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Thirty-Year Time Trends in Diabetic Retinopathy and Macular Edema in Youth With Type 1 Diabetes

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posted on 20.05.2022, 15:33 authored by Digby W. Allen, Gerald Liew, Yoon Hi Cho, Alison Pryke, Janine Cusumano, Stephen Hing, Albert K Chan, Maria E. Craig, Kim C. Donaghue
Objective: To examine trends in diabetic retinopathy (DR) and macular edema (DME) in adolescents with type 1 diabetes between 1990–2019.

Research Design and Methods: We analyzed 5,487 complication assessments in 2,404 adolescents (52.7% female, aged 12–20 years, diabetes duration >5 years), stratified by three decades (1990–1999, 2000–2009, 2010–2019). DR and DME were graded according to the modified Airlie House classification from seven-field stereoscopic fundal photography.

Results: Over three decades, the prevalence of DR was 40, 21, 20% respectively (p<0.001) and DME 1.4, 0.5, 0.9% (p=0.13). Continuous subcutaneous insulin infusion (CSII) use increased (0, 12, 55%; p<0.001); mean HbA1c was bimodal (8.7, 8.5, 8.7%; p<0.001) and the proportion of adolescents meeting target HbA1c <7% did not change significantly (8.3, 7.7, 7.1%; p=0.63). In multivariable generalized estimating equation analysis, DR was associated with 1-2 daily injections (OR 1.88, 95% CI 1.42-2.48) and multiple injections compared to CSII (1.38, 1.10-1.74); older age (1.11, 1.07-1.15), higher HbA1c (1.19, 1.05-1.15), longer duration (1.15, 1.12-1.18), overweight/obesity (1.27, 1.08-1.49) and higher diastolic blood pressure SDS (1.11, 1.01-1.21). DME was associated with 1-2 daily injections (3.26, 1.72-6.19), longer duration (1.26, 1.12-1.41), higher diastolic blood pressure SDS (1.66, 1.22-2.27), HbA1c (1.28, 1.03-1.59) and elevated cholesterol (3.78, 1.84-7.76).

Conclusions: One in five adolescents with type 1 diabetes had DR in the last decade. These findings support contemporary guidelines for lower glycemic targets, increasing CSII use and targeting modifiable risk factors including blood pressure, cholesterol and overweight/obesity.


MEC is supported by an NHMRC Practitioner Fellowship (APP1136735). No potential conflicts of interest relevant to this article were reported. All other authors declare no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.