Prevalence of Diabetic Retinopathy: A Pilot Study from the SEARCH for Diabetes in Youth Study

Transcription

1 Prevalence of Diabetic Retinopathy: A Pilot Study from the SEARCH for Diabetes in Youth Study Elizabeth J Mayer-Davis, PhD University of North Carolina at Chapel Hill For the SEARCH Study Group, May 2014 Funded by CDC/DDT and NIH/NIDDK. Mayer- Davis et al, Diabet Med. 2012

2 SEARCH for Diabetes in Youth Scientific Rationale Increase in type 2 diabetes in youth in several populations especially minority Increase in type 1 diabetes incidence reported worldwide limited US data Reports of atypical diabetes with mixed phenotypes in youth 2

3 SEARCH Study Sites Seattle Children s Hospital Kaiser Permanente Southern California Cincinnati Children s Hospital Medical Center «South Carolina (Coordinated at UNC Chapel Hill) «Wake Forest School of Medicine (Coordinating Center) University of Washington (Central Laboratory) 3

4 Burden of Diabetes in US Youth Applied to US Census data, SEARCH estimated: 191,986 youth (age 0-19 yr) in the US had physiciandiagnosed diabetes in ,984 with T1D; 20,262 with T2D; 4,740 with other types ~18,400 youth are diagnosed with T1D each year ~5,100 youth are diagnosed with T2D each year Pettitt DJ et al., Diabetes Care 37: 2014; SEARCH Study Group, JAMA 2007; Lawrence et al, in review 4

5 Trends in T1D Prevalence, Prevalence per 1, % relative increase N= 4958 cases in 2001 N= 6666 cases in 2009 p< p< Overall Female Male NHW AA H API AI Dabelea and Mayer-Davis et al; JAMA May 7,

6 Trends in T2D Prevalence, , Among Youth Age Years Prevalence per 1, p< % relative increase N= 588 cases in 2001 N=819 cases in 2009 p< p< p< p< p= p=0.023 p< Overall Female Male NHW AA HISP API AI Dabelea and Mayer-Davis et al; JAMA May 7,

7 Prevalence of Poor Glycemic Control (A1c 9.0%) Race/Ethnicity Type 1 (%) Type 2 (%) Non- Hispanic White African- American Hispanic Asian / Pacific Islander NaJve American Petitti et al., J Peds,

8 Prevalence of Cardiovascular Risk Factors in Youth with Diabetes 100 Type 1 Type 2 80 Percent BP TG HDL Waist MetS MetS: > 2 CVD risk factors Rodriguez, et al, Diabetes Care,

9 Diabetes Metab 33: , 2007; Diabetes Care 29: , 2006; Control Clin Trials 25: , Diabetic Retinopathy (DR) Rationale and Objective Previous Prevalence Estimates For Type 1 diabetes (T1D): Range from 4.6% among youth in France to 20% among youth in Australia For Type 2 diabetes (T2D): 4% (n=25, mean duration 1.3 years) among youth from Australia SEARCH Pilot Study Objective: To assess the feasibility of assessment, and the prevalence of DR in the large, diverse cohort of youth with T1D and T2D in the US

10 Methods Data collection period December 2009 through September 2010 Participant characteristics Previous participation in SEARCH Diabetes duration > 5 years 225 individuals with T1D 179 non-hispanic white, 46 other 69 individuals with T2D 19 non-hispanic white, 50 other 10

11 Methods Assessment of DR Retinal images were obtained by non-mydriatic camera (Zeiss Visucam Pro NM) DR was determined by grading 45 color digital fundus images, centered on macula; both eyes Photo grading was conducted at the University of Wisconsin Ocular Epidemiology Reading Center Severity of DR was based on the worse eye Categorized as None, Minimal Non-Proliferative DR (NPDR), Mild-Moderate NPDR, or Proliferative (PDR) 11

12 Prevalence of Diabetic Retinopathy: Pilot Study PREVALENCE Prevalence n= Non-Hispanic White None Min DR Mild/Mod/PDR None Min DR Mild/Mod/PDR TYPE 1 diabetes Other Race/Ethnicity % for T1D (n=225) 49% for T2D (n=69) 4 16 TYPE 2 diabetes

13 Risk Factors for DR: SEARCH Pilot Study Risk Factor Odds RaJo (95% CI) P- Value Diabetes Type (Type 2 vs. Type 1) Race/Ethnicity (Non- white vs. NHW) HbA1c (%) 1.50 (0.58, 3.88) (0.97, 4.33) 0.06 No DR DR, Any Severity P- Value* 8.6 (70 mmol/mol) 9.4 (79 mmol/mol) Systolic Blood Pressure (mmhg) Diastolic Blood Pressure (mmhg) Log Albumin- to- CreaJnine RaJo LDL Cholesterol (mg/dl) HDL Cholesterol (mg/dl) Log Triglycerides *adjusted for diabetes type, race/ethnicity, durajon, HbA1c, gender, age, and parental educajon

14 What s Next? SEARCH Cohort Study Prevalence, incidence and correlates of diabetes complications: Subclinical macrovascular disease Nephropathy Neuropathy Retinopathy and retinal vessel caliber Data collection underway: ~ 2000 youth/young adults examined thus far ~ 3000 total anticipated by March

15 Thank You SEARCH Study Participants and Their Families SEARCH Principal Investigators Beth Mayer-Davis, PhD, Carolinas Site, Study Co-Chair Dana Dabelea, MD, PhD, Colorado and Native American Site PI, Study Co-Chair Larry Dolan, MD, Ohio Site PI Jean Lawrence, ScD, MPH, MSSA, California Site PI Cate Pihoker, MD, Washington Site PI Santica Marcovina, PhD, ScD, Central Laboratory PI Ronny Bell, PhD, Ralph D Agostino, Jr., PhD, Coordinating Center Co-PIs Giuseppina Imperatore, MD, PhD, Sharon Saydah, PhD, CDC Barbara Linder, MD, PhD, NIDDK 15

16 Back-up Info 16

17 Registry Study Design PREVALENT to date* Prevalent 2001 T1D: 5,323 Prevalent 2001 T2D: 712 Prevalent 2009 T1D: 6,679 Prevalent 2009 T2D: 827 INCIDENT to date* Incident T1D: 12,091 Incident T2D: 3,282 * As of 3/25/2014 In person visit (IPV) IPV Proposed IPV Prevalence Proposed SEARCH 1 SEARCH 2 SEARCH 3 SEARCH 4 17