Marie-Ève Robinson1, Ketly Altenor2, Christopher Carpenter3, Ric Bonnell4, Eddy Jean-Baptiste5, Julia von Oettingen1,6. 1. Department of Pediatrics, Division of Endocrinology, McGill University Health Centre, Montreal, QC, Canada. 2. Kay Mackenson Clinic, Pierre Payen, Haiti. 3. Department of Pediatrics, University of California, San Francisco, California. 4. Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Texas at Austin, Austin, Texas, United States of America. 5. Haitian Foundation for Diabetic and Cardiovascular Diseases, Port-au-Prince, Haiti. 6. Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States of America.
Abstract
BACKGROUND: Ophthalmic complications of pediatric diabetes are rare, and rates are unknown in Haitian youth. OBJECTIVES: To determine the prevalence and predictors of diabetic retinopathy (DR) and cataracts in a cohort of Haitian youth with insulin-treated diabetes. METHODS: We performed a cross-sectional retrospective review of pediatric patients with diabetes from a pediatric chronic disease center in Haiti, from December 1, 2012 to November 1, 2016. Data collection included demographic and anthropometric information, total daily insulin dose and result of eye examination by a local ophthalmologist. RESULTS: Of 67 patients (54% female, mean age at diagnosis 14.6 ± 3.9 years, mean diabetes duration 3.3 ± 3.0 years, mean HbA1c 84 ± 22 mmol/mol (9.8% ± 2.0%), mean current insulin requirement 0.49 ± 0.28 IU/kg/day), DR was diagnosed in 10/57 (18%) and cataracts in 10/62 (16%), at a mean age of 19.0 ± 4.3 and 19.1 ± 3.3 years, respectively. Diabetes duration was 4.9 ± 5.4 and 3.0 ± 1.5 years at the time of diagnosis of DR and cataracts, respectively. Age at complication, insulin requirement, sex, body mass index, family history, mean HbA1c and diabetes duration were not significant predictors of an ocular complication. CONCLUSIONS: In this cohort of Haitian youth, DR and cataracts occur prematurely. Low-insulin requirements years after diagnosis, possibly allowing for prolonged undetected hyperglycemia prediagnosis, may explain complication risk. The phenotypes of diabetes in pediatric populations of African ancestry may be distinct. Ophthalmologic evaluation should possibly start at diagnosis, and screening guidelines may need to be adapted.
BACKGROUND: Ophthalmic complications of pediatric diabetes are rare, and rates are unknown in Haitian youth. OBJECTIVES: To determine the prevalence and predictors of diabetic retinopathy (DR) and cataracts in a cohort of Haitian youth with insulin-treated diabetes. METHODS: We performed a cross-sectional retrospective review of pediatric patients with diabetes from a pediatric chronic disease center in Haiti, from December 1, 2012 to November 1, 2016. Data collection included demographic and anthropometric information, total daily insulin dose and result of eye examination by a local ophthalmologist. RESULTS: Of 67 patients (54% female, mean age at diagnosis 14.6 ± 3.9 years, mean diabetes duration 3.3 ± 3.0 years, mean HbA1c 84 ± 22 mmol/mol (9.8% ± 2.0%), mean current insulin requirement 0.49 ± 0.28 IU/kg/day), DR was diagnosed in 10/57 (18%) and cataracts in 10/62 (16%), at a mean age of 19.0 ± 4.3 and 19.1 ± 3.3 years, respectively. Diabetes duration was 4.9 ± 5.4 and 3.0 ± 1.5 years at the time of diagnosis of DR and cataracts, respectively. Age at complication, insulin requirement, sex, body mass index, family history, mean HbA1c and diabetes duration were not significant predictors of an ocular complication. CONCLUSIONS: In this cohort of Haitian youth, DR and cataracts occur prematurely. Low-insulin requirements years after diagnosis, possibly allowing for prolonged undetected hyperglycemia prediagnosis, may explain complication risk. The phenotypes of diabetes in pediatric populations of African ancestry may be distinct. Ophthalmologic evaluation should possibly start at diagnosis, and screening guidelines may need to be adapted.
Authors: Vera A Essuman; Naa N Tagoe; Akye Essuman; Benjamin Abaidoo; Josephine Akpalu; Harold A Sackey; Charles F Hayfron-Benjamin; George Asare; Albert G B Amoah; Thomas A Ndanu; Imelda D B Ofori-Adjei; Nana A Barnes; Benedicta L Appiah-Thompson; Winfried M Amoaku Journal: Int J Environ Res Public Health Date: 2022-04-27 Impact factor: 4.614