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Pediatric Diabetic Retinopathy: Updates in Prevalence, Risk Factors, Screening, and Management

  • Microvascular Complications—Retinopathy (R Channa, Section Editor)
  • Published:
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Abstract

Purpose of Review

Diabetic retinopathy (DR) is a microvascular complication of diabetes mellitus and a major cause of vision loss worldwide. The purpose of this review is to provide an update on the prevalence of diabetic retinopathy in youth, discuss risk factors, and review recent advances in diabetic retinopathy screening.

Recent Findings

While DR has long been considered a microvascular complication, recent data suggests that retinal neurodegeneration may precede the vascular changes associated with DR. The prevalence of DR has decreased in type 1 diabetes (T1D) patients following the results of the Diabetes Control and Complications Trial and implementation of intensive insulin therapy, with prevalence ranging from 14–20% before the year 2000 to 3.7–6% after 2000. In contrast, the prevalence of diabetic retinopathy in pediatric type 2 diabetes (T2D) is higher, ranging from 9.1–50%. Risk factors for diabetic retinopathy are well established and include glycemic control, diabetes duration, hypertension, and hyperlipidemia, whereas diabetes technology use including insulin pumps and continuous glucose monitors has been shown to have protective effects. Screening for DR is recommended for youth with T1D once they are aged ≥ 11 years or puberty has started and diabetes duration of 3–5 years. Pediatric T2D patients are advised to undergo screening at or soon after diagnosis, and annually thereafter, due to the insidious nature of T2D. Recent advances in DR screening methods including point of care and artificial intelligence technology have increased access to DR screening, while being cost-saving to patients and cost-effective to healthcare systems.

Summary

While the prevalence of diabetic retinopathy in youth with T1D has been declining over the last few decades, there has been a significant increase in the prevalence of DR in youth with T2D. Improving access to diabetic retinopathy screening using novel screening methods may help improve detection and early treatment of diabetic retinopathy.

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Data Availability

All data is available in the literature.

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Funding

This work was supported by a Johns Hopkins Children’s Center Innovation Award to RW and RC, and supported in part by an Unrestricted Grant to the Department of Ophthalmology and Visual Sciences, University of Wisconsin, from Research to Prevent Blindness, Inc.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Pediatric Endocrinology, Johns Hopkins School of Medicine, Baltimore, MD, 21287, USA

    Tyger Lin & Risa M. Wolf

  2. Department of Pediatrics, Division of Endocrinology, Case Western Reserve University School of Medicine and Rainbow Babies and Children’s Hospital, Cleveland, OH, USA

    Rose A. Gubitosi-Klug

  3. Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI, USA

    Roomasa Channa

Authors
  1. Tyger Lin
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  2. Rose A. Gubitosi-Klug
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  3. Roomasa Channa
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  4. Risa M. Wolf
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TL, RMW, RAG, and RC wrote the manuscript, and all authors critically reviewed the final draft.

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Correspondence to Risa M. Wolf.

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Lin, T., Gubitosi-Klug, R.A., Channa, R. et al. Pediatric Diabetic Retinopathy: Updates in Prevalence, Risk Factors, Screening, and Management. Curr Diab Rep 21, 56 (2021). https://doi.org/10.1007/s11892-021-01436-x

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