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M.A. Pisacano, G.L. Wang, S. Farah; Prevalence of Diabetic Retinopathy in Juvenile Type 2 Diabetes Mellitus . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4032.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: (1) to increase awareness of a rapidly growing population of juvenile onset type two diabetes mellitus (2) to provide preliminary data regarding the prevalence of diabetic retinopathy in this group (3) to determine whether retinopathy in this group of juvenile type 2 diabetics behaves according to their disease type, in which retinopathy is quite prevalent at the time diagnosis, or according to their age group, in which retinopathy is rare at the onset of the disease (4) to contribute other epidemiologic data regarding presentation, age of onset, family history, ethnicity, body mass index, HbA1c, lipid profiles, proteinuria. Methods: 50 patients less than 30 years of age diagnosed with type 2 diabetes mellitus and referred to ophthalmology by pediatric endocrinologists were examined using 90D slit lamp biomicroscopy and 20D indirect ophthalmoscopy. History and laboratory data were obtained and tabulated. Degree of retinopathy was graded according to ETDRS adaptation of the modified Airlie House classification of diabetic retinopathy. Results: Prevalence of any diabetic retinopathy was approximately 3.1 % in patients with diabetes for less than 2 years. Mean age at diagnosis was 13.5 years, 60% were male, mean BMI was 39kg/m2, and 90% had a family history of diabetes. 25% had abnormal lipid profiles and 36% had proteinuria. Mean HbA1c was 7.3 at diagnosis and 8.4 at the time of examination. The most common presenting symptoms were polydipsia and polyuria, however, 36%were asymptomatic at presentation. 100% of the patients were overweight and 73% were classified as obese. Conclusion: The epidemic of pediatric obesity and concomitant rising prevalence of juvenile onset type 2 diabetes have galvanized a search for better understanding of the disease, its autoimmune markers, therapeutic modalities, and prevention strategies. As this group grows in number it will become more and more important to formulate screening strategies both for the disease and for the secondary prevention of its complications. Although larger numbers and longer follow up are needed before conclusive recommendations can be made regarding screening protocols, preliminary data suggest that juvenile type 2 diabetics develop retinopathy at a rate similar to juvenile onset type 1 diabetics rather than adult onset type 2. This study highlights the need for a larger multicenter clinical trial to confirm these findings.
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