BIOMEDICAL AND PSYCHIATRIC RISK-FACTORS FOR RETINOPATHY AMONG CHILDREN WITH IDDM

OBJECTIVE - Illness duration and glycemic control influence the develo pment of retinopathy in childhood-onset insulin-dependent diabetes mel litus (IDDM). Psychiatric disorders and sociodemographic factors also affect diabetes-related outcomes. However, biomedical and psychosocial factors have not been examined together in modeling the risk of retin opathy. RESEARCH DESIGN AND METHODS - We conducted a single-site prosp ective longitudinal study of 66 children (aged 8-13 years) newly diagn osed with IDDM. Repeated assessments served to derive psychiatric diag noses. Poor glycemic control was defined as the upper 15th percentile of all HbA(1) values. After a median follow-up of 10 years, severity o f retinopathy was determined. It was modeled with a stepwise polychoto mous regression procedure using antecedent biomedical and psychosocial variables. RESULTS - Young adults with childhood-onset IDDM were foun d to be at increased risk of retinopathy the longer they had IDDM, the more persistently they evidenced poor antecedent glycemic control, an d the longer they suffered from depressive illness. These three factor s operated individually and additively with duration of IDDM conferrin g a baseline level of risk. In depressed patients (27%), depression on set antedated the detection of retinopathy generally by 7 years. CONCL USIONS - Duration of childhood-onset IDDM confers a baseline level of risk of retinopathy irrespective of glycemic control; antecedent clini cal depression is also a risk factor. Depression therefore may serve a s a marker of vulnerability and help to identify a subgroup of patient s at risk for complications. The findings raise the question whether t imely treatment of depression could forestall diabetic retinopathy.