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T.D. Fitzsimmons, C.A. Rosende; Retinopathy in Children With Diabetes Type 2 Compared to Diabetes Type 1 . Invest. Ophthalmol. Vis. Sci. 2006;47(13):332.
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The incidence of diabetes mellitus type 2 (DM2) has reached epidemic proportions in the pediatric age group (particularly among Hispanics), and in some geographic areas surpasses the incidence of diabetes type 1 (DM1). The retinal consequences of this epidemic are largely unknown. In a prospective cohort study, we compared the degree of retinopathy observed in pediatric DM2 patients to those with DM1.
Patients aged 5 to 17 years were recruited from pediatric endocrinology clinics after having met standard diagnostic criteria for DM2 or DM1. Clinical data were recorded, including body mass index (BMI), HgA1c level, Tanner stage, and duration of disease (Dx). Patients received full ophthalmologic examinations with seven–field 35mm stereoscopic retinal photography. Two readers collaboratively graded the photographs for presence and severity of retinopathy according to ETDRS standards.
A total of 210 children were recruited, 93 with DM2 and 117 with DM1. Results are tabulated below:
The frequency of retinopathy in children with DM2 (14%) was nearly the same as that observed in children with DM1 (13%). In both groups, the severity of disease was low with no retinopathy observed other than microaneurysms and/or hemorrhages. Using logistic regression, factors such as Tanner score, duration of disease, and HbA1c modeled well in predicting retinopathy for the DM1 group, but the same model fit poorly for the DM2 group, thus implying that the occurrence of retinopathy in DM2 patients is not easily explained by these factors. The immediate threat to vision appears low in pediatric DM2 patients, but the early appearance of retinopathy in a sizeable minority highlights the need for timely detection and longitudinal follow–up.
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