Ocular Pathology More Prevalent in Children With Type 2 Diabetes Than Type 1

Children with type 2 diabetes (T2D) have an elevated risk of developing diabetic retinopathy (DR), and requiring a pars plana vitrectomy (PPV) compared with those with type 1 diabetes (T1D), according to a study published in JAMA Ophthalmology. 

This retrospective analysis examined the records of patients younger than 22 years of age who were newly diagnosed with diabetes between 1970 and 2019. It included 525 participants, 461 with T1D (87.8%) and 64 with T2D (12.2%). The mean age at diabetes diagnosis was 12.1 (5.4) years (range, 73 days to 21.8 years); 261 participants were women (49.7%) and 264 were men (50.3%).

Prevalence of diabetic retinopathy was 32.6% at 15 years. Among patients with T1D, 32.6% developed either proliferative diabetic retinopathy (PDR) or nonproliferative diabetic retinopathy compared with 52.7% of participants with T2D. Kaplan-Meier rates in T1D vs T2D for developing any retinopathy were 31% vs 53%; PDR, 5% vs 8%; diabetic macular edema, 5% vs 4%; a visually significant cataract, 1% vs 9%; or requiring PPV by 15 years after diagnosis of diabetes mellitus, 2% vs 8%.

“Natural history of retinopathy development among youth diagnosed with T2D may differ from that in youth diagnosed with T1D, where patients with T2D may be more susceptible to developing retinopathy than those with T1D despite controlling for diabetes disease duration,” according to the researchers.

Study limitations include a retrospective design, irregularity in follow up, and the omission of children with milder forms of diabetes from the study. The sample size of children with T2D was also significantly smaller than the sample size of children with T1D. 

Reference

Bai P, Barkmeier AJ, Hodge DO, Mohney BG. Ocular sequelae in a population-based cohort of youth diagnosed with diabetes during a 50-year period. JAMA Ophthalmol. Published online December 2, 2021. doi:10.1001/jamaophthalmol.2021.5052