Type 1 diabetes is an autoimmune metabolic condition of childhood onset. It occurs as a result of autoimmune destruction of insulin-producing β cells. The disease is incurable and managed through administration of insulin, physical activity, nutrition management, blood glucose monitoring, and avoidance of either severe hypoglycemia or prolonged hypoglycemia. The aim of treatment is to maintain optimal control of blood glucose levels so as to prevent micro- and macrovascular complications. Diabetic retinopathy is one of these complications. If it is not treated early, it causes microvascular changes in the eyes that result in avoidable and permanent blindness. In patients with type I diabetes, retinopathy is rare during the first 3-5 years of the condition and before puberty. Almost all patients with type 1 diabetes develop retinopathy during the next two decades of life though. Indeed, it is the most common cause of blindness amongst adults aged 20-74 years (Fong et al., 2004).
In the 1990s, the prevalence of diabetic retinopathy amongst adolescents in the US was 41-42 %. This led to the intensification of diabetes management following which a decline in the trend of the condition was noted (Mohsin et al., 2005). Achievement of optimal glucose control amongst young people was, however, noted to be problematic (Downie et al., 2011). Due to its chronic nature, self management is a key component of the treatment of the disease (Patton, 2006). The issue of nonadherence to treatment is, however, a serious problem particularly amongst adolescents (Taddeo, Egedy, & Frappier, 2008). An array of studies has reported nonadherence rates ranging from 10-89% in this group. Nonadherence is reported in relation to administration of insulin, following of dietary and exercise regimens, and other management measures (Patton, 2006).
Significance of the Problem
The problem of diabetic retinopathy is significant because type 1 diabetes is a significant health burden to children and adolescents. The disease (type 1 diabetes) accounts for 5-10% of all cases of diabetes (Patton, 2006). Further, the prevalence of the disease has been on an upward trajectory over the past few decades especially amongst non-Caucasian children and adolescent groups (Imperatore et al., 2012). The exact causes of the surge in the incidence of the disease are unknown but are thought to be related to an alarming increase in the prevalence of childhood obesity and environmental changes (Pozzilli et al., 2011). Current estimates suggest that the disease affects one in every 600 children in the United States (Patton et al., 2006). At an individual level, low or poor adherence compromises glucose control and increases the risk of occurrence of diabetic retinopathy (Patton, 2006). It also contributes to a poorer quality of life, overuse of health care services, escalations of health care costs, and treatment failure. Notably, despite the reported increase in the prevalence of type 1 diabetes and the high rates of non-adherence to treatments, only a few studies have sought to determine the prevalence of diabetic retinopathy amongst adolescents diagnosed with the condition within the last 10 years. One such study was conducted by Downie et al. (2011) in Australia. In addition, some of the statistics indicating a decline of diabetic retinopathy are based on cohort studies that have been following up the participants of the Diabetes Control and Complications Clinical trial conducted in the 1990s. The incidence of diabetic retinopathy in the population of interest may have increased due to the high rates of non-adherence to treatment.
References
Downie, E., Craig, M. E., Hing, S., Cusumano, J., Chan, A. K. F., & Donaghue, K. C. (2011). Continued reeduction in the prevalence of retinopathy in adolescents with type 1 diabetes: Role of insulin therapy and glycemic control. Diabetes Care, 34(11), 2368- 2373.
Fong, D. S., Aiello, L., Gardner, T. W., King, G. L., Blankenship, G., Cavallerano, J. D., Ferris, F. L. & Klein, R. (2004). Retinopathy in diabetes. Diabetes Care, 27(1), 1584-1587.
Hood, K. K., Rohan, J. M., Peterson, C. M., & Drotar, D. (2010). Interventions with adherence- promoting components in pediatric type 1 diabetes. Diabetes Care, 33(7), 1658-1664.
Imperatore, G., Boyle, J. P., Thompson, T. J., Case, D., Dabelea, D., Hamman, R. F., Lawrence, J. M., Liese, A. D., Liu, L. L., Mayer-Davis, E. J., Rodriguez, B. L., & Standiford, D. (2012). Projections of type 1 and type 2 diabetes burden in the U.S. population aged <20 years through 2050. Diabetes Care, 35(12), 2515-2520. Mohsin, F., Craig, M. E., Cusumano, J., Chan, A. K., Hing, S., Lee, J. W., Silink, M., Howard, N. J., & Donaghue, K. C. (2005). Discordant trends in micro vascular complications in adolescents with type I diabetes from 1990 to 2002. Diabetes Care, 28(8), 1974-1980. Patton, S. R. (2006). Adherence to treatment in children and adolescents with type one diabetes mellitus. Michigan: University of Michigan. Pozzilli, P., Guglielmi, C., Caprio, S., & Buzzetti, R. (2011). Obesity, autoimmunity, and double diabetes in youth. Diabetes Care, 34(2), S166-S170. Taddeo, D., Egedy, M., & Frappier, J. (2008). Adherence to treatment in adolescents. Pediatrics and Child Health, 13(1), 19-24.
