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02-07-2019 | Diabetes | News | Article

Young diabetes patients may undergo needless retinopathy examinations

medwireNews: A retrospective analysis of clinical trial data indicates that regular eye examinations may not always be necessary for people younger than 18 years of age with type 1 diabetes, despite current recommendations to the contrary.

The current ADA Standards of Care suggest an initial screening eye examination “once youth have had type 1 diabetes for 3–5 years, provided they are age ≥10 years or puberty has started, whichever is earlier.” Thereafter, examinations are recommended to take place annually or every 2 years if deemed acceptable by an eye care specialist.

However, Rose Gubitosi-Klug (Case Western Reserve University School of Medicine, Cleveland, Ohio, USA) and colleagues believe that, after the initial examination, no further screening is necessary until age 18 years “if no DR [diabetic retinopathy] or mild DR is found on initial screening.”

“If moderate NPDR [non-proliferative diabetic retinopathy] or more severe retinopathy stage is found on the initial screen,” the researchers suggest that rescreens begin before age 18 years and occur at increased frequency.

The investigators reviewed data from 195 participants of the Diabetes Control and Complications Trial (DCCT) who were age 13–17 years of age at study entry. The participants had a median age of 15 years, median diabetes duration of 3.9 years, and a median baseline glycated hemoglobin (HbA1c) of 9.3%.

During a mean 2.3 years of follow-up, the participants underwent an average of 5.3 diabetic retinopathy assessments while still under 18 years of age.

As reported in Pediatric Diabetes, the eye examinations revealed 116 transitions to a more severe degree of DR, typically (91%) from no DR to mild NPDR.

None of the participants developed severe non‐proliferative DR or proliferative (P)DR and just one person reached clinically significant macular edema (CSME) before age 18 years.

This female participant, who was assigned to intensive therapy in the DCCT, had a baseline HbA1c of 10.3%, as well as microalbuminuria and mild NPDR at baseline. Her CSME was detected at the first 6-monthly visit and ultimately resolved without treatment.

When the researchers used older age cutoffs, they found that the incidence of more advanced DR increased with age, with three PDR and seven CSME cases detected in participants before they reached age 21 years. However, in each of these cases, baseline HbA1c was above 9%, diabetes duration was more than 4 years, and all had mild or moderate NPDR on their initial eye examination, the team notes.

Gubitosi-Klug and co-authors conclude that their findings “are reassuring that retinal lesions requiring treatment rarely develop prior to age 18 years in youth with type 1 diabetes, and, for the majority of youth with an initial screen of no DR or mild NPDR, a single screening with fundus photography may be enough before 18 years of age.”

By Laura Cowen

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

Pediatr Diabetes 2019; doi:10.1111/pedi.12877