Race, socioeconomic status thought reasons behind lack of adherence to the recommendations.
As the youth population continues to experience an increased prevalence of obesity, the incidence of type 2 diabetes in children and adolescence is also on the rise, with roughly 45% of all new adolescent diagnoses consisting of T2D, where previously most cases of juvenile diabetes were type 1.
Estimates extrapolated from U.S. Census data suggest that by 2050, the rate of type 1 diabetes in youth will triple, and the rate of type 2 in the same population will quadruple. Along with this unsettling picture, the associated risk of diabetic retinopathy is expected to rise as well. Because DR can lead to blindness, early screening for DR remains important. Screening guidelines are established for TD1 patients, generally supporting retinal exam at 5-6 years from initial diagnosis, while recommending initial screening takes place coincident with diagnosis of T2D. Previous studies report that only 33% of youth with T1D and 50% with T2D obtained eye examinations according to guidelines. This may reflect concerns about younger age, diagnosis of T2D versus T1D, and shorter duration of diabetes in this population. Not surprising is that most studies have been done in adults, and very few of the youth studies looked at other demographic factors that may contribute to the lack of adherence to the guideline recommendations. In the recent issue of JAMA Ophthalmology, a study was presented looking at retinopathy screening rates in youth with diabetes.
Data from 5,453 youth with T1D and 7,233 with T2D were collected from a nationwide managed care network from January 2001 through December 2014. Inclusion criteria were uninterrupted enrollment in the medical plan for at least 3 years and at least 2 diagnoses of diabetes on separate dates. Children who had never filled a prescription for insulin or an oral hypoglycemic, and those with pre-existing diabetes (diagnosed prior to 12 months in the medical plan) were excluded. Those children whose data lacked socioeconomic information were also excluded. The primary outcome was documentation of an eye exam as defined by Current Procedural Terminology. Timing from initial diagnosis to initial eye exam in both T1D and T2D were compared using the log-rank test.
Multivariable Cox proportional hazards regression were used to evaluate the effects of diabetes type and sociodemographic factors on the proportion of those screened.
In those with T1D, the median age at diagnosis was 11 year (interquartile range 8-15 years), while in T2D, the median was 19 years (IQR 16-22 years). The median time in the medical plan for both types was 2.1 years. In the T2D subset, most patients were female (83.5%). Of the T1D patients, 82.6% were white, 8.2% were black, 7.2% Latino, and 2% were Asian, while T2D patients were 69.9% white, 14.6% Latino, 12.8% black, and 2.8% Asian. Survival analysis showed that by 6 years after initial diagnosis, patients with T1D had a higher rate of eye examination than did those with T2D (HR 2.14; 95% CI 1.97-2.33). Whites and Asians had a higher rate of exam (54.7% and 57.3% respectively) than did blacks and Latinos (44.6% and 41.6%). Economic data showed the likelihood of an eye exam increased as household income increased (net worth $500,000 vs < $25,000, HR 1.50; 95% CI 1.34-1.68). Stratified for type of diabetes, analysis showed that type 2 patients were less likely to be examined the farther they were from initial diagnosis, whereas type 1 patients were unaffected. Considering race, utilizing the prevalence of white patients who were screened as the reference point, blacks and Latinos were less likely to be screened (11%, p=0.04 and 18%, p<0.001) respectively, whereas Asians were 9% (NS) more likely to be screened.
Overall, 64.9% of T1D and 42.2% of T2D youths had received an eye examination within six years of their initial diagnosis. This study is considered to be the first to account for race and socioeconomic factors in the youth population, and suggests that existing barriers to DR screening may include lack of understanding on the parts of both the patient and the provider, patient financial barriers such as lack of health insurance, non-acceptance of the diagnosis, and even an aversion to pupillary dilation. While the study was strong in the number of patients analyzed, and available of records to confirm performance of eye exams (versus relying on patients self-reporting), the algorithm used to determine presence of diabetes may have allowed inclusion of misclassified diagnoses, such as use of metformin for prediabetes or insulin resistance. This may have led to underestimating the time of onset to first eye exam, and overestimation of the numbers who were actually screened within 6 years. The general conclusion that youth with diabetes are considerably under-screened for retinopathy is supported, suggesting that practitioners revaluate their approach to screening in this population.
Practice Pearls:
References:
Wang SY, Andrews CA, Gardner TW, Wood M, Singer K, Stein JD. Ophthalmic Screening Patterns Among Youths With Diabetes Enrolled in a Large US Managed Care Network. JAMA Ophthalmol. 2017. Epub 2017/03/23. doi: 10.1001/jamaophthalmol.2017.0089. PubMed PMID: 28334336.
Continue reading here:
Children, Adolescents With Diabetes Might Be Missing Out on Retinopathy Screenings - Diabetes In Control
- TRANSPLANT VIEWS: Stem cell therapy used for diabetic patients [Last Updated On: June 23rd, 2011] [Originally Added On: June 23rd, 2011]
- Diabetes - Video [Last Updated On: November 29th, 2011] [Originally Added On: November 29th, 2011]
- Stem Cell Treatment vs Diet For Diabetes - Video [Last Updated On: January 12th, 2012] [Originally Added On: January 12th, 2012]
- Orgenesis' Sarah Ferber, Ph.D on Using a Diabetes Patient's Own Liver Cells as a Novel Source of Insulin [Last Updated On: June 15th, 2012] [Originally Added On: June 15th, 2012]
- Diabetes drug may kill cancer stem cells, study says [Last Updated On: June 20th, 2012] [Originally Added On: June 20th, 2012]
- Diabetes reversed in mice using stem cells [Last Updated On: June 28th, 2012] [Originally Added On: June 28th, 2012]
- Diabetes Reversed In Mice Thanks To Stem Cell Transplant [Last Updated On: June 28th, 2012] [Originally Added On: June 28th, 2012]
- Diabetes Reversal In Mice Via Stem Cells [Last Updated On: June 28th, 2012] [Originally Added On: June 28th, 2012]
- Diabetes drug makes brain cells grow [Last Updated On: July 6th, 2012] [Originally Added On: July 6th, 2012]
- Diabetes drug helps brain growth, makes mice smarter [Last Updated On: July 6th, 2012] [Originally Added On: July 6th, 2012]
- Diabetes study hit by lack of funds [Last Updated On: September 7th, 2012] [Originally Added On: September 7th, 2012]
- Stem Cells Lupus Testimony Stem Alive - Video [Last Updated On: November 20th, 2012] [Originally Added On: November 20th, 2012]
- Common diabetes drug could fight ovarian cancer [Last Updated On: December 4th, 2012] [Originally Added On: December 4th, 2012]
- Diabetes distresses bone marrow stem cells by damaging their microenvironment [Last Updated On: February 1st, 2013] [Originally Added On: February 1st, 2013]
- Mike Maldonado uses exercise to fight Diabetes and Cancer - Video [Last Updated On: February 22nd, 2013] [Originally Added On: February 22nd, 2013]
- Diabetes : Deep-sea diving tank combined with stem cells to treat condition [Last Updated On: March 12th, 2013] [Originally Added On: March 12th, 2013]
- Diabetes team finds new hormone that could transform care [Last Updated On: April 25th, 2013] [Originally Added On: April 25th, 2013]
- Hormone Shows Potential as Diabetes Treatment in Mice [Last Updated On: April 27th, 2013] [Originally Added On: April 27th, 2013]
- Potential Diabetes Breakthrough - Video [Last Updated On: April 28th, 2013] [Originally Added On: April 28th, 2013]
- Stem Cell Therapy Cures Type 1 Diabetes in Mice [Last Updated On: June 7th, 2013] [Originally Added On: June 7th, 2013]
- John Chick: Giving diabetes the boot [Last Updated On: August 22nd, 2013] [Originally Added On: August 22nd, 2013]
- Scientists Create Personalized Stem Cells, Raising Hopes for Diabetes Cure [Last Updated On: April 28th, 2014] [Originally Added On: April 28th, 2014]
- Stem Cells from a Diabetes Patient [Last Updated On: April 28th, 2014] [Originally Added On: April 28th, 2014]
- Gut Cells May Be Coaxed to Make Insulin for People With Type 1 Diabetes [Last Updated On: July 1st, 2014] [Originally Added On: July 1st, 2014]
- Diabetes tipo 2 Podra ser reversible? [Last Updated On: July 31st, 2014] [Originally Added On: July 31st, 2014]
- James Shapiro: "Cutting Edge Islet and Stem Cell Transplant Therapies in the Clinic for Diabetes" - Video [Last Updated On: August 4th, 2014] [Originally Added On: August 4th, 2014]
- Cure for Type 1 diabetes imminent after Harvard stem-cell breakthrough [Last Updated On: October 9th, 2014] [Originally Added On: October 9th, 2014]
- New diabetes breakthrough 'bigger than the discovery of insulin' [Last Updated On: October 11th, 2014] [Originally Added On: October 11th, 2014]
- A cure for diabetes and awful jokes [Last Updated On: October 12th, 2014] [Originally Added On: October 12th, 2014]
- Stem Cell Success Raises Hopes of Type 1 Diabetes Cure [Last Updated On: October 12th, 2014] [Originally Added On: October 12th, 2014]
- Major step toward diabetes cure - Video [Last Updated On: October 12th, 2014] [Originally Added On: October 12th, 2014]
- Did Scientists Just Cure Type 1 Diabetes? - Video [Last Updated On: October 15th, 2014] [Originally Added On: October 15th, 2014]
- Muscle relaxant may treat rare form of diabetes, scientists find [Last Updated On: November 26th, 2014] [Originally Added On: November 26th, 2014]
- TESTIMONI LAMININE - Ginjal Diabetes dan Komplikasi - Video [Last Updated On: December 3rd, 2014] [Originally Added On: December 3rd, 2014]
- Laminine - Seminar Diabetes - Video [Last Updated On: December 5th, 2014] [Originally Added On: December 5th, 2014]
- Stem cells show promise for reversing type 2 diabetes [Last Updated On: March 19th, 2015] [Originally Added On: March 19th, 2015]
- Vitamin D prevents diabetes and clogged arteries in mice [Last Updated On: March 19th, 2015] [Originally Added On: March 19th, 2015]
- stemtech testimonial diabetes www afastemcell com - Video [Last Updated On: April 29th, 2015] [Originally Added On: April 29th, 2015]
- Afastemcell - testimoni penderita diabetes - Video [Last Updated On: April 29th, 2015] [Originally Added On: April 29th, 2015]
- Diabetes.net Welcome to the Original Diabetes Network [Last Updated On: May 9th, 2015] [Originally Added On: May 9th, 2015]
- Diabetes mellitus [Last Updated On: May 30th, 2015] [Originally Added On: May 30th, 2015]
- Type 2 Diabetes: Everything You Need to Know [Last Updated On: August 6th, 2015] [Originally Added On: August 6th, 2015]
- Diabetes Mellitus Center - Washington, DC - MedicineNet [Last Updated On: August 21st, 2015] [Originally Added On: August 21st, 2015]
- Washington, DC - American Diabetes Association [Last Updated On: August 21st, 2015] [Originally Added On: August 21st, 2015]
- Type 1 Diabetes: Causes, Tests, Symptoms and Treatments [Last Updated On: August 23rd, 2015] [Originally Added On: August 23rd, 2015]
- Type 2 Diabetes: Causes, Symptoms, Prevention, and More [Last Updated On: August 26th, 2015] [Originally Added On: August 26th, 2015]
- Diabetes mellitus - Wikipedia, the free encyclopedia [Last Updated On: August 27th, 2015] [Originally Added On: August 27th, 2015]
- Diabetes | Overview [Last Updated On: August 31st, 2015] [Originally Added On: August 31st, 2015]
- Virginia Diabetes and Endocrinology [Last Updated On: September 7th, 2015] [Originally Added On: September 7th, 2015]
- About Diabetes - American Heart Association [Last Updated On: September 8th, 2015] [Originally Added On: September 8th, 2015]
- Diabetes [Last Updated On: September 12th, 2015] [Originally Added On: September 12th, 2015]
- NIHSeniorHealth: Diabetes - What is Diabetes? [Last Updated On: September 12th, 2015] [Originally Added On: September 12th, 2015]
- Diabetes Symptoms: Common Symptoms of Diabetes [Last Updated On: September 12th, 2015] [Originally Added On: September 12th, 2015]
- Type 2 Diabetes Condition Center - Health.com [Last Updated On: September 12th, 2015] [Originally Added On: September 12th, 2015]
- Diabetes - Symptoms, Diagnosis, Treatment of Diabetes - NY ... [Last Updated On: September 12th, 2015] [Originally Added On: September 12th, 2015]
- Raleigh North Carolina Office of the American Diabetes ... [Last Updated On: September 12th, 2015] [Originally Added On: September 12th, 2015]
- Louisiana Office of the American Diabetes Association [Last Updated On: September 21st, 2015] [Originally Added On: September 21st, 2015]
- Diabetes Basics - What is Diabetes? - Lifeclinic [Last Updated On: October 3rd, 2015] [Originally Added On: October 3rd, 2015]
- Kentucky: Cabinet for Health and Family Services - Diabetes [Last Updated On: October 3rd, 2015] [Originally Added On: October 3rd, 2015]
- Albuquerque-Santa Fe, New Mexico American Diabetes [Last Updated On: October 7th, 2015] [Originally Added On: October 7th, 2015]
- Chicago Illinois Office of the American Diabetes Association [Last Updated On: October 16th, 2015] [Originally Added On: October 16th, 2015]
- Wisconsin Diabetes Prevention and Control Program | Wisconsin ... [Last Updated On: October 25th, 2015] [Originally Added On: October 25th, 2015]
- Diabetes Basics [Last Updated On: July 25th, 2016] [Originally Added On: July 25th, 2016]
- Diabetes: Symptoms, Causes and Treatments - Health News [Last Updated On: July 25th, 2016] [Originally Added On: July 25th, 2016]
- What Can I Eat If I Have Diabetes [Last Updated On: August 1st, 2016] [Originally Added On: August 1st, 2016]
- JDRF Type 1 Diabetes Research Funding and Advocacy [Last Updated On: August 5th, 2016] [Originally Added On: August 5th, 2016]
- children with DIABETES Online Community [Last Updated On: August 5th, 2016] [Originally Added On: August 5th, 2016]
- WHO | Diabetes programme [Last Updated On: August 5th, 2016] [Originally Added On: August 5th, 2016]
- Bridgewater, New Jersey - American Diabetes Association [Last Updated On: August 14th, 2016] [Originally Added On: August 14th, 2016]
- Diabetes Prevention and Control - New Jersey [Last Updated On: August 17th, 2016] [Originally Added On: August 17th, 2016]
- NJDOH - Family Health services - New Jersey [Last Updated On: August 17th, 2016] [Originally Added On: August 17th, 2016]
- Diabetes Australia [Last Updated On: August 18th, 2016] [Originally Added On: August 18th, 2016]
- Diabetes Facts & Information | Joslin Diabetes Center [Last Updated On: August 23rd, 2016] [Originally Added On: August 23rd, 2016]
- Diabetes mellitus type 2 - Wikipedia, the free encyclopedia [Last Updated On: August 23rd, 2016] [Originally Added On: August 23rd, 2016]
- Diabetes - Better Health Channel [Last Updated On: August 23rd, 2016] [Originally Added On: August 23rd, 2016]
- Diabetes Symptoms: American Diabetes Association [Last Updated On: September 1st, 2016] [Originally Added On: September 1st, 2016]
- Types of Diabetes | NIDDK [Last Updated On: September 7th, 2016] [Originally Added On: September 7th, 2016]
- Diabetes mellitus - Wikipedia [Last Updated On: October 26th, 2016] [Originally Added On: October 26th, 2016]
- Diabetes May Be Warning Sign of Pancreatic Cancer - WebMD [Last Updated On: February 6th, 2017] [Originally Added On: February 6th, 2017]
- Roche won't sell diabetes businessit's looking for deals to boost it instead - FierceBiotech [Last Updated On: February 6th, 2017] [Originally Added On: February 6th, 2017]