Modifiable Factors Associated with Diabetic Retinal Disease and Retinal Neural Layer Thickness in Youth with Type 1 Diabetes.

PURPOSE: To evaluate associations of risk factors with diabetic retinopathy (DR), diabetic macular edema (DME), and neural retinal layer thickness in youth with type 1 diabetes (T1D).

DESIGN

Retrospective cross-sectional chart review study.

PARTICIPANTS

Youth participants (< 22 years of age) with T1D from a tertiary diabetes center.

METHODS

Standardized record review of youth with T1D with clinic visits from 2005 through 2020. Spectral-domain (SD) macula scans were collected in a subset of patients, and automated retinal layer segmentation was performed for all retinal layers.

MAIN OUTCOME MEASURES: Presence of DR and DME and retinal layer thickness.

RESULTS

One thousand three hundred fifty-nine youth (2704 eyes) were included in this study; 49.6% female, mean age 13.7 ± 4.3 years, T1D duration 7.0 ± 5.2 years, T1D age of onset 7.7 ± 4.7 years, and HbA1c 8.4 ± 1.3%. Of eyes in this sample, 2565 (94.9%) had no DR and 139 (5.1%) had DR; 9 (0.3%) had DME. Older age, longer T1D duration, earlier T1D onset, higher HbA1c, and elevated/high BP were significantly associated with DR presence; these relationships remained significant in multivariable models that included age, sex, T1D duration, and HbA1c. In the 9 eyes with DME, it was associated with overweight/obese BMI. In 109 eyes (69 youth) with SDOCT imaging, and no DR, higher HbA1c was significantly associated with thinner central subfield thickness (CST), ganglion cell layer (GCL), and inner plexiform layer (IPL). Overweight/obese BMI was significantly associated with thicker retinal nerve fiber layer, GCL, and IPL. When correcting for multiple comparisons, higher HbA1c remained significantly associated with thinner CST and IPL.

CONCLUSIONS

In this cohort, DR presence was associated with modifiable risk factors of worse glycemic control and higher BP. Higher HbA1c also was correlated with thinner CST and IPL, suggesting a possible association with retinal neurodegeneration. While DME was extremely rare, it may be associated with higher BMI. Although this cohort represents a recent population, it predates the latest innovations (e.g., automated insulin delivery) shaping diabetes management today. These findings support the potential importance of controlling modifiable systemic risk factors in diabetic eye disease in youth with T1D.

FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.