Endocrine Abstracts (2009) 23 OC6.3

Audit of paediatric diabetic eye screening

Navpreet Dhillon, Adele Farnsworth, Lesley Porter, Nick Shaw, Jeremy Kirk, Wolfgang Hoegler & Tim Barrett

Birmingham Children’s Hospital NHS Trust, Birmingham, UK.

Introduction: NICE recommends annual screening for diabetic retinopathy in children with type 1 diabetes aged over 12 years and/or with duration of diabetes over 5 years. This audit aimed to evaluate patient attendance for retinopathy screening, to identify the prevalence of retinopathy and maculopathy and to ascertain characteristics of patients.

Methods: This was a retrospective audit of patients attending for eye screening from January 2008 to April 2009, in a large paediatric diabetic clinic (n=329). Data from the Twinkle database was used to identify patient attendance, sociodemographic information, HbAlc, duration of diabetes and microalbuminuria. Patients with retinopathy were compared to those without retinopathy.

Results: Of 145 /189 (89%) eligible patients attended screening, median (range) for age 13.5 (7.1–18.2) years, duration of diabetes 6.0 (0.5–13.8) years, and HbAlc 8.9 (5.8–14)%. Of 29/145 (20%) patients had stage one retinopathy (one or more haemorrhage and/or microaneurysms). Patients with retinopathy had a significantly higher HbAlc (9.9 vs 8.7%), longer duration of diabetes (8.1 vs 5.5 years) and higher microalbuminuria (10.1 vs 7.1 mg/mmol), (all P<0.05). There was no significant relationship of retinopathy to age.

Conclusion: There are significant differences in metabolic control in children with or without early retinopathy. Diabetic retinopathy is a common finding even within a paediatric clinic. Feedback of results to patients can be used as a motivational factor to improve glycaemic control. The significant rate of microvascular complications in this paediatric cohort stresses the urgent need to implement alternative strategies to improve glycaemic control with the goal to reduce long-term morbidity and mortality.

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