Oza Chirantap, Khadilkar Anuradha, Bhor Shital, Curran Katie, Sambare Chitra, Ladkat Dipali, Bettiol Alessandra, Quinn Michael, Sproule Alan, Willoughby Colin, Peto Tunde
Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India.
Centre for Public Health, Queen's University Belfast, Northern Ireland.
Clin Med Insights Endocrinol Diabetes. 2024 Sep 2;17:11795514241275921. doi: 10.1177/11795514241275921. eCollection 2024.
There are very few reports on the prevalence of diabetic retinopathy (DR) in children and youth with type-1 diabetes (T1D). Studies have also found very low rates of referral for DR screening in children and youth with T1D. We conducted this study to determine the prevalence of DR, to study the reliability of ISPAD screening recommendations and to identify predictors of DR, its progression and regression in Indian children and youth with T1D.
This study included 882 children and youth with T1D. Demographic data, anthropometry, blood pressure, sexual maturity rating, ophthalmological examination (slit lamp for cataract) and biochemical measurements were performed using standard protocols. Fundus images were captured using the Forus Health 3netra classic digital non-mydriatic fundus camera by the same experienced operator. De-identified images were assessed by a senior grader and ophthalmologist (Belfast Ophthalmic Reading Center). Severity of DR was graded as per the UK National Health Service (NHS) DR classification scale.
We report 6.4% and 0.2% prevalence of DR and cataract in Indian children and youth with T1D, respectively. All the subjects with DR had early non-proliferative DR. We report that amongst subjects with DR, only 2 subjects were aged less than 11 years and had duration of illness less than 2 years. Presence of hypertension and older age were significant predictors of DR ( < .05). Subjects with DR had significantly higher triglyceride concentrations ( < .05), of these, 6.9% had progression and 2.9% had regression at 1 year follow up; the change in glycaemic control was a significant positive predictor of progression of DR ( < .05). None of the participants included in the study progressed to develop sight-threatening DR.
DR is not uncommon in Indian children and youth with T1D, thus screening for DR needs to be initiated early, particularly in older individuals with higher disease duration. Controlling blood pressure and triglyceride concentrations may prevent occurrence of DR. Improving glycaemic control may prevent progression of DR in Indian children and youth with T1D.
关于1型糖尿病（T1D）儿童和青少年糖尿病视网膜病变（DR）患病率的报道极少。研究还发现，T1D儿童和青少年中接受DR筛查转诊的比例极低。我们开展这项研究，以确定印度T1D儿童和青少年中DR的患病率，研究国际儿童青少年糖尿病学会（ISPAD）筛查建议的可靠性，并确定DR及其进展和消退的预测因素。
本研究纳入了882例T1D儿童和青少年。使用标准方案收集人口统计学数据、人体测量学数据、血压、性成熟等级、眼科检查（裂隙灯检查白内障）和生化指标。由同一位经验丰富的操作人员使用Forus Health 3netra经典数字免散瞳眼底相机拍摄眼底图像。经过去识别处理的图像由一名资深分级人员和眼科医生（贝尔法斯特眼科阅读中心）进行评估。DR的严重程度根据英国国家医疗服务体系（NHS）DR分类标准进行分级。
我们报告，印度T1D儿童和青少年中DR和白内障的患病率分别为6.4%和0.2%。所有DR患者均为早期非增殖性DR。我们报告，在DR患者中，只有2例年龄小于11岁且病程小于2年。高血压和年龄较大是DR的显著预测因素（P<0.05）。DR患者的甘油三酯浓度显著更高（P<0.05），其中，6.9%在1年随访时有进展，2.9%有消退；血糖控制的变化是DR进展的显著正向预测因素（P<0.05）。本研究中的参与者均未进展为威胁视力的DR。
DR在印度T1D儿童和青少年中并不罕见，因此需要尽早开始DR筛查，尤其是在病程较长的年长个体中。控制血压和甘油三酯浓度可能预防DR的发生。改善血糖控制可能预防印度T1D儿童和青少年DR的进展。
