PREVALENCE AND RISK-FACTORS FOR RETINOPATHY IN ADOLESCENTS WITH TYPE-1 DIABETES

Objectives: To establish the prevalence of, and risk factors associate d with, diabetic retinopathy in an Australian adolescent diabetes clin ic population. Design: A prospective longitudinal study; baseline find ings. Patients: Two hundred and fifty-five patients with Type 1 (insul in-dependent) diabetes mellitus assessed by our service were studied. Entry criteria were: age 11.0-19.9 years; diabetes duration of at leas t two years; and gradable fundus photographs of at least one eye. Main outcome measures: The presence and severity of retinopathy, as assess ed by the grading of stereoscopic fundus photographs. Possible risk fa ctors assessed were age, sex, diabetes duration, pubertal stage, blood pressure, glycaemic control and total cholesterol level. Results: The prevalence of retinopathy was 42%; all of those affected had mild bac kground retinopathy. Highly significant associations were found with g lycaemic control and both total and prepubertal duration of diabetes. No associations were found with age, sex, pubertal stage, blood pressu re or total cholesterol level. Conclusions: The high prevalence of ear ly diabetic retinopathy in this group of Australian adolescents is com parable to recent reports from other centres. The significant associat ions with glycaemic control and duration of diabetes provide further s trong evidence for the benefit of optimal glycaemic control during ado lescence. Our finding that the prepubertal years of diabetes contribut e to the development of retinopathy suggests that glycaemic control be fore puberty should also be optimised. The planned followup of this co hort will establish the risk of progression to vision-threatening reti nopathy and allow risk factors to be further evaluated.