ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Pediatr Diabetes. 2020 Feb;21(1):106–111. doi: 10.1111/pedi.12936. PMID: 31618523

Children with type 1 diabetes (T1DM) should be screened regularly for signs of retinopathy by fundus photography in order to prevent visual impairment. According to Danish national guidelines, screening should take place at ages 12, 15, and 18 years after a minimum of 3 years of diabetes duration. As glycemic control has improved over time, the prevalence of retinopathy is expected to have decreased.

This study investigated the prevalence, degree, and progression of retinopathy in children with T1DM, to inform the question whether screening at age 12 years is currently still indicated in Denmark. Data on all Danish children with T1DM onset between 2003 and 2013 (n =2943) were collected from the ‘DanDiabKids’ registry. 2382 children had registered screenings.

The prevalence of retinopathy at ages 12, 15, and 18 years was 0.9%, 2.3%, and 3.1%, respectively. Only minimal background retinopathy was detected in over 90% overall, and in 100% at 12 years. On subsequent rescreening, retinopathy had resolved spontaneously in 87.5% of cases overall, and in 100% of cases detected at 12 years.

Thus, the prevalence of retinopathy in Danish T1DM children is low. At 12 years, the prevalence was 0.9%, all with minimal background retinopathy, and this resolved in 100% on rescreening. Retinopathy screening at age 12 years in Denmark does not seem to have any clinical relevance.

Even with improved glycemic control due to intensive insulin treatment, after 30 years diabetes duration 20% of all T1DM patients suffer from proliferative retinopathy. ISPAD guidelines recommend screening for retinopathy from age 11 years onwards and/or after 5 years of diabetes duration. The Danish national diabetes registry provides data on all children with T1DM up to age 18 years. Older Danish data from the 1990s showed evidence of diabetic retinopathy in 17.7%. However, in recent years metabolic control has improved and diabetic retinopathy in this age group seems to have become rare. This is well supported by the data in this study; all patients aged <15 years had only minimal background retinopathy that was completely reversible. Other recent studies have reported even lower prevalence of diabetic retinopathy. Screening recommendations for diabetic retinopathy in children should therefore be revised.