Global priority that needs increased attention  of diabetic retinopathy in children with Type 2 diabetes

Researchers at McMaster University, Hamilton, Ontario reported that a systematic review and meta-analysis of global prevalence of diabetic retinopathy (DR), in paediatric type 2 diabetes (T2D), records an increasing risk of DR in children which warrants the implementation of a global screening initiative.  The results of the review and meta-analysis, covering almost 6,000 patients, showed that the global prevalence of DR in paediatric T2D was 6.99% (95% CI, 3.75%-11.00%).  The researchers stated that the obesity epidemic “has been the primary factor in the increase in paediatric type 2 diabetes case numbers globally”. As T2D is a more “aggressive disorder in youths than it is in adults, with early comorbidities and complications including hypertension, nephropathy, polycystic ovary syndrome, and dyslipidemia”.  Without co-ordinated action on an international level, the epidemic may expect to increase and subsequently pressurise many national healthcare budgets.

Results from the Canadian study showed that 27 studies with the pooled analysis reported a global prevalence of DR in paediatric T2D for 6.99% (95% CI, 3.75%-11.00%; I2 = 95%; 615 patients). 5,924 unique patients were collated with an age range at T2D diagnosis from 6.5-21.0 years.  The analysis showed that fundoscopy was less sensitive than 7-field stereoscopic fundus photography in detecting retinopathy and the prevalence of DR increased over time and was 1.11% (95% CI, 0.04%-3.06%; I2 = 5%) at less than 2.5 years after T2D diagnosis, 9.04% (95% CI, 2.24%-19.55%; I2 = 88%), at 2.5 to 5.0 years after T2D diagnosis, and 28.14% (95% CI, 12.84%-46.45%; I2 = 96%) at more than 5 years after T2D diagnosis. The researchers also commented that given children are now developing T2D early in life, they can expect to live with their diabetes for several decades, which may increase their lifetime risk of developing DR and progress to blindness if undetected and untreated.

This systematic review in this study showed that the current data estimates “1 in 14 children and adolescents with T2D will have DR within a few years after their diabetes diagnosis”. In addition, while a number of patients in the analysis had either minimal or mild non-proliferative DR (NPDR), a significant minority had “more severe disease, such as proliferative DR or macular oedema, that can lead to visual impairment and potentially irreversible vision loss”.  In conclusion, the researched commented that, “in this study, DR prevalence in paediatric T2D increased significantly at more than 5 years after diagnosis. These findings suggest that retinal microvasculature is an early target of T2D in children and adolescents, and annual screening with fundus photography beginning at diagnosis offers the best assessment method for early detection of DR in paediatric patients”.