Key points Ask What is the risk of ocular sequelae with diabetes diagnosed in childhood? Findings In this cohort study of 525 young people (age <22 years), the risk of diabetic retinopathy was 88% higher in those with type 2 diabetes (T2D) compared to those with type 1 diabetes (T1D) within the first 15 years of the disease. Similarly, the risk of developing proliferative diabetic retinopathy or requiring pars plana vitrectomy was higher in T2D than in T1D. Meaning These findings suggest that children with T2D are at higher risk of developing retinopathy than those with T1D, which may require earlier surveillance and intervention to prevent vision-threatening complications. |
Importance
Despite the increasing prevalence of type 2 diabetes (T2D) diagnosed in childhood, little is known about the natural history of ocular sequelae in youth-onset type 2 diabetes compared to type 1 diabetes (T1D).
Aim
To assess the risk of developing ocular complications associated with diabetes among young people diagnosed with diabetes.
Design, environment and participants
This population-based retrospective medical record review included all residents of Olmsted County, Minnesota (95.7% white in 1990), diagnosed with diabetes before age 22 years (hereafter referred to as children) since 1 January 1970, until December 31, 2019.
Main results and measures
Risk of developing eye complications over time.
Results
Among 1,362 individuals with a diabetes diagnosis code, medical record reviews confirmed a diagnosis of T1D or T2D in 606 children, of whom 525 (86.6%) had at least 1 vision exam (mean age [SD] at diabetes diagnosis, 12.1 [5.4] years; 264 [50.3%] men).
Diabetes-associated ocular complications occurred in 147 of 461 children (31.2%) with T1D and 17 of 64 children (26.6%) with T2D.
The hazard ratio illustrating the risk between T2D and T1D rates was 1.88 (95% CI, 1.13-3.12; P = 0.02) for developing any diabetic retinopathy (nonproliferative or major), 2.33 (95% CI, 0.99-5.50; P = 0.048) for proliferative diabetic retinopathy, 1.49 (95% CI, 0.46-4.89; P = 0.50 ) for diabetic macular edema, 2.43 (95% CI, 0.54-11.07; P = 0.24) for a visually significant cataract, and 4.06 (95% CI, 1.34-12.33 ; P = 0.007) to require pars plana vitrectomy 15 years after diabetes diagnosis.
Conclusions and relevance
Diabetic retinopathy, proliferative diabetic retinopathy, and need for pars plana vitrectomy occurred within a shorter duration of diabetes for children with T2D compared to T1D in this population-based cohort.
Children with T2D had almost twice the risk of developing retinopathy compared to those with T1D. These findings suggest that to prevent serious ocular complications, children with T2D may require ophthalmoscopic evaluations at least as frequently or more frequently than children with T1D.
