DEVELOPMENT AND PROGRESSION OF DIABETIC-RETINOPATHY - ADOLESCENTS AT RISK

The aims of this study were to evaluate short-term changes in retinopa thy in adolescents, and to examine the relationship of these changes t o risk factors. Two-hundred and three adolescents, with a median age o f 14.5 (range 10.4 to 20.6) yr and a median duration of diabetes of 6. 6 (1.1 to 16.3) yr, were included in the study. Retinopathy was assess ed on two occasions, using stereoscopic fundus photography; the median time between assessment was 1.3 (0.5 to 3.0) yr. At baseline, 41 % of the adolescents had background retinopathy. When patients were strati fied according to the median diabetes duration (DD) (6.6 yr) and glyca emic control over the 12 months prior to assessment (HbA(1C)) (8.4 %), the percentage of retinopathy in each group was: lowDD/lowHbA(1C),, 1 3 %; lowDD/highHbA(1C) 40 %; highDD/lowHbA(1C) 42 %; and highDD/highHb A(1C) 72 %. Using a 2-step criteria for stability or change in retinop athy, 11 % of the 203 adolescents showed progression of retinopathy, 4 1 % had stable retinopathy, 5 % showed regression, and 43 % had no ret inopathy at either assessment. Change in retinopathy was related to ag e at baseline assessment (borderline significance, p = 0.06), diabetes duration (p < 0.001), glycaemic control (p < 0.001) and total cholest erol (p = 0.04), and was also related to DD/HbA(1C) group membership ( chi(2), p < 0.001). This study highlights the combined adverse effect of long diabetes duration and poor glycaemic control on the developmen t and progression of retinopathy during adolescence, and identifies a group that is likely to show progression over a relatively short perio d.