DIABETIC-RETINOPATHY IN PEDIATRIC-PATIENTS WITH TYPE-1 DIABETES - EFFECT OF DIABETES DURATION, PREPUBERTAL AND PUBERTAL ONSET OF DIABETES, AND METABOLIC CONTROL

Objective: The objective of this study was to determine the contributi on of prepubertal and pubertal onset and duration of diabetes to the d evelopment of diabetic retinopathy. Study design: A total of 1391 stan dardized fundus examinations (stereo fundus-photography) were performe d in 441 children or adolescents with type-1 diabetes (median age 15.5 years, median duration of diabetes 6.3 years). Results: Mild nonproli ferative retinopathy was present in 72 patients (median age 19.9 years ). Life table analysis revealed a median duration of diabetes until re tinopathy was first diagnosed at 16.6 years (95% confidence interval: 15.3 to 18.3). Patients were stratified according to diabetes onset be fore or in puberty (greater than or equal to 10.4 years in girls, grea ter than or equal to 12.2 years in boys). In children with a prepubert al onset of diabetes, retinopathy occurred after a pubertal duration o f 10.9 years compared with 15.1 years in children with onset of diabet es in puberty (p < 0.01), demonstrating the additional risk conveyed b y the prepubertal years of diabetes. Long-term metabolic control had a significant influence on the prevalence of retinopathy: patients with a median HbA(lc) greater than or equal to 7.5% had development of ret inopathy on average after 15.5 years compared with 18.3 years in patie nts with lower HbA(lc) values (p < 0.05). Conclusion: Both prepubertal and pubertal duration of diabetes are relevant for the development of background retinopathy. Good metabolic control should be attempted ir respective of age.