Clinical Outcomes and Cost-Effectiveness of Retinopathy Screening in Youth With Type 1 Diabetes

Since type 1 diabetes can lead to asymptomatic microvascular disease, regular screening for diabetic retinopathy (DR) in youth with type 1 diabetes has been recommended. The American Diabetes Association (ADA) (1) advises annual retinopathy screening once a child is 10 years old and has had type 1 diabetes for 3–5 years. This recommendation may have been appropriate in the pre-intensive treatment era, when elevated A1C levels were associated with early development of DR (2). However, results of the Diabetes Control and Complications Trial (3) demonstrated that intensive treatment in adolescents markedly delayed early microvascular changes in the retina. Since A1C levels in youth with type 1 diabetes are much lower now than they were 20 years ago (4,5), the yield from such screening examinations is also likely to be reduced. Most DR screening studies have been carried out by retinal specialists using state-of-the-art technology (6). In many pediatric diabetes clinics like ours, however, general ophthalmologists and optometrists do not use advanced techniques to perform most routine eye screening, which may reduce the likelihood of identifying early retinal changes. The aim of this study was to examine the prevalence of positive DR exams in our Pediatric Diabetes Clinic population in comparison to the yield from blood pressure and microalbuminuria screening in the same patients. Charts of all type 1 diabetic patients in our Diabetes Clinic were …