Differences in retinopathy prevalence and associated risk factors across 11 countries in three continents: A cross-sectional study of 156,090 children and adolescents with type 1 diabetes

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  • Australasian Diabetes Data Network (ADDN) Study Group, the Prospective Diabetes Follow-up Registry (DPV) initiative, Danish National Diabetes Registry (DanDiabKids), National Pediatric Diabetes Audit (NPDA), Region Marche Registry for Diabetes, Diabeter Diabetes Database, Slovenian Childhood Diabetes Registry, SEARCH for Diabetes in Youth Study

Objective: To examine the prevalence, time trends, and risk factors of diabetic retinopathy (DR) among youth with type 1 diabetes (T1D) from 11 countries (Australia, Austria, Denmark, England, Germany, Italy, Luxemburg, Netherlands, Slovenia, United States, and Wales). Subjects and Methods: Data on individuals aged 10–21 years with T1D for >1 year during the period 2000–2020 were analyzed. We used a cross-sectional design using the most recent year of visit to investigate the time trend. For datasets with longitudinal data, we aggregated the variables per participant and observational year, using data of the most recent year to take the longest observation period into account. DR screening was performed through quality assured national screening programs. Multiple logistic regression models adjusted for the year of the eye examination, age, gender, minority status, and duration of T1D were used to evaluate clinical characteristics and the risk of DR. Results: Data from 156,090 individuals (47.1% female, median age 15.7 years, median duration of diabetes 5.2 years) were included. Overall, the unadjusted prevalence of any DR was 5.8%, varying from 0.0% (0/276) to 16.2% between countries. The probability of DR increased with longer disease duration (aORper-1-year-increase = 1.04, 95% CI: 1.03–1.04, p < 0.0001), and decreased over time (aORper-1-year-increase = 0.99, 95% CI: 0.98–1.00, p = 0.0093). Evaluating possible modifiable risk factors in the exploratory analysis, the probability of DR increased with higher HbA1c (aORper-1-mmol/mol-increase-in-HbA1c = 1.03, 95% CI: 1.03–1.03, p < 0.0001) and was higher among individuals with hypertension (aOR = 1.24, 95% CI: 1.11–1.38, p < 0.0001) and smokers (aOR = 1.30, 95% CI: 1.17–1.44, p < 0.0001). Conclusions: The prevalence of DR in this large cohort of youth with T1D varied among countries, increased with diabetes duration, decreased over time, and was associated with higher HbA1c, hypertension, and smoking.

TidsskriftPediatric Diabetes
Udgave nummer8
Sider (fra-til)1656-1664
StatusUdgivet - 2022

Bibliografisk note

Funding Information:
We acknowledge all registries for making data available for this international project: Australasian Diabetes Data Network (ADDN) supported by JDRF Australia, the recipient of the Australian Research Council Special Research Initiative in Type 1 Juvenile Diabetes, the Prospective Diabetes Follow‐up Registry (DPV) initiative supported by the German Center for Diabetes Research (grant 82DZ01402), Danish National Diabetes Registry (DanDiabKids) supported by a yearly grant from The Danish Clinical Quality Program, National Pediatric Diabetes Audit (NPDA) commissioned by the Healthcare Quality Improvement Partnership (HQIP) on behalf of the NHS in England and Wales, Slovenian Childhood Diabetes Registry (supported by Slovenian Research Agency grants J3‐6798, V3‐1505, and P3‐0343), SEARCH for Diabetes in Youth Study supported by the National Institute of Diabetes and Digestive and Kidney Diseases (1UC4DK108173‐01) and by the Centers for Disease Control and Prevention (CDC). Other registries/cohorts do not report additional support. Finally, we acknowledge the collection of data by all participating centers in this investigation.

Publisher Copyright:
© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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