Background Diabetic retinopathy is a leading microvascular complication and preventable cause of vision loss. NHS diabetes eye screening program (DESP) assesses for early signs, enabling review of modifiable risk factors.
Aims and Objectives Establish clinical characteristics and modifiable risk factors for patients with retinopathy identified by DESP under Leeds Children’s Hospital.
Material and Methods Retrospective case control, comparing patients with evidence of diabetic retinopathy versus age-matched control. Patients identified by DESP, mild non-proliferative diabetic retinopathy (NPDR) (R1/M1) or more severe.
Results Retinopathy identified in 9.7% of those eligible for eye screening (n=37/380). There was a female predominance 59.4% (n=22/37) compared to the control group 47.2% (n=27/36). On average, the retinopathy group had 2.6 years longer duration of diabetes and lower clinic attendance.
The mean last two HbA1C measurements were higher in the retinopathy group (n=69.9mmol/mol and 71.4mmol/mol) compared to control (n=60.6mmol/l and 58.7mmol/mol). Similarly time in range (TIR) was lower (n=43% versus n=52%). More of those in the retinopathy group had an HbA1C >80mmol/l 29.7% (n=11/37) versus 13.8% n=5/36).
There was more technology uptake in the control group; pump use 63.8% (n=23/36) versus 54.0% (n=20/37), hybrid closed-loop (HCL) (n=5 versus n=1) and 86.1% (n=31/36) using sensors versus 75.6% (n=28/37).
The retinopathy group had more evidence of other microvascular disease, urine albumin-creatinine ratio (uACR) 1.35mg/mmol versus 0.7mg/mmol, with 5 patients in retinopathy group having uACR >2.5mg/mmol compared to 0.0mg/mmol.
Importantly both groups mean body mass index (BMI) standard deviation score (SDS) were in the overweight category (SDS>+1) and mean total lipids and triglycerides exceeded recommended cut offs of >4mmol/l and >1mmol/l respectively. More patients had high triglycerides (>1.5mmol/l) in the retinopathy group 27.0% (n=10/37) versus 8.3% (n=3/36). Systolic blood pressure (SBP) was comparable.
Conclusion Rates of retinopathy are comparable to previous studies. Those with retinopathy were mostly female, had higher mean HbA1C, lower mean TIR and longer mean duration of diabetes. Those with retinopathy were twice as likely to have a meanHbA1C >80mmol/l. Technology uptake was 10% greater in those without retinopathy, with five times greater HCL use.
Engaging the teenagers with poor control remains a key challenge; those with retinopathy had poorer clinic attendance. The importance of lifestyle intervention has been highlighted.
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