Alarming number of youths with type 2 diabetes have eye damage

Almost half of young adults with type 2 diabetes develop a potentially blinding eye complication called diabetic retinopathy within a dozen years after diagnosis, new research reveals.

The findings, from one of the longest-running nationally representative studies in the U.S. focusing on youth-onset type 2 diabetes, provide crucial guidance on diabetes management and eye care to young patients and their families, as well as doctors and the public, says study author Dr. Rose Gubitosi-Klug, a paediatric endocrinologist at UH Rainbow Babies and Children’s Hospital in Cleveland, OH.

“My colleagues and I in pediatrics are alarmed,” Gubitosi-Klug says.

“Initially, about 14 per cent of participants had very early changes to the eye. When we looked a second time just seven years later, about half are now experiencing changes to the eye, some with advanced disease that’s not normally seen until someone is in their fourth or fifth decade of life.”

The study was published online September 16 in the journal Diabetes Care. Diabetic retinopathy — the leading cause of blindness in working-age adults and one of the top reasons for preventable blindness — is characterized by damage to the blood vessels at the back of the eye. These abnormal vessels resemble scar tissue that can pull the retina out of place, causing blurriness, floaters, or severe vision loss.

Scientists had believed that United States (U.S.) rates of diabetic retinopathy would double between 2010 and 2050, “but with this new data, we expect this rate will more than double,” says Gubitosi-Klug, who’s also a professor of pediatrics at Case Western Reserve School of Medicine in Cleveland.

Previously, the TODAY (Treatment Options for Diabetes in Adolescents and Youth) study had reported a 13.9 per cent prevalence of diabetic retinopathy in young people who had had type 2 diabetes for an average of about five years. Seven years later, between 2017 and 2018, 420 of the original 517 participants again had retinal photograph tests that were evaluated for the presence of diabetic retinopathy and its advance.

In the later analysis, 49 per cent of participants — whose average age was just 25 — had developed diabetic retinopathy. While 39 per cent had mild or very mild cases of the eye condition, about 4 per cent had its most severe form. Compared with mildly affected patients, those with more extreme progression had higher blood sugar and blood pressure levels, as well as more health problems.

Participants represented diverse racial and ethnic groups, including Hispanic, Black, and Native American people considered at higher risk of developing type 2 diabetes, making the findings generalizable to the American public, Gubitosi-Klug notes.

About 210,000 youths in the U.S. under age 20 are estimated to have diabetes, according to the American Diabetes Association. These patients should strive to tightly control blood sugar levels and work closely with their doctors to do so, Gubitosi-Klug advises.

“Even if their vision is OK now, diabetes likes to take effect on your tissues earlier, so see your doctors and follow up with an ophthalmologist,” she says. “And don’t skip those eye screenings.”

Beyond the study findings related to eye health, doctors should understand that children “at a young age are not only developing diabetes, but developing the complications of diabetes,” Gubitosi-Klug continues.

“I think there’s been hesitancy to aggressively treat them with medications for diabetes or high blood pressure because they’re young. But waiting is putting them on the path to developing these complications.”Even people without diabetes should be aware of this issue, she says.

“We need to work with families to overcome barriers to make sure healthy food is available to all, and that schools and kids can focus together on healthy eating and activity to help prevent these kids going on to have diabetes.”

And routine eye exams should also include the extra step of dilated retinal testing, Gubitosi-Klug says. With about one in 10 Americans diagnosed with diabetes, and another 88 million with pre-diabetes, such testing could reveal early signs of diabetic retinopathy or other dangerous vision changes.

“There’s good news: If we catch early lesions and improve diabetes control, we know from other studies that some eye findings can improve,” she says. “So, there’s always a benefit in trying to improve your diabetes management.”