Monday, June 5, 2023
Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™
ABIM Diplomates - maximum of 0.25 ABIM MOC points
Nurses - 0.25 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)
Pharmacists - 0.25 Knowledge-based ACPE (0.025 CEUs)
Physician Assistant - 0.25 AAPA hour(s) of Category I credit
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This activity is intended for diabetologists/endocrinologists, family medicine/primary care clinicians, internists, ophthalmologists, pediatricians, public health and prevention officials, nurses, pharmacists, physician assistants, and other members of the healthcare team for youths with T2D.
The goal of this activity is for members of the healthcare team to be better able to describe estimated global prevalence of diabetic retinopathy (DR) in pediatric T2D, according to a systematic review and meta-analysis.
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CME / ABIM MOC / CE Released: 4/28/2023
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Primarily because of the obesity epidemic, many children are developing type 2 diabetes (T2D) early in life and will live with diabetes for several decades. This may increase their lifetime risk of developing diabetic retinopathy (DR), which If undetected and untreated can cause blindness.
Type 2 diabetes is more aggressive in youths than in adults. Early comorbidities and complications include hypertension, nephropathy, polycystic ovary syndrome, and dyslipidemia. Current guidelines recommend DR screening in youths with T2D at diagnosis and annually thereafter, but the global burden of DR is still unknown.
Nearly 1 in 4 children diagnosed with T2D for 5 years or more develop DR, according to a new report. The global prevalence of DR in pediatric patients with T2D is about 7%, which appears to increase with age.
"In our clinical practice, we have seen an increase in children presenting with [T2D] over the past few years. These patients present with multiple simultaneous comorbidities and complications like hypertension, fatty liver, and other conditions," senior author M. Constantine Samaan, MD, told Medscape Medical News.
"The exact scale of diabetes-related eye disease was not clear, and we decided to quantify it," said Samaan, an associate professor of pediatrics at McMaster University and pediatric endocrinologist at McMaster Children's Hospital in Hamilton, Ontario, Canada.
"What we found was that in pediatric patients with [T2D], [DR] is present in 1 in 14 youth. The risk of retinopathy increased significantly 5 years after diagnosis to almost 1 in 4," he noted.
"While we acknowledged that the number of [DR] cases was relatively small and there was heterogeneity in studies, we were surprised that retinopathy rates rose so fast in the first few years after diabetes diagnosis," Samaan indicated.
The findings signal that the increase in the prevalence of DR is emerging decades earlier among children compared with adults with T2D, the authors wrote in their article published March 1 in JAMA Network Open.
"While the guidelines for eye care in children with [T2D] recommend screening at diagnosis and annually afterward, these recommendations are not followed in almost half of these patients," Samaan said. "There is a need to ensure that patients get screened to try and prevent or delay retinopathy onset and progression."
Analyzing Prevalence RatesDiabetic retinopathy is the leading cause of blindness in patients with T2D. Between 21% and 39% of adults have DR at diagnosis, with rates subsequently increasing, the authors wrote.
Samaan and colleagues conducted a systematic review and meta-analysis to estimate the global prevalence of DR in pediatric patients with T2D. They included studies that had a study population of at least 10 participants diagnosed at age 21 years and younger, an observational study design, and prevalence data on DR.
Among the 29 studies included, 6 were cross-sectional, 13 had a retrospective cohort design, and 10 had a prospective cohort design. Patients were diagnosed between the ages of 6.5 and 21 years, and the diabetes duration ranged from 0 to 15 years after diagnosis.
The overall global prevalence of DR in 5924 pediatric patients was 7%. Prevalence varied by study design, ranging from 1.1% in cross-sectional studies to 6.5% in prospective cohort studies and 11.3% in retrospective cohort studies.
In the 9 studies that reported DR classification based on criteria, the prevalence of minimal to moderate nonproliferative DR was 11.2%, the prevalence of severe nonproliferative DR was 2.6%, the prevalence of proliferative DR was 2.4%, and the prevalence of macular edema was 3.1%.
In the 5 studies that reported DR diagnosis using fundoscopy, the prevalence was approximately 0.5%. In the 4 studies that used 7-field stereoscopic fundus photography, the prevalence was about 13.6%.
In the pooled analysis of 27 studies, the prevalence of DR was about 1.8% less than 2.5 years after diabetes diagnosis but more than doubled to 5.1% in years 2.5 to 5 and jumped to 28.8% more than 5 years after diagnosis.
Differences by Sex and Ethnicity"We were also surprised that there was very limited evidence to understand the sex and race differences in retinopathy risk," said Samaan. "Further research is warranted, considering that more girls develop [T2D] than boys, and the risk of [T2D] is higher in some racial groups."
In addition, older age, longer diabetes duration, and higher hypertension prevalence were associated with [DR] prevalence. There were no associations with obesity prevalence or mean age at diabetes diagnosis; however, patients who developed [DR] had a higher mean glycated hemoglobin [HbA1c] level of 1.4% compared with patients without retinopathy.
Samaan and colleagues are continuing to research the comorbidities and complications that children with T2D face as well as mechanisms that drive diabetes outcomes among children and adolescents.
For now, the findings highlight the importance of retinopathy screening and personalized diabetes treatment to protect vision, Samaan reiterated.
No funding source for the study was reported. The authors have reported no relevant financial relationships.
JAMA Netw Open.2023;6:e231887.[1]
