Last Decade Saw Marked Drop in Diabetes-Linked Retinopathy

Increase in multiple injections/infusions, decrease in HbA1c for teens with type 1 diabetes

FRIDAY, Oct. 28 (HealthDay News) -- The prevalence of retinopathy in adolescents with type 1 diabetes decreased significantly from 1990 to 2009, according to a study published in the November issue of Diabetes Care.

Elizabeth Downie, from the Children's Hospital at Westmead in Sydney, Australia, and colleagues investigated trends in the prevalence of microvascular complications from 1990 to 2009 in 1,604 adolescents (aged 12 to 20 years; with median duration of 8.6 years) with type 1 diabetes. Seven-field fundal photography, timed overnight urine collections for albumin excretion rate (AER), and albumin-to-creatinine ratio (ACR) were used to detect early retinopathy, and peripheral nerve function was measured using thermal and vibration threshold.

The investigators found that there was a significant decline in retinopathy over time, from 53 percent in 1990 to 1994 to 12 percent in 2005 to 2009. There were significant borderline elevations of AER/ACR and microalbuminuria. Use of multiple daily injections (MDI)/continuous subcutaneous insulin infusion (CSII) increased significantly, the median hemoglobin A1c (HbA1c) decreased significantly, and severe hypoglycemia remained unchanged over time. Retinopathy was significantly associated with age, HbA1c, one to two injections per day, diabetes duration, systolic blood pressure standard deviation scores (SDS), and socioeconomic disadvantage. Borderline AER/ACR was significantly associated with male gender, age, HbA1c, weight SDS, insulin dose per kilograms, one to two injections per day, and socioeconomic disadvantage. Microalbuminuria was significantly correlated with age, HbA1c, diastolic blood pressure SDS, and one to two injections per day.

"The decline in retinopathy supports contemporary guidelines that recommend lower glycemic targets and use of MDI/CSII in children and adolescents with type 1 diabetes," the authors write.

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