Introduction  

Diabetes mellitus (DM) refers to a group of diseases where enough insulin is not produced. It can also result when a person’s body system fails to respond to the insulin produced. Sugar in the blood is controlled by insulin, a hormone. If diabetes is not managed, it can cause high blood sugar levels leading to damaged nerves, organs, and blood vessels.

Patients with diabetes mellitus can develop diabetic retinopathy (DR), a disorder that affects the eyes. In recent years, lifestyle changes have seen an increase in diabetes among young people. There has been a significant increase in children and young adults with type 1 and 2 diabetes, putting them at risk of losing their vision. Though DR is preventable, it is the leading cause of impaired vision in young people. Diabetes is more common in developed nations than in developing countries, primarily due to obesity. Research indicates that children will develop DR five to 15 years after DM diagnosis.
 

Types

Three types make up DM, which include:

  • Type 1 diabetes caused by a lack of insulin production. Insulin injections or pumps are needed to manage this type
     
  • Type 2 diabetes caused by cells that do not use insulin effectively. It is managed with a combination of exercise, diet, and oral medications
     
  • One that occurs during gestation or pregnancy

 

Causes & Risk Factors 

A lack of enough insulin production causes diabetes. It can also result from the body cells’ failure to respond to insulin. There are certain risk factors associated with DR's development. Some of them can be treated or avoided, such as smoking, obesity, blood pressure, etc. However, some of the risk factors are unavoidable or untreatable and include:

  • Puberty - Some studies have shown that hormonal changes in puberty constitute a risk factor for the development of DR
     
  • Studies have shown that pregnancy is a risk factor because of factors such as hypertension and poor metabolic control
     
  • Diabetes - All patients with diabetes carry the risk of developing DR, and the risk increases with those who do not manage to control blood sugar well
     
  • Duration of disease - How long a patient has had DM is a risk factor. Typically, the duration within which children or patients can develop DR is eight to ten years after the diagnosis of DM
     
  • Age - Age is related to how long one has had diabetes. Thus, the longer a person has had diabetes, the higher the chances of developing DR. Children, therefore, have a minimal risk of developing significant eye complications. Very little literature exists on DR's presence in children under ten years with type 1 diabetes, and even if there is DR, it is mild

 

Signs & Symptoms 

Patients with DM may or may not have symptoms. Signs and symptoms of type 1 diabetes may develop over several weeks and include:

  • Increased thirst
     
  • Increased hunger
     
  • Frequent urination
     

The most common sign of the presence of gestational and type 2 diabetes is increased blood glucose.
 

Signs and symptoms of DR include:

Blurry vision
The lens of the eye can swell if the blood glucose in a patient is high. Once the level of glucose is normalized, blurry vision disappears

Cataracts
The cataract can obscure or blur vision, requiring surgery

Glaucoma
DM patients have an increased likelihood of developing glaucoma than the general population. Glaucoma develops with increased eye pressure and can lead to loss of vision or blindness

Retinopathy
It refers to the leakage, blockage, or abnormal growth of the retina's blood vessels. With retinopathy, children can lose the sharp central vision used to see fine details. Children under 10 are unlikely to develop retinopathy, and the risk increases with the duration of DM
 

Diagnosis

DM must be diagnosed early so that patients undergo routine screening for DR. DR can progress rapidly in adolescents and lead to irreversible blindness. DM is diagnosed through specific blood tests. These include glycated hemoglobin (A1C), fasting blood sugar,  random blood sugar and oral glucose tolerance tests.

DR is diagnosed through the following:

Physical eye examination
The doctors check for abnormal blood vessels, optic nerve abnormalities, bleeding in the eye, any fatty retinal deposits, etc.

Optical coherence tomography
Imaging tests can provide a cross-sectional retinal image. This examination can also be useful in monitoring the effectiveness of treatment

Fluorescein angiography test
Pictures are taken after the eyes have been dilated and a special dye injected into a vein. These images can tell which blood vessels are leaking or closed
 

Treatment 

DM has no cure, but one can lead a long life by managing the disease. Early diagnosis and treatment of DR is essential to spare vision.
 

Medical Treatment

The patient will be closely monitored to determine when to begin treatment. Anti-VEGF medications can be injected into the eye to block new blood vessels' growth and treat retinopathy to preserve vision.
 

Surgical Treatment

In advanced DR, surgical intervention is required, depending on how the retina has been affected. Photocoagulation can stop blood and fluid from leaking. Panretinal photocoagulation is used to shrink the abnormal blood vessels while a vitrectomy helps to remove blood and scar tissue.
 

Home Care

Healthy eating is imperative in the management of DM. Recommended foods are those high in fiber and nutrition but low in calories and fat. Avoid sugary foods, carbohydrates, and unsaturated fats. A 30-minutes aerobic exercise session is recommended because physical activity transports sugar into the cells, thus lowering blood sugar. Insulin therapy, careful monitoring, oral medications, and surgery (in some cases) can manage types 1 and 2.
 

Prognosis & Long-Term Outlook

Without treatment, DM can lead to a stroke, blindness, damaged kidneys and nerves, heart attack, and peripheral vascular disease. With proper control of blood sugar, a child can grow to live a long life and reduce diabetic eye disease. If DR is not treated, it can lead to blindness.
 

Prevention & Follow Up

The chances of developing or being significantly impacted by DR are reduced with better blood sugar control. Patients must measure their blood sugar levels as directed by the physician. Once a diagnosis of DM is made, the patient must undergo an eye examination. Follow-up visits will then be scheduled where screening for DR continuously takes place. Patients aged nine and above are screened three to five years after DM diagnosis and attend annual eye examinations. Some guidelines suggest that the first screening should occur at puberty following DM diagnosis followed by yearly exams.