Alix School of Medicine, Mayo Clinic, Phoenix, Arizona.
Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
JAMA Ophthalmol. 2022 Jan 1;140(1):51-57. doi: 10.1001/jamaophthalmol.2021.5052.
Despite the increasing prevalence of type 2 diabetes (T2D) diagnosed in childhood, little is known about the natural history of ocular sequelae in youth-onset T2D compared with type 1 diabetes (T1D).
To assess the risk of developing diabetes-associated ocular complications among youth diagnosed with diabetes.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective, population-based medical record review included all residents of Olmsted County, Minnesota (95.7% White in 1990), diagnosed with diabetes at younger than 22 years (hereinafter referred to as children) from January 1, 1970, through December 31, 2019.
Risk of developing ocular complications over time.
Among 1362 individuals with a diagnostic code of diabetes, medical record reviews confirmed a diagnosis of T1D or T2D in 606 children, of whom 525 (86.6%) underwent at least 1 eye examination (mean [SD] age at diabetes diagnosis, 12.1 [5.4] years; 264 [50.3%] male). Diabetes-associated ocular complications occurred in 147 of the 461 children (31.2%) with T1D and in 17 of the 64 children (26.6%) with T2D. The hazard ratio illustrating the risk between T2D and T1D rates was 1.88 (95% CI, 1.13-3.12; P = .02) for developing any diabetic retinopathy (nonproliferative or greater), 2.33 (95% CI, 0.99-5.50; P = .048) for proliferative diabetic retinopathy, 1.49 (95% CI, 0.46-4.89; P = .50) for diabetic macular edema, 2.43 (95% CI, 0.54-11.07; P = .24) for a visually significant cataract, and 4.06 (95% CI, 1.34-12.33; P = .007) for requiring pars plana vitrectomy by 15 years after the diagnosis of diabetes.
Diabetic retinopathy, proliferative diabetic retinopathy, and the need for pars plana vitrectomy occurred within a shorter diabetes duration for children with T2D compared with T1D in this population-based cohort. Children with T2D had almost twice the risk of developing retinopathy compared with those with T1D. These findings suggest that to prevent serious ocular complications, children with T2D may require ophthalmoscopic evaluations at least as frequently as or more frequently than children with T1D.
尽管儿童期诊断的 2 型糖尿病（T2D）的患病率不断增加，但与 1 型糖尿病（T1D）相比，人们对青年发病的 T2D 患者眼部后遗症的自然史知之甚少。
评估在确诊糖尿病的青少年中发生糖尿病相关眼部并发症的风险。
设计、地点和参与者：本回顾性、基于人群的病历回顾研究纳入了明尼苏达州奥姆斯特德县（1990 年白人占 95.7%）的所有居民，他们在 22 岁之前（以下简称儿童）被诊断患有糖尿病，时间范围为 1970 年 1 月 1 日至 2019 年 12 月 31 日。
随时间推移发生眼部并发症的风险。
在 1362 名有糖尿病诊断代码的患者中，通过病历回顾确认了 606 名儿童患有 T1D 或 T2D，其中 525 名（86.6%）至少接受了 1 次眼部检查（糖尿病诊断时的平均[标准差]年龄为 12.1[5.4]岁；264 名[50.3%]为男性）。在 461 名患有 T1D 的儿童和 64 名患有 T2D 的儿童中，分别有 147 名（31.2%）和 17 名（26.6%）发生了糖尿病相关眼部并发症。T2D 和 T1D 之间发生任何糖尿病视网膜病变（非增殖性或更严重）的风险比为 1.88（95%CI，1.13-3.12；P=0.02），增殖性糖尿病视网膜病变为 2.33（95%CI，0.99-5.50；P=0.048），糖尿病性黄斑水肿为 1.49（95%CI，0.46-4.89；P=0.50），视力显著白内障为 2.43（95%CI，0.54-11.07；P=0.24），糖尿病性玻璃体积血需要玻璃体切除术的风险为 4.06（95%CI，1.34-12.33；P=0.007）。在糖尿病诊断后 15 年内。
与该人群中的 T1D 相比，T2D 患儿的糖尿病视网膜病变、增殖性糖尿病视网膜病变和需要玻璃体切除术的时间更短。与 T1D 患儿相比，T2D 患儿发生视网膜病变的风险几乎增加了 2 倍。这些发现表明，为了预防严重的眼部并发症，T2D 患儿可能需要至少与 T1D 患儿一样频繁或更频繁地进行眼底检查。
