Risk of Diabetic Retinopathy Increases Over Time in Children with T2D

M. Constantine Samaan, MD, MSc

Courtesy of McMaster University

A recent systematic review and meta-analysis revealed the prevalence of diabetic retinopathy (DR) in children with type 2 diabetes (T2D) increased significantly more than 5 years after diagnosis.

Of approximately 6000 individuals across 27 observational studies, data showed 6.99% of patients with pediatric diabetes had DR. Current data indicate that approximately 1 in 14 children and adolescents with T2D will have DR within a few years after diagnosis of diabetes

“These results suggest that the increasing risk of DR in children with T2D warrants the implementation of global screening programs at diagnosis and annually to ensure early detection and treatment to preserve vision in this population,” wrote the investigative team.

Consequences of the obesity epidemic have increased rates of pediatric T2D numbers globally, and earlier T2D development has been linked to an increased lifetime risk of DR if left untreated. Current guidelines recommend screening for DR in youths at T2D diagnosis, but the global burden of DR is not yet quantified fully. The investigative team at McMaster University, led by M. Constantine Samaan, MD, MSc, suggests a better understanding of the scale of DR will support the development of clinical guidelines dedicated to pediatric T2D.

The systematic review and meta-analysis set out to assess the global prevalence of DR in pediatric patients with T2D, as well as the severity profile of DR and the current diagnostic assessment methods. Investigators searched Embase, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, the Web of Science, and the gray literature for relevant records from the date of database inception to April 2021. Updated searches were conducted by the investigative team in May 2022.

Search terms applied included diabetic retinopathy, diabetes mellitus, type 2, prevalence studies, and child, adolescent, teenage, youth, and pediatric. A total of 3 teams, each with 2 reviewers, independently screened for observational studies with 10 or more participants that reported the prevalence of DR. After screening nearly 2000 studies, Samaan and colleagues found 27 studies meeting the inclusion criteria for the pooled analysis.

Among these studies, involving 5924 unique patients, the global prevalence of DR in pediatric T2D was 6.99% (95% CI, 3.75% – 11.00%; I2 = 95%; P <.001; 615 patients). Data showed the DR prevalence was 1.14% in cross-sectional studies, 11.29% in retrospective cohort studies, and 6.52% in prospective cohort studies.

Investigators observed fundoscopy was less sensitive than 7-field stereoscopic fundus photography in detecting retinopathy ([0.47%; 95% confidence interval [CI], 0% - 3.30%; I2 = 0%] vs. [13.55%; 95% CI, 5.43% = 24.29%; I2 = 92%]). When analyzing mean T2D duration, the prevalence of DR at less than 2.5 years after diagnosis was 1.11% (95% CI, 0.04% - 3.06%; I2 = 5%).

Data showed the prevalence was 9.04% (95% CI, 2.24% - 19.55%; I2 = 88%) for T2D duration of 2.5 to 5.0 years and 28.14% (95% CI, 12.84% – 46.45%; I2 = 96%) at more than 5 years after T2D diagnosis. Age (P <.001), diabetes duration (P = .02), and hypertension prevalence (P = .03) were positively associated with DR prevalence, but no differences were noted based on sex, race, or obesity.

Based on the review’s findings suggesting a relationship between the prevalence of DR and diabetes duration, investigators stressed the immediate need for regular screening to be performed consistently. Samaan and colleagues noted the benefit of early identification of DR could include an increased focus on improving glycemic control to minimize microvascular disease, maintaining blood pressure, and streamlining the monitoring of progression.

“Mechanistic insights into the pathogenesis of DR in children with T2D remain limited, and this area warrants prioritized investigation,” investigators wrote. “Increasing the number of children with T2D who undergo regular DR screening is important to meet current clinical practice guideline standards.”