Continued Reduction in the Prevalence of Retinopathy in Adolescents With Type 1 Diabetes

Abstract

OBJECTIVETo examine trends in microvascular complications in adolescents with type 1 diabetes between 1990 and 2009 in Sydney, Australia.RESEARCH DESIGN AND METHODSWe used analysis of complications in 1,604 adolescents (54% female, aged 12–20 years, median duration 8.6 years), stratified by four time periods using Generalized Estimation Equations as follows: T1 (1990–1994), T2 (1995–1999), T3 (2000–2004), and T4 (2005–2009). Early retinopathy was detected using seven-field fundal photography, albumin excretion rate (AER) using timed overnight urine collections, and albumin-to-creatinine ratio (ACR) and peripheral nerve function using thermal and vibration threshold.RESULTSRetinopathy declined (53, 38, 23, and 12%; P < 0.001), as did borderline elevation of AER/ACR (45, 30, 26, and 30%; P < 0.001) and microalbuminuria (8, 4, 3, and 3%; P = 0.006). Multiple daily injections (MDI)/continuous subcutaneous insulin infusion (CSII) use increased (17, 54, 75, and 88%; P < 0.001), median HbA1c decreased (9.1, 8.9, 8.5, and 8.5%; P < 0.001), and severe hypoglycemia was unchanged (6, 8, 10, and 7%; P = 0.272). Retinopathy was associated with diabetes duration (odds ratio [OR] 1.12 [95% CI 1.08–1.17]), age (1.13 [1.06–1.20]), HbA1c (1.16 [1.08–1.25]), systolic blood pressure (BP) SDS (1.31 [1.16–1.48]), socioeconomic disadvantage (1.42 [1.04–1.95]), and 1 to 2 injections per day (vs. MDI/CSII; 1.35 [1.05–1.73]); borderline AER/ACR with male sex (1.32 [1.02–1.70]), age (1.19 [1.12–1.26]), HbA1c (1.18 [1.08–1.29]), weight SDS (1.31 [1.21–1.53]), insulin dose per kilograms (1.64 [1.13–2.39]), 1 to 2 injections per day (1.41 [1.08–1.84]), and socioeconomic disadvantage (1.68 [1.23–2.31]); and microalbuminuria with age (1.14 [1.01–1.29]), HbA1c (1.20 [1.05–1.37]), diastolic BP SDS (1.76 [1.26–2.46]), and 1 to 2 injections per day (1.95 [1.11–3.41]).CONCLUSIONSThe decline in retinopathy supports contemporary guidelines that recommend lower glycemic targets and use of MDI/CSII in children and adolescents with type 1 diabetes.

Retinopathy in type 1 diabetes mellitus: Major differences between rural and urban dwellers in northwest Ethiopia

“…Globally, as a consequence of the DCCT and UKPDS studies, the targets for glycaemic control have been tightened and retinopathy rates have begun to fall [21,22]. The HbA1c levels in the present cross-sectional report were not dissimilar to those found at present in many routine diabetes clinics in westernised countries [19,21,22]. How do the results of the present report compare with previous results from Ethiopia and other African countries?…”

“…Although the average HbA1c levels were above the goal of ≤ 7.0% [≤ 53 mmol/mol], there was no significant difference between the glycaemic control of the urban and rural T1DM groups, despite the specific difficulties of insulin storage and regular blood glucose monitoring for the rural patients. Globally, as a consequence of the DCCT and UKPDS studies, the targets for glycaemic control have been tightened and retinopathy rates have begun to fall [21,22]. The HbA1c levels in the present cross-sectional report were not dissimilar to those found at present in many routine diabetes clinics in westernised countries [19,21,22].…”

“…A recent publication from the Wisconsin Diabetes Registry Study [21] reported 6% retinopathy prevalence at 4 years in young T1DM patients with a cumulative mean level of HbA1c 9.1% from the start of the study. An Australian study [22] has reported 12% retinopathy at 8.9 years duration of T1DM with an average HbA1c of 8.5%. There is overlap in the prevalence of retinopathy between the urban group of the present report (who are adults) and those of the Wisconsin and Australian studies (adolescents); in this case caution is needed when comparing retinopathy in adults with that in patients who have had diabetes before and during the pubertal phase of development.…”

Cardiovascular Disease Risk Factors in Youth With Diabetes Mellitus

“…141,142 There are limited data in youth with adolescents with T2DM, but these data suggest similar retinal abnormalities are developing. 143,144 Factors influencing retinopathy in children with T1DM include vitamin D deficiency, 145 BP, 146 duration of disease, 147 and glucose control. 148, 149 The prevalence appears to be declining in both children 150 and adults, 138 possibly related to more intensive treatment.…”

Risk factors for development and progression of nonproliferative retinopathy in normoalbuminuric patients with type 1 diabetes

“…Diabetic retinopathy is also associated with mortality and cardiovascular disease incidence in diabetes [2]. Prospective studies identified poor glycemic control, duration of diabetes and blood pressure as most important risk factors for development of retinopathy [3][4][5][6][7]. Retinopathy and nephropathy are most important microvascular complications in patients with diabetes.…”