Diabetes Care. 2021 Sep 16;45(5):1049-55. doi: 10.2337/dc21-1072.
The Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study reported a 13.9% prevalence of diabetic retinopathy (DR) in youth with mean ± SD type 2 diabetes duration of 4.9 ± 1.5 years. After 7 years of additional follow-up, we report the risk factors for progression of DR in the TODAY cohort.
Retinal photographs ( = 517) were obtained in 2010-2011 and again in 2017-2018 ( = 420) with standard stereoscopic seven-field digital fundus photography. Photographs were graded centrally using the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. A total of 367 patients with gradable fundus photographs in at least one eye at both assessments were included in analyses of progression of DR, defined as an increase of three or more steps on the ETDRS scale.
With mean ± SD age of 25.4 ± 2.5 years and diabetes duration of 12.0 ± 1.5 years, there was a 49% prevalence of any DR among participants. Prevalence by DR stage was as follows: 39% for very mild or mild nonproliferative DR (NPDR), 6% moderate to severe NPDR, and 3.8% proliferative DR. Compared with nonprogressors, participants who progressed three or more steps had significantly lower BMI, higher HbA, higher blood pressure, increased triglycerides, decreased C-peptide, and higher prevalence of other comorbidities. Multivariate analysis demonstrated that HbA was the dominant factor impacting DR progression.
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.
青少年及青年2型糖尿病治疗选择（TODAY）研究报告称，平均±标准差2型糖尿病病程为4.9±1.5年的青年中糖尿病视网膜病变（DR）患病率为13.9%。经过7年的额外随访，我们报告了TODAY队列中DR进展的危险因素。
在2010 - 2011年以及2017 - 2018年再次获取视网膜照片（n = 517；n = 420），采用标准立体七视野数字眼底摄影。照片由中心使用早期糖尿病视网膜病变治疗研究（ETDRS）量表进行分级。在两次评估中至少一只眼睛有可分级眼底照片的367例患者被纳入DR进展分析，DR进展定义为ETDRS量表上增加三级或更多级。
参与者的平均±标准差年龄为25.4±2.5岁，糖尿病病程为12.0±l.5年，任何DR的患病率为49%。按DR分期的患病率如下：非常轻度或轻度非增殖性DR（NPDR）为39%，中度至重度NPDR为6%，增殖性DR为3.8%。与未进展者相比，进展三级或更多级的参与者BMI显著更低、HbA1c更高、血压更高、甘油三酯升高、C肽降低以及其他合并症患病率更高。多变量分析表明，HbA1c是影响DR进展的主要因素。
青年起病的2型糖尿病血糖控制不佳会使DR进展的风险升高，包括在青年期出现晚期、威胁视力的疾病。
