Diabetic retinopathy in pediatric patients with type-1 diabetes: Effect of diabetes duration, prepubertal and pubertal onset of diabetes, and metabolic control☆,☆☆,★,★★
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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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.
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Reprint requests: P. D. Reinhard W. Holl, MD, University Children's Hospital, Prittwitzstr. 43, D-89070 Ulm / Germany.
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9/21/87971