Diabetic retinopathy in pediatric patients with type-1 diabetes: Effect of diabetes duration, prepubertal and pubertal onset of diabetes, and metabolic control,☆☆,,★★

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Abstract

Objective: The objective of this study was to determine the contribution of prepubertal and pubertal onset and duration of diabetes to the development of diabetic retinopathy. Study design: A total of 1391 standardized fundus examinations (stereo fundus-photography) were performed in 441 children or adolescents with type-1 diabetes (median age 15.5 years, median duration of diabetes 6.3 years). Results: Mild nonproliferative retinopathy was present in 72 patients (median age 19.9 years). Life table analysis revealed a median duration of diabetes until retinopathy was first diagnosed at 16.6 years (95% confidence interval: 15.3 to 18.3). Patients were stratified according to diabetes onset before or in puberty (≥10.4 years in girls, ≥12.2 years in boys). In children with a prepubertal onset of diabetes, retinopathy occurred after a pubertal duration of 10.9 years compared with 15.1 years in children with onset of diabetes in puberty (p < 0.01), demonstrating the additional risk conveyed by the prepubertal years of diabetes. Long-term metabolic control had a significant influence on the prevalence of retinopathy: patients with a median HbA1c ≥7.5% had development of retinopathy on average after 15.5 years compared with 18.3 years in patients with lower HbA1c values (p < 0.05). Conclusion: Both prepubertal and pubertal duration of diabetes are relevant for the development of background retinopathy. Good metabolic control should be attempted irrespective of age. (J Pediatr 1998;132:790-4)

Section snippets

PATIENTS AND METHODS

A total of 505 patients were seen for diabetes mellitus at our center between 1991 and 1996. Twenty-three patients with non-type-1 diabetes (MODY, secondary diabetes in thalassemia, or cystic fibrosis) were excluded from the analysis. Eye examination was not performed in 41 patients, of whom 33 were younger than 5 years of age. Therefore 441 patients (91.5% of total) were included in the study (210 male patients, 231 female patients). At the time of the most recent eye examination, the median

RESULTS

A total of 1391 standardized fundus examinations in 441 pediatric patients were available for analysis. A diagnosis of mild nonproliferative retinopathy was made in 72 patients (39 male patients, 33 female patients). The shortest diabetes duration until retinopathy (one microaneurysm) was 2.2 years, and the youngest child with retinopathy had a chronologic age of 5.5 years. More advanced forms of retinopathy (clinically nonsignificant maculopathy, moderate nonproliferative diabetic retinopathy,

DISCUSSION

In the large group of patients treated at one center, the median diabetes duration until the first occurrence of diabetic retinopathy was 16.6 years. This result is significantly better compared with reports in the literature, applying a similar method for the detection of mild retinopathy. Studies in pediatric patients reported diabetic retinopathy after an average of 7.5 or 9.1 years.23, 24 In adult patients with type-1 diabetes, with the same method for fundus examination as applied in this

Acknowledgements

We are grateful to Mrs. H. Nebenführ and Mrs. U. Weinstein for excellent patient care and help with data entry into the computer system. The authors are grateful to Prof. E. Kohne and the technicians in the hemoglobin laboratory of the University Children's Hospital for speedy measurements of HbA1c.

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  • Cited by (0)

    From the Department of Pediatrics and the Department of Ophthalmology, University of Ulm, Germany.

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    Financial support for Dr. Holl was available from the German Ministry of Health, the regional government of Baden-Württemberg, the German Diabetes Association, and the Dr. Heinz Bürger-Büsing-Fund from the Association of Diabetic Children and Adolescents, Kaiserslautern.

    Reprint requests: P. D. Reinhard W. Holl, MD, University Children's Hospital, Prittwitzstr. 43, D-89070 Ulm / Germany.

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