referring youth with DM to ophthalmologists or optometrists to check for DR at least as often as the current guidelines recommend, and there may be subgroups of patients who maybe are at increased risk for DR who may benefit from screening for DR even earlier than the existing guidelines recommend,” she said. – by Robert Linnehan
- Reference:
- Wang SY, et al. Ophthalmology. 2016;doi:10.1016/j.ophtha.2016.10.031.
- For more information:
- Sophia Y. Wang, MD, can be reached at Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, 1500 E. Medical Center Drive, Ann Arbor, MI 48109; email: sophiayw@med.umich.edu.
Disclosure: Wang reports no relevant financial disclosures.