Iraqi Postgraduate Medical Journal

Abstract

ABSTRACT:
BACKGROUND:
Diabetes mellitus is characterized by hyperglycemia and glycosuria and is an end point of a few disease processes. The most common type occurring in childhood is type 1 DM, which is accompanied by chronic and dangerous micro vascular changes affecting most body systems, especially the eye, leading to cataract and diabetic retinopathy. Diabetic retinopathy without appropriate management is emerging as one of the leading causes of blindness. Therefore, it is necessary to identify relevant risk factors, improve the early diagnosis and management of diabetic retinopathy to reduce the risk of blindness.
OBJECTIVE:
To estimate the presence of eye complications (cataract and retinopathy) among children and adolescent with type1 diabetes mellitus and to study the effect of various factors on their occurrence.
PATIENTS AND METHODS:
This study was carried out over nine months period(from first of May till the end of January) at Children Welfare Teaching hospital/Medical City .It included 150 children who had type1diabetes mellitus for at least 4 years in children with pre pubertal onset of diabetes and two years in children with pubertal onset .History was taken, physical examination and investigations were done, then ophthalmological examination looking for eye complications (cataract or retinopathy) performed by ophthalmologist. Statistical analysis done using T test, Chi square, P value <0.05 regarded as statistically significant
RESULTS:
This study included 150 patients with type 1 diabetes mellitus, their age ranges from 4.5 - 19 years, with duration ranges from 2-18 years. Female to male ratio was 1.8:1.Out of 150 diabetic patients, 24/150 (16%) had eye complications, 9 (6%) of them had retinopathy while other 15 (10%) had cataract .The age of all patients who had eye complication was >10 years which is highly significant (P value: 0.009) and the incidence of eye complications increases with increasing duration of diabetes (p value 0.04). Twenty two (14.7%) female and two (1.3 %) male had eye complications, which is highly significant (P value: 0.002). HbA1c >10 in 17/24 (70.8%) patients with eye complications. there were significant association between the presence of eye complications and macroalbuminuria (p value: 0.02), and limited joint mobility (p value: 0.001) .out of 24 patients with eye complications, 16 (66.6%) patients had short stature and 7(4.7%) patients had celiac disease.
CONCLUSION and recommendations:
The incidence of eye complications (cataract and diabetic retinopathy) increases with increasing age and duration of diabetes and it is more common in female and it is associated with the presence of other chronic complications (LJM, nephropathy and short stature).So screening all patients with type 1 DM according to the guidelines is required for early detection and treatment of eye complications using new methods like fundal photography.