Related Experiment Videos
Biomedical and psychiatric risk factors for retinopathy among children with IDDM
1Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania, USA.
Insights
Diabetic retinopathy risk in childhood-onset insulin-dependent diabetes mellitus (IDDM) increases with longer disease duration and poor glycemic control. Clinical depression also significantly elevates this risk, suggesting it as a vulnerability marker.
Area of Science:
- Pediatrics
- Endocrinology
- Ophthalmology
Background:
- Diabetic retinopathy is a major complication of childhood-onset insulin-dependent diabetes mellitus (IDDM).
- Both illness duration and glycemic control are known influences on retinopathy development.
- Psychosocial factors, such as psychiatric disorders, also impact diabetes outcomes, but their combined effect with biomedical factors on retinopathy risk is not well understood.
Purpose of the Study:
- To investigate the combined influence of biomedical and psychosocial factors on the risk of developing retinopathy in children with newly diagnosed IDDM.
- To model retinopathy risk using antecedent biomedical and psychosocial variables in a longitudinal study.
Main Methods:
- A prospective longitudinal study of 66 children (aged 8-13 years) newly diagnosed with IDDM.
- Psychiatric diagnoses were derived from repeated assessments.
- Retinopathy severity was assessed after a median follow-up of 10 years and modeled using stepwise polychotomous regression.
Main Results:
- Increased risk of retinopathy was associated with longer duration of IDDM, persistent poor glycemic control (top 15% HbA1), and longer duration of depressive illness.
- These factors contributed individually and additively to retinopathy risk, with IDDM duration providing a baseline risk.
- In 27% of patients, depression onset preceded retinopathy detection by approximately 7 years.
Conclusions:
- Duration of IDDM and antecedent clinical depression are significant risk factors for retinopathy, independent of glycemic control.
- Depression may serve as a marker for identifying a subgroup of patients at higher risk for diabetic complications.
- The findings suggest that timely treatment of depression could potentially help prevent or delay the onset of diabetic retinopathy.
Objective:
Illness duration and glycemic control influence the development of retinopathy in childhood-onset insulin-dependent diabetes mellitus (IDDM). Psychiatric disorders and sociodemographic factors also affect diabetes-related outcomes. However, biomedical and psychosocial factors have not been examined together in modeling the risk of retinopathy.
Research Design And Methods:
We conducted a single-site prospective longitudinal study of 66 children (aged 8-13 years) newly diagnosed with IDDM. Repeated assessments served to derive psychiatric diagnoses. Poor glycemic control was defined as the upper 15th percentile of all HbA1 values. After a median follow-up of 10 years, severity of retinopathy was determined. It was modeled with a stepwise polychotomous regression procedure using antecedent biomedical and psychosocial variables.
Results:
Young adults with childhood-onset IDDM were found to be at increased risk of retinopathy the longer they had IDDM, the more persistently they evidenced poor antecedent glycemic control, and the longer they suffered from depressive illness. These three factors operated individually and additively, with duration of IDDM conferring a baseline level of risk. In depressed patients (27%), depression onset antedated the detection of retinopathy generally by 7 years.
Conclusions:
Duration of childhood-onset IDDM confers a baseline level of risk of retinopathy irrespective of glycemic control; antecedent clinical depression is also a risk factor. Depression therefore may serve as a marker of vulnerability and help to identify a subgroup of patients at risk for complications. The findings raise the question whether timely treatment of depression could forestall diabetic retinopathy.