Youth with Diabetes Not Receiving Screenings for Retinopathy

Children with diabetes unlikely to receive ophthalmologic exams in accordance with guidelines.

The prevalence of type 2 diabetes among children and young adults has increased over the past several years, likely due to high rates of childhood obesity. The US Census projects that type 2 diabetes cases among this population will quadruple and type 1 diabetes cases will triple by 2050, with racial and ethnic minorities disproportionately affected.

Despite the growing incidences of type 2 diabetes among children, findings from a study published by JAMA Ophthalmology suggest that this group is not receiving screenings for retinopathy.

Diabetic retinopathy is a serious condition that can lead to blindness if left untreated. Unfortunately, diabetic retinopathy is typically asymptomatic until late stages, which makes screening for the condition especially important.

However, different recommendations suggest that patients receive their first screening at different times, varying from 3 to 5 years after initial diagnosis depending on age in some cases, according to the study.

Previous studies have found that only one-third of patients with type 1 diabetes receive screenings within the guidelines. The investigators found that age, diagnosis of type 2 diabetes, and diabetes duration have been linked to not receiving the recommended screenings.

In the current study, the authors evaluated the rate of eye examinations among children with diabetes and sociodemographic factors that may be associated. Included in the study were inpatient and outpatient claims for enrollees under age 21 with health insurance.

A total of 5453 children with type 1 diabetes and 7233 children with type 2 diabetes participated. A majority of patients with diabetes were white, with a smaller portion of black and Latino patients.

Compared with type 2 diabetes, patients with type 1 were more likely to receive eye examinations. Within 6 years of diagnosis, 64.9% of children with type 1 diabetes and 42.2% of children with type 2 diabetes had received the screening, according to the study.

The authors reported that white and Asian children received more eye examinations, compared with black and Latino children. Approximately 54.7% of white and 57.3% of Asian children received screenings within 6 years of diagnosis, while only 44.6% of black and 41.6% Latino children received an exam.

Compared with whites, black and Latino children were 11% and 18% less likely to receive the eye exam, according to the study. Additionally, children from higher income families were more likely to receive the eye exam than children from lower income families.

Overall, the authors found that only 31.1% of children with diabetes received the screening, despite its recommendation by numerous professional societies.

The authors noted that their findings confirm results from prior studies, while also discovering that race and socioeconomic status can influence adherence to ophthalmic examination recommendations in youth with diabetes, according to the study.

Although all populations were insured, black and Latino children and those from lower income families were less likely to receive the screening. This finding is particularly concerning because these populations are estimated to have the largest growing diabetes prevalence in the future.

Increasing the uptake of screening for diabetic retinopathy (DR) in children would likely reduce the number of serious, sight-threatening complications, according to the article. Further studies should examine how to best target populations that are not receiving the screenings.

“Identifying ways to improve adherence to ophthalmic screening guidelines, including for racial minorities and economically disadvantaged youth, can help with timely diagnosis of DR so that sight-threatening consequences of DR can be avoided,” the authors concluded.