ESPE Abstracts

Introduction: Diabetic retinopathy is a leading microvascular complication and preventable cause of vision loss. NHS diabetes eye screening program (DESP) assesses for early signs, with population prevalence between 3.5% and 24.2%. Understanding the factors involved is important to reduce morbidity.

Aims and objectives: Establish clinical characteristics and modifiable risk factors for patients with retinopathy identified by DESP under the care of Leeds Children’s Hospital.

Material and methods: Retrospective case control, comparing patients with evidence of diabetic retinopathy vs age-matched control. Patients identified by DESP, mild non-proliferative diabetic retinopathy (NPDR) (R1/M1) or more severe. Review data collected as part of routine care from the diabetes management system (DMS) and electronic records.

Results: Retinopathy was apparent in 9.7% of those eligible for eye screening (n=37/380). There was a female predominance at 59.4% (n=22/37) compared to the control group 47.2% (n=27/36). On average, the retinopathy group had 2.6 years longer duration of diabetes and lower clinic attendance. The mean last two HbA1C measurements were higher in the retinopathy group (n=69.9mmol/mol and 71.4mmol/mol) compared to control (n=60.6mmol/l and 58.7mmol/mol). Similarly time in range (TIR) was lower (n=43% vs n=52%). More of those in the retinopathy group had an HbA1C >80mmol/l 29.7% (n=11/37) vs 13.8% n=5/36). There was more technology uptake in the control group; pump use 63.8% (n=23/36) vs 54.0% (n=20/37), hybrid closed-loop (HCL) (n=5 vs n=1) and 86.1% (n=31/36) using sensors vs 75.6% (n=28/37). The retinopathy group had more evidence of other microvascular disease, urine albumin-creatinine ratio (uACR) 1.35mg/mmol vs 0.7mg/mmol, with 5 patients in retinopathy group having uACR >2.5mg/mmol compared to 0.0mg/mmol. Importantly both groups mean body mass index (BMI) standard deviation score (SDS) were in the overweight category (SDS>+1) and mean total lipids and triglycerides exceeded recommended cut offs of >4mmol/l and >1mmol/l respectively. More patients had high triglycerides (>1.5mmol/l) in the retinopathy group 27.0% (n=10/37) vs 8.3% (n=3/36). Systolic blood pressure (SBP) was comparable.

Conclusion: Rates of retinopathy are comparable to previous studies. Observationally, those with retinopathy were mostly female, had slightly higher mean HbA1C, lower mean TIR and longer mean duration of diabetes. Those with retinopathy were twice as likely to have a meanHbA1C >80mmol/l. Technology uptake was 10% greater in those without retinopathy, with additional five times greater HCL use. Engaging the teenagers with poor control remains a key challenge, notably those with retinopathy had poorer clinic attendance. Additionally the importance of lifestyle intervention has been highlighted.