With diabetes on the rise among the young, doctors of optometry have an opportunity to educate patients

May 3, 2017
Many young people, even after diagnoses, are not being examined for diabetes retinopathy.

The incidence of young people with diabetes is on the rise in the U.S., and so are the complications of the disease, recent studies have shown.

In a study published April 13 in The New England Journal of Medicine ( NEJM) , researchers looked at the prevalence of the disease among 11,245 youth ages 0 to 19 and another 2,846 with type 2 diabetes ages 10 to 19 years of age. The research covered a 10-year period.

Adjusting for such variables as age, sex and race/ethnic group, the number of newly diagnosed diabetes type 1 cases rose 1.8% per year, while the annual rate for newly diagnosed diabetes type 2 cases increased by 4.8%. The study calls the diagnosis of diabetes in youth, "a substantial clinical and public health burden."

"The incidences of both type 1 and type 2 diabetes among youths increased significantly in the 2002-2012 period, particularly among youth of minority racial and ethnic groups," the NEJM reported.  

Linking diabetes and eye disease  

A second study , published in the Journal of the American Medical Association on Feb. 28, looked at children and adolescents with early onset diabetes in five U.S. states: California, Colorado, Ohio, South Carolina and Washington.  

The observational study involved 1,746 students with type 1 diabetes and 272 with type 2 diabetes over a five-year period. Researchers found a higher prevalence of complications and comorbidities among young people with type 2 diabetes than type 1.  

Complications cited in the study included diabetic kidney disease, retinopathy, peripheral neuropathy, cardiovascular autonomic neuropathy, arterial stiffness and hypertension.  

"Among teenagers and young adults who had been diagnosed with diabetes during childhood and adolescence, the prevalence of complications and co-morbidities was higher among those with type 2 diabetes compared with type 1, but frequent in both groups," the study concluded. "These findings support early monitoring of these patients for development of complications."  

In both studies, the young people were part of a SEARCH for Diabetes in Youth registry, a national study launched in 2000 to research diabetes among children and young adults. The study is funded by the Centers for Disease Control and Prevention and the National Institute of Diabetes and Digestive Kidney Disease.

A third study appeared March 23 in JAMA Ophthalmology. The study's authors reported that of 12,686 youth 21 years of age or younger, only "65% with type 1 diabetes and 42% with type 2 diabetes had undergone an eye examination by 6 years after initial diabetes diagnosis."  

The authors write, "Despite possessing health insurance, many youths with diabetes are not receiving eye examinations by 6 years after initial diagnosis to monitor for DR (diabetic retinopathy)."  

Role of doctors of optometry  

The results come as no shock to doctors of optometry, such as David Masihdas, O.D., of Salt Lake City, Utah, and Tina MacDonald, O.D., of Beverly Hills, California, who frequently see these patients in their practices.  

"It doesn't surprise me," says Dr. MacDonald, a diabetes educator. "The fact that the numbers are increasing saddens me. We need to be reaching more people."  

Still, both doctors expressed optimism for young people with diabetes.  

"It used to be that the diagnosis of diabetes was a death sentence," Dr. Masihdas says. "That's no longer true. Nowadays you can live a full life being diabetic."

Both doctors agree—education is key in helping young people manage their diabetes, because the risk of developing diabetes and its serious complications grow as we get older.

Dr. Masihdas explains to patients with diabetes that their treatment will be like a three-legged stool: eating right, exercising and taking their medication.  

"Doctors of optometry need to be more proactive," says Dr. Masihdas, noting that some patients and doctors may be uncomfortable with the conversation. "What I have found is that if I know someone is at risk, I talk to them in general terms and educate them on why they need to make changes in their lifestyle. As health care providers, we need to let them know how they can take care of their vision and eye health. Patients generally appreciate talking about it."  

Patients also will need support, even the ones who have managed their disease successfully, Dr. MacDonald says. Both doctors expressed concerns over a recent study that suggested patients with type 1 diabetes could reduce the frequency of their eye exams, depending on their risks for diabetes.  

"No one wants to think they are the ones who will get complications," Dr. MacDonald says. "But they do. I'd like to see more parents have their children get comprehensive, dilated eye examinations. And the public needs to be educated on what good health is."  

She adds, "Every encounter with a doctor of optometry is a good, worthwhile one."   In 2014, doctors of optometry diagnosed 240,000 patients with diabetes after coming to their practices for regular eye examinations.  

For additional information on diabetes, read the AOA's evidenced-based clinical practice guideline Eye Care of the Patient With Diabetes Mellitus.

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