Modifiable risk factors for diabetic retinopathy (DR) and macular edema (DME) in children with type 1 diabetes (T1D)

Abstract

Purpose : Although risk factors for DR and DME are well-established in adults with diabetes, they are not as clearly defined in pediatric populations. This study aimed to identify factors associated with DR and DME in a pediatric population with T1D.

Methods : Retrospective chart review was conducted of pediatric (≤21 years old) medical records from the Joslin’s Beetham Eye Institute from 2005-2020. Data collected included demographic characteristics and DR and DME severity. Body mass index (BMI) and blood pressure (BP) were categorized according to CDC sex and age-adjusted growth curves (BMI: under/normal weight (<85^th %ile), overweight/obese (≥85^th %ile); BP: normal (<90th %ile), elevated/high (≥90^th %ile). Analyses were adjusted for correlation between eyes of the same person.

Results : In total, 1735 youth (3454 eyes) were included with mean±SD age 15.4±4.6 yrs, T1D duration 7.1±5.3 yrs, T1D onset 8.3±5.4 yrs, and A1c 8.4±1.3%; 50.7% were female, 30.7% were overweight/obese, and 4.1% had elevated/high BP. DR was present in 8.5% and DME in 1.3% of the eyes. Unadjusted analyses found DR presence was associated with higher A1c (p<.0001), longer T1D duration (p<.0001), younger age of T1D onset (p=0.0002), older attained age (p<.0001), female sex (p=0.001), and elevated/high BP (p<.0001). After backwards elimination modeling, older age (p<.0001), longer T1D duration (p=0.002), and higher A1c (p=0.01) remained significantly associated with DR. In unadjusted analyses, DME was associated with higher A1c (p=0.0003), longer T1D duration (p<.0001), younger age of T1D onset (p=0.02), older age (p<.0001), female sex (p=0.03), elevated/high BP (p=0.002), and obese/overweight BMI (p = 0.03). When adjusting for A1c, T1D duration, age of T1D onset, age, and DR presence, obese/overweight BMI (p=0.04) and elevated/high BP (p=0.04) remained associated with DME.

Conclusions : In this pediatric group with T1D, DR with or without DME was present in 8.5% of eyes. In addition to non-modifiable factors, DR and DME were associated with modifiable systemic risk factors (A1c, BMI, BP). Efforts to optimize these factors in youth from an early age may help reduce adverse ocular outcomes. Future longitudinal studies can assess if early intervention to improve glycemic control, weight, and BP can reduce occurrence of DR and DME in youth with T1D.

This is a 2021 ARVO Annual Meeting abstract.