Retinopathy in Youth With Type 2 Diabetes Participating in the TODAY Clinical Trial

Drews, Kimberly L.; Levitsky, Lynne L.; Danis, Ronald P.; Tamborlane, William V.; Haymond, Morey W.; Laffel, Lori M.; Lipman, Terri H.

doi:10.2337/dc12-2387

Cited by 108 publications

(71 citation statements)

References 12 publications

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“…Similar to prior studies, HbA 1c levels in our study were higher among patients with DR than among those without DR. 22–24,26–28 We found that higher HbA 1c values is associated with increased hazard of DR, consistent with previous literature among youth with T1DM 6,22,23 and T2DM 26 . While we also found that males with T2DM were at increased risk for DR compared with females, previous studies reporting sex-related differences in the development of DR have only been in youth with T1DM and have been inconsistent, noting either increased DR among females 29,30 or among males, 31 postulating hormonal differences during puberty as a possible explanatory factor.…”

Section: Discussionsupporting

confidence: 92%

“…25 Among the 517 participants in the TODAY clinical trial—the largest study of DR among youth with T2DM—the prevalence of DR on fundus photography after a mean DM duration of 4.9 years was 13.7%. 26 A recent retrospective chart review of 338 children with T1DM with a median DM duration of 4.9 years and 32 children with T2DM with a median DM duration of 2.0 years did not observe any DR based on clinical records. 14 …”

Section: Discussionmentioning

confidence: 94%

“…Previously reported rates of DR among children and adolescents have varied from as low as 0% to over 50% for youth with T1DM and T2DM, 14,22–26 in settings as diverse as Sweden, 22 southern India, 24 the U.S., 14,26 and Canada. 25 Direct comparison of the present analysis with these earlier studies is challenging because they differ in participant age-range, sample size, local standards of DM care, follow-up duration, glycemic control, and DR-assessment method.…”

Section: Discussionmentioning

confidence: 99%

“…We found a greater female predominance among youth with T2DM than has been previously reported in the literature (typically 61% to 65% female), which may be due to differences in characteristics of the study samples. 25,26,41,42 Despite efforts to ensure that the study population included only incident DM cases by requiring 12 months in the plan without prior initial DM diagnosis, some of these youth may have had pre-existing DM, especially among those with T2DM. Thus, we may be underestimating the time from disease onset to first recorded DR diagnosis and overestimating the numbers of youth with DR whose diagnosis may be delayed by following current guidelines.…”

Section: Discussionmentioning

confidence: 99%

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Incidence and Risk Factors for Developing Diabetic Retinopathy among Youths with Type 1 or Type 2 Diabetes throughout the United States

et al. 2017

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Objectives Despite the increasing prevalence of Type 2 diabetes mellitus (T2DM) among children and adolescents, little is known about their risk of developing diabetic retinopathy (DR). We sought to identify risk factors for DR in youth with DM, to compare DR rates for youth with Type 1 diabetes mellitus (T1DM) and T2DM, and to assess whether adherence to DR screening guidelines promoted by the American Academy of Ophthalmology, American Academy of Pediatrics, and American Diabetes Association adequately capture youth with DR. Design Retrospective observational longitudinal cohort study. Participants Youth aged ≤ 21 years with newly diagnosed T1DM or T2DM enrolled in a large U.S. managed care network. Main Outcome Measure Hazard ratios (HR) with 95% confidence intervals (CIs) for developing DR. Methods In this study of youth aged ≤ 21 years with newly diagnosed T1DM or T2DM enrolled in a large U.S. managed care network who were under ophthalmic surveillance, we identified the incidence and timing of DR onset for youth with T1DM and T2DM. Kaplan-Meier survival curves assessed the timing of initial diagnosis of DR for youth with each type of diabetes. Multivariable Cox proportional hazard regression modeling identified factors associated with the hazard of developing DR. Model predictors were age and calendar year at initial diabetes mellitus diagnosis, sex, race/ethnicity, net worth, and glycosylated hemoglobin (HbA1c). Results Among the 2240 youth with T1DM and 1768 youth with T2DM, 20.1% and 7.2% developed DR, over a median follow-up of 3.2 and 3.1 years, respectively. Survival curves demonstrated that youth with T1DM developed DR faster than youth with T2DM (P<0.0001). For every one-point increase in HbA1c, the hazard for DR increased by 20% (HR=1.20, CI 1.06–1.35) and 30% (HR=1.30, CI 1.08–1.56) among youth with T1DM and T2DM, respectively. Current guidelines suggest ophthalmic screening begin 3–5 years after initial DM diagnosis, at which point in our study, over 18% of youth with T1DM had already had received ≥1 DR diagnosis. Conclusions Youth with T1DM or T2DM exhibit a considerable risk for DR and should undergo regular screenings by eye-care professionals to ensure timely DR diagnosis and limit progression to vision-threatening disease.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Incidence and Risk Factors for Developing Diabetic Retinopathy among Youths with Type 1 or Type 2 Diabetes throughout the United States

et al. 2017

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“…Further analyses from TODAY show that in youth with type 2 diabetes dyslipidaemia 162 and hypertension 163 are common and worsen over time. Both microalbuminuria and retinopathy increase with diabetes duration and severity is related to glycaemic control 163,164 . These observations provide much needed insights and will certainly spawn additional work to allow us to better treat type 2 diabetes in youth.…”

Section: Treatment and Prevention: Goals And Outcomes Of Clinical Trialsmentioning

confidence: 99%

Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future

2014

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Normal regulation of glucose metabolism is determined by a feedback loop involving the islet β-cell and insulin-sensitive tissues in which tissue sensitivity to insulin determines the magnitude of the β-cell response. When insulin resistance is present, the β-cell maintains normal glucose tolerance by increasing insulin output. It is only when the β-cell is incapable of releasing sufficient insulin in the presence of insulin resistance that glucose levels rise. While β-cell dysfunction has a clear genetic component, environmental changes play a vital role. Modern approaches have also informed regarding the importance of hexoses, amino acids and fatty acids in determining insulin resistance and β-cell dysfunction as well as the potential role of alterations in the microbiome. A number of new treatment approaches have been developed, but more effective therapies that slow the progressive loss of β-cell function are needed. Recent clinical trials have provided important information regarding approaches to prevent and treat type 2 diabetes as well as some of the adverse effects of these interventions. However, additional long-term studies of medications and bariatric surgery are required in order to identify novel approaches to prevention and treatment, thereby reducing the deleterious impact of type 2 diabetes.

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Association of Type 1 Diabetes vs Type 2 Diabetes Diagnosed During Childhood and Adolescence With Complications During Teenage Years and Young Adulthood

Dabelea

Stafford

Mayer‐Davis

et al. 2017

JAMA

555

456

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Role of the Funder/Sponsor: Drs Linder (NIH), Imperatore, and Saydah (CDC) were participating members of the study steering committee and the writing group for this manuscript because of the cooperative funding agreements. They were involved in the design of the study but not the conduct of the study; they were not involved in the collection, management, and analysis of the data, but were involved in interpretation of the data; they were involved in the preparation, review, and approval of the manuscript and the decision to submit the manuscript for publication.

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Retinopathy in Youth With Type 2 Diabetes Participating in the TODAY Clinical Trial

Cited by 108 publications

References 12 publications

Incidence and Risk Factors for Developing Diabetic Retinopathy among Youths with Type 1 or Type 2 Diabetes throughout the United States

Incidence and Risk Factors for Developing Diabetic Retinopathy among Youths with Type 1 or Type 2 Diabetes throughout the United States

Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future

Association of Type 1 Diabetes vs Type 2 Diabetes Diagnosed During Childhood and Adolescence With Complications During Teenage Years and Young Adulthood

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