Retinopathy in Finnish Children With Type 1 Diabetes
Retinopathy in Finnish Children With Type 1 Diabetes
Aim A population-based study was carried out to evaluate the prevalence and risk factors of diabetic retinopathy (DR) in children with type 1 diabetes (T1D) in The Northern Osthrobothnia Hospital District, Finland. The aim was to compare the current prevalence and the risk factors with those obtained in a study performed in a similar setting 17 years earlier.
Methods and patients The prevalence of DR was evaluated from fundus photographs in a cross-sectional manner in children and adolescents with T1D (n=297) living in the Northern Osthrobothnia Hospital District on 1 January 2007.
Results The prevalence of DR was 7.6% (12/158) in males and 16.5% (23/139) in females in the present study and 7.3% in males and 12.9% in females in the former study. The mean age of the patients was 11.9 and 11.8 years, and the mean duration of diabetes was 4.9 and 5.0 years in the present and the former study, respectively. DR was associated with older age (p<0.001), longer duration of diabetes (p<0.001), higher glycated haemoglobin A1c (GHbA1c ) (9.3% in those with DR vs 8.3% in those without DR, p=0.001, or 78 vs 67 mmol/mol, respectively) and female sex (p=0.016); in a logistic regression analysis, these factors explained 35% of DR. These risk factors are essentially the same as identified in the cohort 17 years earlier. GHbA1c levels had not significantly improved during that time.
Conclusions The overall prevalence of DR among children with T1D was 11.8% (35/297) showing no decrease over the past 17 years; in girls, DR was diagnosed more often in the present than in the former study, but there was no change in the prevalence among the boys. Glycaemic control had remained unchanged.
The incidence of childhood type 1 diabetes (T1D) in Finland has increased fourfold since the 1950s, being 64/100 000/year in children under 15 years of age in 2005, and thus it is higher in Finland than in any other country in the world. The incidence has increased most rapidly among the children under 10 years of age, and this trend is continuing, but the reason for this is unknown.
Diabetic retinopathy (DR) is a common micro-vascular complication of diabetes. It may lead to impaired vision or even permanent blindness; DR is the cause of 10% of the cases of impaired vision among working-age people in Finland.
Hyperglycaemia, long duration of diabetes, onset of puberty and pregnancy are known risk factors for the onset and progression of DR. DR is rare in children before puberty, and as far as we are aware, no cases of vision-threatening DR have been reported in prepubertal children. However, the onset of DR during childhood and adolescence is not rare and may precede vision-threatening DR during early adulthood.
The prevalence of DR among children living in The Northern Osthrobothnia Hospital District was evaluated in 1989–1990 in a populationbased study. Among children aged 4.6–16.9 years, 21/216 (9.7%) had DR in fundus photographs, and 22/216 did not attend the examination.
The possibilities of good glycaemic control of T1D have improved since the year 1990. Human insulin, the insulin analogues, insulin pumps as well as continuous monitoring of blood glucose have been introduced. The health-awareness and education levels of the population including families with a child with T1D have improved, and knowledge about dietary matters has increased.
The present study was carried out to evaluate the current prevalence of childhood DR in The Northern Osthrobothnia Hospital District. The aim of the study was to compare today's prevalence and the risk factors for DR with those obtained in the earlier study.
Abstract and Introduction
Abstract
Aim A population-based study was carried out to evaluate the prevalence and risk factors of diabetic retinopathy (DR) in children with type 1 diabetes (T1D) in The Northern Osthrobothnia Hospital District, Finland. The aim was to compare the current prevalence and the risk factors with those obtained in a study performed in a similar setting 17 years earlier.
Methods and patients The prevalence of DR was evaluated from fundus photographs in a cross-sectional manner in children and adolescents with T1D (n=297) living in the Northern Osthrobothnia Hospital District on 1 January 2007.
Results The prevalence of DR was 7.6% (12/158) in males and 16.5% (23/139) in females in the present study and 7.3% in males and 12.9% in females in the former study. The mean age of the patients was 11.9 and 11.8 years, and the mean duration of diabetes was 4.9 and 5.0 years in the present and the former study, respectively. DR was associated with older age (p<0.001), longer duration of diabetes (p<0.001), higher glycated haemoglobin A1c (GHbA1c ) (9.3% in those with DR vs 8.3% in those without DR, p=0.001, or 78 vs 67 mmol/mol, respectively) and female sex (p=0.016); in a logistic regression analysis, these factors explained 35% of DR. These risk factors are essentially the same as identified in the cohort 17 years earlier. GHbA1c levels had not significantly improved during that time.
Conclusions The overall prevalence of DR among children with T1D was 11.8% (35/297) showing no decrease over the past 17 years; in girls, DR was diagnosed more often in the present than in the former study, but there was no change in the prevalence among the boys. Glycaemic control had remained unchanged.
Introduction
The incidence of childhood type 1 diabetes (T1D) in Finland has increased fourfold since the 1950s, being 64/100 000/year in children under 15 years of age in 2005, and thus it is higher in Finland than in any other country in the world. The incidence has increased most rapidly among the children under 10 years of age, and this trend is continuing, but the reason for this is unknown.
Diabetic retinopathy (DR) is a common micro-vascular complication of diabetes. It may lead to impaired vision or even permanent blindness; DR is the cause of 10% of the cases of impaired vision among working-age people in Finland.
Hyperglycaemia, long duration of diabetes, onset of puberty and pregnancy are known risk factors for the onset and progression of DR. DR is rare in children before puberty, and as far as we are aware, no cases of vision-threatening DR have been reported in prepubertal children. However, the onset of DR during childhood and adolescence is not rare and may precede vision-threatening DR during early adulthood.
The prevalence of DR among children living in The Northern Osthrobothnia Hospital District was evaluated in 1989–1990 in a populationbased study. Among children aged 4.6–16.9 years, 21/216 (9.7%) had DR in fundus photographs, and 22/216 did not attend the examination.
The possibilities of good glycaemic control of T1D have improved since the year 1990. Human insulin, the insulin analogues, insulin pumps as well as continuous monitoring of blood glucose have been introduced. The health-awareness and education levels of the population including families with a child with T1D have improved, and knowledge about dietary matters has increased.
The present study was carried out to evaluate the current prevalence of childhood DR in The Northern Osthrobothnia Hospital District. The aim of the study was to compare today's prevalence and the risk factors for DR with those obtained in the earlier study.
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