News Article
Retinopathy Risk Higher With Earlier Onset Type 2 Diabetes
Patients with younger-onset type 2 diabetes showed a significantly greater prevalence and severity of retinopathy, compared with older-onset patients, according to a large, retrospective study.
Further stratification of patients based on mean hemoglobin A
A total of 624 patients with duration of 20-30 years of known type 2 diabetes at last follow-up were selected from more than 8,300 patients with type 2 diabetes referred to Royal Prince Alfred Hospital, Sydney, from 1989 to 2007. Available data included demographic details, age of diagnosis, HbA
Patients were divided into three groups according to age of diabetes onset: those who manifested the disease younger than 45 years of age (322 patients, 55% men); at 45-55 years (232 patients, 54% men); and older than 55 years (70 patients, 57% men). The odds ratios for the development of retinopathy were 1.9, 1.1, and 1.0, respectively, for each age of onset. In addition, the youngest-onset group had a "notable excess in vision-threatening retinopathy," according to the researchers.
Each 1% rise in HbA
To obviate bias associated with a higher attrition rate from comorbidities in those with later-onset diabetes and retinopathy, the researchers also studied 852 patients with diabetes of shorter duration (10-12 years). They found that these patients also showed a similar significant trend of more retinopathy in the younger-onset group, compared with those over the age of 55.
Instead of early-onset type 2 diabetes being a naturally more severe disease, "we cannot discount the possibility that for younger patients, the metabolically severe cases are more likely to be diagnosed and preferentially referred to our clinic, resulting in a bias toward detection of more youth with retinopathy," the researchers acknowledged.
The major strengths of their study were the sample size, amount and type of data collected, and the long follow-up, compared with other studies - "sufficient time for retinopathy to develop," they stated.
"[This study] suggests an increased inherent tissue susceptibility to the damaging effects of hyperglycemia at a younger age. This further supports the importance of delaying the onset of diabetes even if it cannot be completely prevented. It also implies a need for more stringent metabolic targets for younger individuals in the early years after diabetes onset," they concluded.
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