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December 2, 2021
Ocular Sequelae in a Population-Based Cohort of Youth Diagnosed With Diabetes During a 50-Year Period
Patricia Bai, BA1; Andrew J. Barkmeier, MD2; David O. Hodge, MS3; et al Brian G. Mohney, MD2
Author Affiliations
JAMA Ophthalmol. Published online December 2, 2021. doi:10.1001/jamaophthalmol.2021.5052
Key Points
Question What is the risk of ocular sequelae with diabetes diagnosed in childhood?

Findings In this cohort study of 525 youth (aged <22 years), the risk of diabetic retinopathy was 88% greater in those with type 2 diabetes (T2D) compared with those with type 1 diabetes (T1D) within the first 15 years of disease. Similarly, risk of developing proliferative diabetic retinopathy or requiring pars plana vitrectomy was greater in T2D than T1D.

Meaning These findings suggest that children with T2D have a higher risk of developing retinopathy than those with T1D, potentially requiring earlier surveillance and intervention to prevent vision-threatening complications.

Abstract
Importance Despite the increasing prevalence of type 2 diabetes (T2D) diagnosed in childhood, little is known about the natural history of ocular sequelae in youth-onset T2D compared with type 1 diabetes (T1D).

Objective To assess the risk of developing diabetes-associated ocular complications among youth diagnosed with diabetes.

Design, Setting, and Participants This retrospective, population-based medical record review included all residents of Olmsted County, Minnesota (95.7% White in 1990), diagnosed with diabetes at younger than 22 years (hereinafter referred to as children) from January 1, 1970, through December 31, 2019.

Main Outcomes and Measures Risk of developing ocular complications over time.

Results Among 1362 individuals with a diagnostic code of diabetes, medical record reviews confirmed a diagnosis of T1D or T2D in 606 children, of whom 525 (86.6%) underwent at least 1 eye examination (mean [SD] age at diabetes diagnosis, 12.1 [5.4] years; 264 [50.3%] male). Diabetes-associated ocular complications occurred in 147 of the 461 children (31.2%) with T1D and in 17 of the 64 children (26.6%) with T2D. The hazard ratio illustrating the risk between T2D and T1D rates was 1.88 (95% CI, 1.13-3.12; P = .02) for developing any diabetic retinopathy (nonproliferative or greater), 2.33 (95% CI, 0.99-5.50; P = .048) for proliferative diabetic retinopathy, 1.49 (95% CI, 0.46-4.89; P = .50) for diabetic macular edema, 2.43 (95% CI, 0.54-11.07; P = .24) for a visually significant cataract, and 4.06 (95% CI, 1.34-12.33; P = .007) for requiring pars plana vitrectomy by 15 years after the diagnosis of diabetes.

Conclusions and Relevance Diabetic retinopathy, proliferative diabetic retinopathy, and the need for pars plana vitrectomy occurred within a shorter diabetes duration for children with T2D compared with T1D in this population-based cohort. Children with T2D had almost twice the risk of developing retinopathy compared with those with T1D. These findings suggest that to prevent serious ocular complications, children with T2D may require ophthalmoscopic evaluations at least as frequently as or more frequently than children with T1D.