With both type 1 and type 2 diabetes on the rise in children, it’s important to understand the factors that can lead to the development of diabetic retinopathy.
Diabetic retinopathy is a principal cause of vision loss around the world. With both type 1 and type 2 diabetes on the rise among children and adolescents, an understanding of the factors linked to the development of diabetic retinopathy in pediatric patients is becoming increasingly important. An investigation looked at what factors may play a role in developing retinopathy.1
Investigators performed a cross-sectional study that included pooled data from 2 large academic pediatric centers. A brief point-of-care diabetic retinopathy screening was performed on participants, which included 2 color images per eye that was graded by 2 retina specialists for diabetic retinopathy presence and severity. Electronic health records were used to collect demographic and clinical data, such as type of diabetes, clinical measurements, and laboratory results.
There were 1640 participants in the study who had an average name of 15.7 years and 647 participants (39.5%) were non-Hispanic White; 506 (30.9%) were Hispanic; 384 (23.4%) were non-Hispanic Black; and 103 (6.3%) were of other races or ethnicities. A type 1 diabetes diagnosis was found for 1216 participants and a type 2 diabetes diagnosis occurred in 416 participants. An insulin pump was used by 558 patients with type 1 diabetes and 5 patients with type 2 diabetes. Following examination, diabetic retinopathy was discovered in 57 of the patients. When compared to patients who did not have diabetic retinopathy, those who had retinopathy had higher hemoglobin A1c (HbA1c) levels (mean, 10.3% [2.4%] vs 9.2% [2.1%]; P < .001) and a greater duration of diabetes (mean, 9.4 [4.4] years vs 6.6 [4.4] years; P < .001). Following adjustment for race and ethnicity, insurance status, diabetes duration, and HbA1c level, insulin pump was linked to a lower likelihood of diabetic retinopathy (odds ratio, 0.43; 95% CI, 0.20-0.93; P = .03).
The investigators found that insulin pump use in patients with type 1 diabetes was independently linked to a lower likelihood of diabetic retinopathy. They believe that this is likely because of decrease variability in glycemic levels as well as increased amount of time in range, which means the time that blood glucose levels are within the 70-180 mg/dL range.
1. Ferm M, DeSalvo D, Prichett L, Sickler J, Wolf R, Channa R. Clinical and demographic factors associated with diabetic retinopathy among young patients with diabetes. JAMA Netw Open. 2021;4(9):e2126126. doi:10.1001/jamanetworkopen.2021.26126