Elsevier

Ophthalmology

Volume 124, Issue 4, April 2017, Pages 424-430
Ophthalmology

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

Presented at the Association for Research in Vision and Ophthalmology Annual Meeting, May 4, 2015, Denver, CO.
https://doi.org/10.1016/j.ophtha.2016.10.031Get rights and content

Purpose

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 youths with diabetes mellitus, to compare DR rates for youths with type 1 diabetes mellitus (T1DM) and those with 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 youths with DR.

Design

Retrospective observational longitudinal cohort study.

Participants

Youths aged ≤21 years with newly diagnosed T1DM or T2DM who were enrolled in a large US managed-care network.

Methods

In this study of youths aged ≤21 years with newly diagnosed T1DM or T2DM who were under ophthalmic surveillance, we identified the incidence and timing of DR onset. Kaplan–Meier survival curves assessed the timing of initial diagnosis of DR for participants. 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 glycated hemoglobin A1c fraction (HbA1c).

Main Outcome Measures

Hazard ratios (HRs) with 95% confidence intervals (CIs) for developing DR.

Results

Among the 2240 youths with T1DM and 1768 youths with T2DM, 20.1% and 7.2% developed DR over a median follow-up time of 3.2 and 3.1 years, respectively. Survival curves demonstrated that youths with T1DM developed DR faster than youths with T2DM (P < 0.0001). For every 1-point increase in HbA1c, the hazard for DR increased by 20% (HR = 1.20; 95% CI 1.06–1.35) and 30% (HR = 1.30; 95% CI 1.08–1.56) among youths with T1DM and T2DM, respectively. Current guidelines suggest that ophthalmic screening begin 3 to 5 years after initial diabetes mellitus diagnosis, at which point in our study, >18% of youths with T1DM had already received ≥1 DR diagnosis.

Conclusions

Youths 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.

Section snippets

Data Source

The Clinformatics Data Mart database (OptumInsight, Eden Prairie, MN), a data set that has been used previously to study ocular diseases,17, 18, 19 contains detailed records of beneficiaries in a large, nationwide managed-care network in the United States. We accessed data on all beneficiaries 21 years of age or younger at their initial enrollment during January 1, 2001, through December 31, 2014. Medical claims from inpatient and outpatient health care encounters and associated International

Patient Characteristics

Among the 2240 eligible youths with newly diagnosed T1DM and 1768 with newly diagnosed T2DM, the median age at DM onset in those with T1DM and T2DM were 12 and 18 years, respectively, and the median follow-up times after initial DM diagnosis were 3.2 and 3.1 years, respectively. The maximum follow-up time was 13.0 and 12.7 years for youths with T1DM and T2DM, respectively, resulting in a maximum age of 34 years at the end of follow-up. The majority of participants with T2DM were female (83.0%).

Discussion

In this study of youths in a large US managed-care network, >20% of youths with T1DM and 7% with T2DM, with a median of >3 years of follow-up, received a diagnosis of DR. Youth with T1DM had nearly a 3-fold-increased incidence and prevalence of DR compared with youths with T2DM. For each year older a child was at initial DM diagnosis, the risk for developing DR increased among those with T1DM. Higher household net worth and female sex seemed to be protective against DR among those with T2DM.

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    See Editorial on page 422.

    Financial Disclosure(s): The author(s) have made the following disclosure(s): J.D.S., T.W.G.: Research to Prevent Blindness Physician Scientist Award; J.D.S.: W.K. Kellogg Foundation; T.W.G: Juvenile Diabetes Research Foundation, R01EY20582 and DP3DK094292, the Taubman Institute; W.H.H.: P30DK020572 Michigan Diabetes Research Center; Consultant – Kalvista, Novartis, Novo Nordisk, and the Janssen Research Foundation. No conflicting relationship exists for any other author.

    The funding organizations had no role in the design or conduct of this research.

    Author Contributions:

    Conception and design: Wang, Andrews, Herman, Gardner, Stein

    Analysis and interpretation: Wang, Andrews, Herman, Gardner, Stein

    Data collection: Wang, Stein

    Obtained funding: Stein

    Overall responsibility: Wang, Andrews, Herman, Gardner, Stein

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