Endocrine Abstracts

Retinopathy is one of the more serious complications of type 1 diabetes. There is emerging knowledge re the development of retinopathy in childhod diabetes. We studied the clinical profiles of children with retinopathy in an industrial town in Northern England. The current clinic size is 160. 42 patients were identied from clinic records as having retinopathy. Formal screening is offered to all patients from age 12. The age range was 11–20 years; median age 16. 55% were female and 45% male. 41 patients had type 1 diabetes mellitus and 1 patient had glucokinase deficiiency We looked at average HBA1C of each of these patients since diagnosis. The average HBA1C was 80.38 mmol. The range of average HBA1c was from 41.7 to 112 mmol. The NPDA audit for the corresponding time period showed a clinic mean HBA1C of 68.8. The average duration of diabetes in the 42 patients was 8 years and 9 months. 40 out of the 42 patients had been admitted to hospital because of their diabetes (the North-West average is that 17.2% of paediatric diabetes patients get admitted annually). Altogether there were 167 admissions: 55 due to DKA, 25 due to a hypoglycaemic episode requiring third party assistance and 86 admissions as a result of high blood sugars. Only two patients never had a hospital admission related to their diabetes. Four patients had a history of hypoglycaemic seizures. Four patients had pre proliferative or proliferative changes. The others had background changes only. These four patients had an average HBA1c of 103.4 and a cumulative total of 10 admissions due to DKA. There were three cases of maculopathy This study shows that development of diabetes retinopathy correlates with higher HBA1C and longer duration of diabetes. The development of retinopathy in individuals with excellent HBA1C scores also indicates the presence of individual susceptibility to microvascular disease. There is clearly a much higher than usual number of admissions and episodes of severe hypoglycaemia and DKA in this group. Further research could show if the relationship between retinopathy and DKA/severe hypoglycaemia is in itself causative or merely an association with poorer control.