Nearly 7% of children and adolescents with type 2 diabetes have diabetic retinopathy. The prevalence increased significantly as the duration of diabetes increased to 5 years or more. These findings from a recent meta-analysis were published in the journal JAMA Network Open.^1,2

Cioana et al coauthors conducted a systematic review and meta-analysis to determine the global prevalence of diabetic retinopathy in pediatric type 2 diabetes. Twenty-seven observational studies that reported the prevalence of diabetic retinopathy involving 5924 patients were included in the meta-analysis following a comprehensive literature search. The participants had been diagnosed with type 2 diabetes between 6.5 and 21 years of age.

Pooled analysis revealed that the overall global prevalence of diabetic retinopathy, the primary study outcome, in pediatric type 2 diabetes was 6.99%. The sensitivity of fundoscopy in detecting retinopathy was less when compared to seven-field stereoscopic fundus photography; 0.47% vs 13.55%, respectively. As the duration of diabetes increased, the prevalence of retinopathy also increased from 1.11% at <2.5 years to 9.04% at 2.5-5 years and then rose to 28.14% when duration of type 2 diabetes following diagnosis was more than 5 years. The prevalence was also seen to rise with age. Surprisingly, sex, race or obesity were not associated with the risk of developing retinopathy. The mean HbA1c was 1.4% among patients who developed diabetic retinopathy vs those who did not have retinopathy.

Out of the 27 studies, 9 reported on the prevalence of type of diabetic retinopathy: 11.2% had minimal-to-moderate nonproliferative diabetic retinopathy, 2.6% had severe nonproliferative diabetic retinopathy, 2.4% had proliferative diabetic retinopathy and 3.1% had macular edema.  

This study shows the higher prevalence of diabetic retinopathy among children and adolescents with type 2 diabetes. More significantly, retinopathy developed within 5 years of diagnosis. While most patients had minimal or mild nonproliferative diabetic retinopathy, a small percentage of patients did have nonproliferative diabetic retinopathy and macular edema leading to irreparable loss of vision. The study also highlights fundus photography as a more sensitive tool (vs fundoscopy) to diagnose diabetic retinopathy.

Besides maintaining optimal glycemic and BP control, children and adolescents with type 2 diabetes must undergo screening for diabetic retinopathy at time of diagnosis of diabetes and then yearly as  recommended by guidelines using fundus photography. Early detection may preserve vision and quality of life by preventing or delaying the development of diabetic retinopathy and/or its progression.

References

1. Cioana M, et al. Global Prevalence of diabetic retinopathy in pediatric type 2 diabetes: a systematic review and meta-analysis. JAMA Netw Open. 2023 Mar 1;6(3):e231887. doi: 10.1001/jamanetworkopen.2023.1887
2. Retinopathy emerging decades earlier in kids with type 2 diabetes than in adults - Medscape - Mar 23, 2023.