February 10, 2020
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Type 2 diabetes earlier in life raises likelihood of retinopathy

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Timothy L. Middleton

Adults with type 2 diabetes before age 40 years are more likely to develop retinopathy than those diagnosed later in life, according to findings published in Diabetic Medicine.

“The persistence of an increased risk of clinically significant diabetic retinopathy amongst those with young-onset diabetes relative to those with older-onset disease across an extended duration of diabetes exposure times is a very interesting finding,” Timothy L. Middleton, MBBS, MPhil, FRACP, specialist endocrinologist and research fellow at the Royal Prince Alfred Hospital Diabetes Centre in Sydney, told Healio. “It would suggest that the retina of youth and young adults with type 2 diabetes is significantly more susceptible to the development of retinopathy.”

Middleton and colleagues evaluated the prevalence of diabetic retinopathy, microalbuminuria, chronic kidney disease, peripheral neuropathy and ischemic heart disease in a cohort of 3,322 adults with type 2 diabetes. Participants had young-onset type 2 diabetes if they were diagnosed between ages 15 and 40 years (n = 348; mean age, 48 years; 46% women). The reference group was made up of participants diagnosed between ages 60 years and 70 years (n = 460; mean age, 77 years; 44% women) while participants who were diagnosed between ages 40 and 50 years (n = 588; mean age, 58.6 years; 40% women) and between ages 50 and 60 years (n = 796; mean age, 67.3 years; 47% women) were also included.

Participants with young-onset type 2 diabetes and a diabetes duration of at least 10 years but less than 15 years were more likely to develop retinopathy than those with similar diabetes duration who were diagnosed after age 60 years but before age 70 years (OR = 2.8; 95% CI, 1.9-4.1), as were those with young-onset diabetes duration of at least 15 years but less than 20 years (OR = 2.2; 95% CI, 1.4-3.5) and those with young-onset diabetes duration of at least 20 years but less than 25 years (OR = 5.6; 95% CI, 1.8-16). The researchers noted that “a similar pattern” emerged for more severe retinopathy diagnoses.

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Adults with type 2 diabetes before age 40 years are more likely to develop retinopathy than those diagnosed later in life.

“Understanding of the pathogenesis of diabetic retinopathy is evolving,” the researchers wrote. “It is plausible that the diabetic milieu in youth could favor vascular proliferation and give rise to higher rates of retinopathy. Clearly, further work is required to elucidate the true underlying mechanisms.”

Conversely, participants with young-onset type 2 diabetes and diabetes duration of at least 10 years but less than 15 years were less likely to develop albuminuria (OR = 0.5; 95% CI, 0.4-0.8), CKD (OR = 0.04; 95% CI, 0.02-0.07) and macrovascular disease (OR = 0.2; 95% CI, 0.1-0.3) than those with similar diabetes duration who were diagnosed after age 60 years but before age 70 years; outside of albuminuria in those with a diabetes duration of at least 20 years but less than 25 years, the likelihood of these conditions was also reduced for longer diabetes durations among those with young-onset type 2 diabetes.

“Our work implies that young people with type 2 diabetes are especially at risk of the complication of retinopathy, even after known risk factors are taken into account,” Middleton said. “Given an increased susceptibility to retinopathy in young-onset type 2 diabetes, it would seem prudent to ensure frequent diabetic retinopathy surveillance and aggressive risk factor management is undertaken for all individuals with young-onset type 2 diabetes.” – by Phil Neuffer

For more information:

Timothy L. Middleton, MBBS, MPhil, FRACP, can be reached at timothy.middleton@health.nsw.gov.au.

Disclosures: The authors report no relevant financial disclosures.