Early-onset Type 2 diabetes linked to premature retinopathy
MedWire News: People with early-onset Type 2 diabetes are at high risk for developing retinopathy prematurely, report UK researchers.
The increased risk is driven predominantly by the presence of hypertension and prolonged exposure to suboptimal glycemic control, they say.
As reported in the journal Diabetes Research and Clinical Practice, Soon Song and Trevor Gray, both from Northern General Hospital, Sheffield, UK, used the hospital diabetes register and eye screening database to identify 2516 Type 2 diabetes patients.
For each patient, the severity of retinopathy was classified into background or significant retinopathy (SigDR), which was defined as pre-proliferative, proliferative, or maculopathy.
Early- and later-onset Type 2 diabetes was defined as age of diagnosis below 40 years and 40 years and above, respectively, in accordance with the National Institute for Health and Clinical Excellence (NICE) recommendation in the UK.
The authors also categorized the subjects according to diabetes duration into three groups (<10, 10-20, and >20 years).
The authors found that in all, 455 patients had early-onset diabetes.
They report that the prevalence of overall retinopathy became significantly higher among the early-onset cohort than in the later-onset cohort after 10 years of diabetes duration.
In people with a diabetes duration of 10-20 years, the prevalence of overall retinopathy in the early compared with later-onset groups was 67.4% versus 54.7%, respectively; for diabetes duration of more than 20 years the corresponding rates were 84.3% versus 72.8%, respectively.
Furthermore, the rate of increase for SigDR was greater in the early-onset cohort, which experienced a similar burden of SigDR up to 20 years earlier than the later-onset cohort.
"Based on this observation, it is plausible that early-onset Type 2 diabetes subjects will most likely experience a higher burden of retinopathy than the later-onset cohort at similar chronological age," say the authors.
Logistic regression analysis revealed that diabetes duration, poor glycemic control (glycated hemoglobin >7.5%), and hypertension were significant predictors of overall retinopathy and SigDR in the early-onset cohort.
"Intensive glycemic and blood pressure control are crucial to reduce the future attrition of retinopathy," say the authors.
"Translating this concept into clinical practice is imperative, particularly in the community where the majority of early-onset Type 2 diabetes subjects are diagnosed and managed, thus, raising the awareness among primary care physicians will be vital," they add.
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By Sally Robertson