Thirty-Year Time Trends in Diabetic Retinopathy and Macular Edema in Youth With Type 1 Diabetes

Abstract

OBJECTIVE To examine trends in diabetic retinopathy (DR) and diabetic macular edema (DME) in adolescents with type 1 diabetes between 1990 and 2019. RESEARCH DESIGN AND METHODS We analyzed 5,487 complication assessments for 2,404 adolescents (52.7% female, aged 12–20 years, diabetes duration >5 years), stratified by three decades (1990–1999, 2000–2009, 2010–2019). DR and DME were graded according to the modified Airlie House classification from seven-field stereoscopic fundal photography. RESULTS Over three decades, the prevalence of DR was 40, 21, and 20% (P < 0.001) and DME 1.4, 0.5, and 0.9% (P = 0.13), respectively, for 1990–1999, 2000–2009, and 2010–2019. Continuous subcutaneous insulin infusion (CSII) use increased (0, 12, and 55%; P < 0.001); mean HbA1c was bimodal (8.7, 8.5, and 8.7%; P < 0.001), and the proportion of adolescents meeting target HbA1c <7% did not change significantly (8.3, 7.7, and 7.1%; P = 0.63). In multivariable generalized estimating equation analysis, DR was associated with 1–2 daily injections (odds ratio 1.88, 95% CI 1.42–2.48) and multiple injections in comparison with CSII (1.38, 1.09–1.74); older age (1.11, 1.07–1.15), higher HbA1c (1.19, 1.05–1.15), longer diabetes duration (1.15, 1.12–1.18), overweight/obesity (1.27, 1.08–1.49) and higher diastolic blood pressure SDS (1.11, 1.01–1.21). DME was associated with 1–2 daily injections (3.26, 1.72–6.19), longer diabetes duration (1.26, 1.12–1.41), higher diastolic blood pressure SDS (1.66, 1.22–2.27), higher HbA1c (1.28, 1.03–1.59), and elevated cholesterol (3.78, 1.84–7.76). CONCLUSIONS One in five adolescents with type 1 diabetes had DR in the last decade. These findings support contemporary guidelines for lower glycemic targets, increasing CSII use, and targeting modifiable risk factors including blood pressure, cholesterol, and overweight/obesity.