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Development and Progression of Diabetic Retinopathy in Adolescents and Young Adults With Type 2 Diabetes: Results From the TODAY Study

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posted on 16.09.2021, 16:58 by Rose Gubitosi-Klug, Ingrid Libman, Kimberly L. Drews, Diane Uschner, Barbara A. Blodi, Lori Laffel, Lynne L. Levitsky, Mihai Mititelu, Steven M. Willi, Neil H. White, Phil Zeitler

Objective: The Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) trial reported a 13.9% prevalence of diabetic retinopathy (DR) in youth with an average 4.9 ± 1.5 years of type 2 diabetes duration. After seven years of additional follow up, we report the risk factors for progression of DR in the TODAY cohort.

Research Design and Methods: Retinal photographs (n = 517) were obtained in 2010-2011 and again in 2017-18 (n = 420) with seven standard stereoscopic field digital fundus photography. Photographs were graded centrally using the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. Three hundred sixty-seven patients with gradable fundus photographs in at least one eye at both assessments were included in analyses of progression of diabetic retinopathy, defined as an increase of three or more steps on the ETDRS scale.

Results: With mean age of 25.4 ± 2.5 years and diabetes duration of 12.0 ± 1.5 years, participants had a 49% prevalence of any diabetic retinopathy. Prevalence by DR stage included: 39% very mild or mild non-proliferative diabetic retinopathy (NPDR); 6% moderate to severe NPDR; and 3.8% proliferative diabetic retinopathy. Compared with non-progressors, participants who progressed three or more steps had significantly lower BMI, higher HbA1c, higher blood pressure, increased triglycerides, decreased C-peptide, and higher prevalence of other comorbidities. Multivariate analysis demonstrated that HbA1c was the dominant factor impacting DR progression.

Conclusions: Poor glycemic control of youth-onset type 2 diabetes imparts a high risk for progression of DR, including advanced, sight-threatening disease by young adulthood.


This work was completed with funding from NIDDK and the NIH Office of the Director through grants U01-DK61212, U01-DK61230, U01-DK61239, U01-DK61242, and U01-DK61254. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The NIDDK project office was involved in all aspects of the study, including: design and conduct; collection, management, analysis, and interpretation of the data; review and approval of the manuscript; and decision to submit the manuscript for publication.