title: Diabetic retinopathy in pediatric patients with type-1 diabetes: effect of diabetes duration, prepubertal and pubertal onset of diabetes, and metabolic control.
abstract: OBJECTIVE
  The objective of this study was to determine the contribution of prepubertal and pubertal onset and duration of diabetes to the development of diabetic retinopathy.
  
  
  METHODS
  A total of 1391 standardized fundus examinations (stereo fundus-photography) were performed in 441 children or adolescents with type-1 diabetes (median age 15.5 years, median duration of diabetes 6.3 years).
  
  
  RESULTS
  Mild nonproliferative retinopathy was present in 72 patients (median age 19.9 years). Life table analysis revealed a median duration of diabetes until retinopathy was first diagnosed at 16.6 years (95% confidence interval: 15.3 to 18.3). Patients were stratified according to diabetes onset before or in puberty (> or = 10.4 years in girls, > or = 12.2 years in boys). In children with a prepubertal onset of diabetes, retinopathy occurred after a pubertal duration of 10.9 years compared with 15.1 years in children with onset of diabetes in puberty (p < 0.01), demonstrating the additional risk conveyed by the prepubertal years of diabetes. Long-term metabolic control had a significant influence on the prevalence of retinopathy: patients with a median HbA1c > or = 7.5% had development of retinopathy on average after 15.5 years compared with 18.3 years in patients with lower HbA1c values (p < 0.05).
  
  
  CONCLUSIONS
  Both prepubertal and pubertal duration of diabetes are relevant for the development of background retinopathy. Good metabolic control should be attempted irrespective of age.
authors.affiliation: Department of Pediatrics, University of Ulm, Germany.
authors.forename: R W
authors.initials: RW
authors.lastname: Holl
authors.forename: G E
authors.initials: GE
authors.lastname: Lang
authors.forename: M
authors.initials: M
authors.lastname: Grabert
authors.forename: E
authors.initials: E
authors.lastname: Heinze
authors.forename: G K
authors.initials: GK
authors.lastname: Lang
authors.forename: K M
authors.initials: KM
authors.lastname: Debatin
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000378:metabolism; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D015993:Life Tables; D008297:Male; D015995:Prevalence; D011627:Puberty / Q000378:metabolism; D013997:Time Factors