Diabetic Retinopathy Screening in Youth May Not Be Needed

Miriam E Tucker

October 18, 2016

Screening for diabetic retinopathy in youth with type 1 diabetes may be a waste of resources, new findings suggest.

Results from the Type 1 Diabetes Exchange Clinic Registry were published online October 7 as a research letter in Diabetes Care by pediatric endocrinologist Giovanna Beauchamp, MD, of the University of Florida, Gainesville, and colleagues.

Current American Diabetes Association guidelines suggest annual eye exams in children with type 1 diabetes at the start of puberty or beginning at age 10 after having had diabetes for 3 to 5 years.

The authors surveyed 12,535 patients in the nationwide T1D Exchange Registry, all of whom were under 21 years of age and not pregnant, with a mean age of 12 years, diabetes duration of 5 years, and HbA1c 8.6%.

In questionnaires, the youths or their parents were asked, "Have you ever received treatment for diabetic retinopathy (change in the retina of the eye due to diabetes), such as with laser, injections into or around the eye, or vitrectomy surgery?"

Just 0.36% (45) respondents reported having received retinopathy treatment. But interestingly, when ophthalmologist reports or medical records were checked, none had actually ever received treatment for diabetic retinopathy.

"Thus, treated [diabetic retinopathy] is extremely rare in children enrolled in the T1D Exchange Clinic Registry," the authors say, noting that the findings indicate that screening all youth with type 1 diabetes solely on the basis of age and diabetes duration may not be justified.

"Future studies may indicate that [diabetic retinopathy] screening guidelines can be improved via inclusion of other risk factors such history of glycemic control, presence of microalbuminuria, hypertension, and dyslipidemia," Dr Beauchamp and colleagues say.

In the meantime, studies using retinal photographs would be necessary to provide data confirming the frequency of treatable eye disease and the potential impact of liberalizing the guidelines, they add.

Given the low yield combined with the high cost of eye exams, current guidelines may also not be cost-effective for this low-risk group, the authors say.

Indeed, liberalization of retinopathy screening guidelines could allow for the resources currently spent on this to be redirected to areas currently in need of support for youth with type 1 diabetes, such as mental health and nutrition counseling, they conclude.

The T1D Exchange is supported through the Leona M and Harry B Helmsley Charitable Trust. The authors have no further relevant financial relationships.

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Diabetes Care. Published online October 7, 2016. Article

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