Insulin Pump Use Linked With Decreased Risk of Diabetic Retinopathy in Young Patients With T1D

Insulin pump use may decrease risk of diabetic retinopathy (DR) development in young patients with type 1 diabetes (T1D), according to study findings published in JAMA Network Open.

With an increasing incidence of T1D and type 2 diabetes (T2D) in young people, the authors suggested that further investigation of comorbidities linked with these conditions is of increasing importance. Notably, diabetic macular edema and DR are 2 of the most common ophthalmic complications in patients with diabetes, with DR representing the leading cause of blindness among working-age adults worldwide.

“Studies have examined the prevalence of both pediatric and adult DR in multiple countries, but within the United States, the largest studies have focused on adults with diabetes,” said the study authors. “Although large pediatric cohorts from countries with national diabetes registries have been examined, US children, adolescents, and young adults are an increasing and diverse group who are not well represented by these studies.”

Seeking to estimate the burden and risk factors of DR among young US populations, researchers conducted a cross-sectional study of data derived from 2 large pediatric hospitals that have robust DR screening programs, Baylor College of Medicine/Texas Children’s Hospital (BCM/TCH) Diabetes and Endocrine Care Center and Johns Hopkins University (JHU) Pediatric Diabetes Center.

In the study, data on 1640 patients aged 5 to 21 years with T1D (n = 1216) or T2D (n = 416) were collected (mean [SD] age, 15.7 [3.6] years; 867 female individuals [52.9%]).

Prospective data were collected at the JHU center from December 3, 2018, to November 1, 2019, via point-of-care screening using fundus photography (n = 308), and retrospective data were derived from the BCM/TCH center via electronic health records of those who received point-of-care screening using retinal cameras between June 1, 2016, and May 31, 2019 (n = 1332).

Demographic and clinical data were also assessed, including insurance status, duration of diabetes, receipt of medications, and patient-reported race and ethnicity:

• 506 (30.9%) were Hispanic.
• 384 (23.4%) were non-Hispanic Black.
• 647 (39.5%) were non-Hispanic White.
• 103 (6.3%) were of other races or ethnicities or did not specify.

In assessing medication use of participants, the investigators found that 558 of 1216 patients (45.9%) with T1D used an insulin pump, whereas 5 of 416 patients (1.2%) with T2D used an insulin pump. Incidence of DR was reported in 57 patients (3.5%).

For those who developed DR vs those who did not, a longer duration of diabetes (mean [SD], 9.4 [4.4] years vs 6.6 [4.4] years; P < .001) and higher glycated hemoglobin (A1C) levels (mean [SD], 10.3% [2.4%] vs 9.2% [2.1%]; P < .001) were found.

After adjusting for race and ethnicity, insurance status, diabetes duration, and A1C level, patients with T1D who reported insulin pump use were associated with a 57% decreased risk of DR (odds ratio [OR], 0.43; 95% CI, 0.20-0.93; P = .03).

“The number of patients with type 2 diabetes who were receiving insulin pump therapy was too small to allow a multivariable analysis that included pump use,” noted researchers.

When assessing medication use by race, patients with T1D who used an insulin pump vs those who did not were more likely to be White (361 of 558 patients [64.7%] vs 250 of 658 patients [38.0%], respectively; P < .001), with pump use significantly lower among Black patients (66 of 244 participants [27.0%]) compared with White patients (361 of 611 participants [59.1%]; P < .001).

Moreover, the likelihood of having DR was found to be 2.1 times higher among Black participants compared with White individuals (OR, 2.12; 95% CI, 1.12-4.01; P = .02)—a difference that did not remain significant after adjusting for duration of diabetes, insurance status, insulin pump use (among patients with T1D only), and mean A1C level. No significant differences were identified between White and Hispanic participants (OR, 1.22; 95% CI, 0.62-2.38; P = .57).

“Outcomes may improve further with the increased use of closed-loop or automated insulin delivery systems,” concluded researchers. “Future studies could investigate whether improved access to diabetes care and technologies, such as insulin pumps, may mitigate the racial disparities in DR prevalence.”

Reference

Ferm ML, DeSalvo DJ, Prichett LM, Sickler JK, Wolf RM, Channa R. Clinical and demographic factors associated with diabetic retinopathy among young patients with diabetes. JAMA Netw Open. Published online September 27, 2021. doi:10.1001/jamanetworkopen.2021.26126