Abstract
Purpose :
To evaluate risk factors associated with diabetic retinopathy and neural retinal layer thickness in youth with type 1 diabetes (T1D).
Methods :
Retrospective cross-sectional chart review was conducted of youth (2-21.9 years old) medical records from the Joslin’s Beetham Eye Institute between 2005-2020. Demographic and clinical data were reviewed and collected using standardized forms. SDOCT macula scans were collected for a subset of patients and automated retinal layer segmentation was performed for determining inner and outer layers (IRL, ORL). Multivariate regression analysis was performed to investigate the relationship between demographics, body mass index (BMI), blood pressure (BP), HbA1c, retinal layer cell thickness and volume with presence of DR.
Results :
1359 youth participants (2704 eyes) were included in this study. 49.6% were female, 84.4% white with mean age 13.7±4.3 yrs, T1D duration of 7.0±5.2 yrs, T1D age of onset 7.7±4.7 yrs, HbA1c 8.4±1.3%, BMI 21.9±4.3, systolic BP 109.2±10.4, and diastolic BP 65.8±7.4. Of the eyes in this cohort, 2565 (94.9%) had no DR and 139 (5.14%) had DR [nonproliferative DR:5.1%, proliferative DR:0.04%]. Older age (p<0.001), longer duration of T1D (p<0.001), earlier T1D onset (p<0.04), higher HbA1c (p<0.001), and high systolic and diastolic BP (each p<0.001) were significantly associated with DR presence, and these relationships remained significant when adjusting for age, gender, HbA1c, T1D duration and age at diabetes onset. In 109 eyes (69 subjects) with SDOCT imaging, and no DR, higher HbA1c was significantly associated with thinner central subfield thickness (p = 0.001) and thinner IRL (p=0.004). Higher systolic BP was significantly associated with increased IRL volume (p=0.02). No significant relationship was found between total IRL or ORL thickness and BMI, diastolic BP, or T1D duration.
Conclusions :
In this cohort, DR was associated with older age, longer T1D duration, earlier T1D onset and some modifiable risk factors, supporting the fact that control of BP as well as HbA1c is important to prevent DR onset. Moreover, higher HbA1c was correlated with thinner IRL in eyes with no DR, possibly indicating that neurodegeneration is associated with worse glycemic and BP control. These findings highlight the importance of controlling modifiable risk factors to prevent DR and potentially reduce subclinical neural retinal loss in youth with T1D.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.