Risk factors for having diabetic retinopathy at first screening in persons with type 1 diabetes diagnosed under 18 years of age

Abstract

Objective: To determine the risk factors for having diabetic retinopathy (DR) in children and young people (CYP) with type 1 diabetes (T1DM) at first screening.Methods: Records from the Diabetes Eye Screening Wales (DESW) service for people in Wales, UK, with T1DM diagnosed under age 18 years were combined with other electronic health record (EHR) data in the Secure Anonymised Information Linkage (SAIL) Databank. Data close to the screening date were collected, and risk factors derived from multivariate, multinomial logistic regression modelling.Results: Data from 4,172 persons, with median (Lower Quartile, Upper Quartile) age 16.3 (13.0, 22.3) years and duration of diabetes 6.6 (2.3, 12.3) years were analysed. 62.6% (n = 2,613) had no DR, 26.7% (n = 1,112) background DR and 10.7% (n = 447) had referable DR (RDR). No RDR was observed under 19 years of age. Factors associated with an increased risk of DR were diabetes duration, elevated HbA1c and diastolic blood pressure. People diagnosed with T1DM before age 12 years had an odds ratio of 1.23 for developing DR for each year they had diabetes, compared with an odds ratio of 1.34 for those diagnosed at age 12 years or older.Conclusions: This study found that 37.4% of the study cohort had DR at first screening, the risk being greater the longer the duration of diabetes or higher the HbA1c and diastolic blood pressure. In addition, people diagnosed at 12 years of age or over were more likely to have DR with each additional year with diabetes.

Epidemiology of type 1 diabetes mellitus in children in Kazakhstan: Data from unified national electronic health system 2014-2021

“…Prevalence of diabetic retinopathy (DR) was 11.4% in this cohort, which is lower than the estimates from the US [24], where 20.1% of youths with T1DM developed DR over 3.2 median years of observation; and the estimates from the UK, where 37.4% had DR at first screening [25]. Prevalence of diabetic nephropathy (DN) was 1.8%, which is considerably lower than the estimated 15-20% DN development rate among T1DM youths [26,27].…”

Diabetes-Related Microvascular Complications in Primary Health Care Settings in the West Bank, Palestine

“…This study revealed significant associations between age and participants' educational level and several problems related to diabetes. The study identified several socio-economic characteristics that were found to be associated with an increased risk of developing DR [58][59][60]. The present study revealed a significant correlation between age and the likelihood of developing retinopathy, with those aged 40 years and older exhibiting a risk that is more than twice as high as their younger counterparts.…”

Risks and Prevalence of Diabetic Retinopathy in Children and Young People with Type 1 Diabetes Mellitus

“…This was also seen in Wales where 10% of those with a duration of diabetes of 2 years had DR. However, other studies have shown no DR below a duration of diabetes of 5 years [26]. In the NPDA 4.7% of those with T1D for less than 1 year had abnormal screenings increasing to 14.7% at 5-9 years and 33.5% after 15 years or longer [27].…”

“…reported to range between 2.3% and 57.6% [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. In Wales between 2003 and 2018 in 4,172 people diagnosed with T1D up to the age of 18 years eligible for screening (in those with T1D from 12 years) with gradable retinal photographs, the prevalence of background DR was 26.7%, referable DR 10.7% and proliferative DR 4.1% [26].…”