A Worrisome Increase in Diabetic Retinopathy Prevalence Among Young Adults

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Researchers say their findings of increased prevalence argue for screening for diabetic retinopathy in young adults.

Diabetic retinopathy is one of the leading causes of blindness the U.S., and research findings reported in JAMA Ophthalmology show that the prevalence is increasing overall and spiking among young people.

Diabetic retinopathy among people with type 1 diabetes ages 20 to 29 increased almost fivefold, from 6.5 persons per 100,000 in 2015 to 30.7persons per 100,000 in 2022, according to the research results. Among those with type 2 diabetes, the prevalence jumped 2.5-fold in the 20-29 age group, from 9.6 persons per 100,000 in 2015 to 23.6 persons per 100,000 in2022.

The overall increase among people with type 1 diabetes, ages 20 to 70, was 15%, from 61.4 persons per 100,000 in 2015, to 70.4 persons per 100,000 in 2022. Among those with type 2 diabetes, the increase was small, just 7%, from 432.7 persons per100,000 in 2015 to 461.7 per 100,000 in 2022.

When lead author Jonathan Markle, M.D., of the Centerfor Ophthalmic Bioinformatics Research at the Cole Eye Institute in Cleveland, and his colleagues looked at the prevalence by race and ethnicity they found that the prevalence increases were higher among Hispanic patients with type 2 diabetes. For example, the 20-29 age group, the prevalence of diabetic retinopathy jumped over fivefold compared with the 2.5-fold increase for that age group overall.

The basic outlines of these findings fit with those from other studies. But Markle and his colleagues say their study has a breakdown of people with type 1 and 2 diabetes that many other studies lack. They also said their study included data from more age groups than and the entire country, used an electronic health record database that encompasses 93 million patients at 56 healthcare organizations throughout the country.

When Markle and his colleagues analyzed patients by race, gender and ethnicity, White males had the highest prevalence of diabetic retinopathy among those with type 1 diabetes and Hispanic males, the highest prevalence among those with type 2 diabetes.

“The substantial racial and ethnicity population differences observed among Black and Hispanic or Latino patients with T2DR [type 2 diabetic retinopathy] can likely be traced back to established factors, such as socioeconomic risk factors, lack of insurance, education, access to care and comorbidities such as obesity and hypertension” wrote Markle and his colleagues.

In their conclusion, Markle and his colleagues say their findings argue for screening for diabetic retinopathy among young adults and the development of diabetic retinopathy interventions about Hispanic and Black patients with type 2 diabetes to keep the condition from getting worse.

The research findings were published online on the JAMA Ophthalmology website on June 13.

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