Allen et al. (1) examined trends in diabetic retinopathy (DR) and diabetic macular edema among adolescents with type 1 diabetes between 1990 and 2019 by reviewing data from a local tertiary diabetes center. The authors also explored risk factors associated with ophthalmic complications through multivariable generalized estimating equations. The study adds to existing evidence on the prevalence and risk factors associated with ocular complications in younger adults with type 1 diabetes.
In younger patients with type 1 diabetes, a large body of literature has demonstrated that the prevalence of DR has decreased over time (2). Results of the Diabetes Control and Complications Trial (DCCT) showed that with intensive insulin management, the risk of DR was reduced by 76% (3). We summarized the data of related articles published in recent years. The aggregated results show that the average prevalence of DR in studies before 2010 was about 19% (with a sample size of 2,662), while the average prevalence of DR reported in studies after 2010 was relatively lower, at about 10.3% (with a sample size of 7,502). This general trend is consistent with the conclusions of Allen et al. (1). However, the DR rate reported by Allen et al. was twice the average prevalence of previous DR.
We would be grateful to the authors for their responses to the following questions. 1) Allen et al. (1) mentioned in the text that the included patients had longer duration of diabetes and higher BMI, which may account for the greater prevalence of clinically significant ocular complications. Could this relatively high DR rate be related to other factors, such as sex, household economic level, and smoking? 2) We observed that a significant proportion of patients included in previous studies were younger than 15 years of age but that the majority of the patients described in the authors’ article are over 15 years of age. This indicates not only that the patients included in the study of Allen et al. (1) had longer duration of diabetes but also that the patients were all in puberty or even past puberty. Evidence suggests that DR is more common after puberty and after 5–10 years of diabetes, with a lower risk of developing DR-threatening vision before age 12 years (4,5). This also seems to explain why the DR rates were very high in all three time periods in the study by Allen et al. (1). What do the authors think about this inference?
See accompanying article, p. e185.
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Duality of Interest. No potential conflicts of interest relevant to this article were reported.
Data Availability. The data sets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
