Purpose

To analyze the systemic and ocular outcomes in patients with young-onset type 2 diabetes (YO-DM2) based on grade of presenting diabetic retinopathy (DR).

Methods

Retrospective cohort study analysis of empaneled patients with type 2 diabetes <40 years old with retinopathy screening within the Los Angeles Department of Health Services between 01/01/2017–07/01/2021 were included. Patients were stratified based on presenting severity of DR determined on fundus photographs or clinical examination. Patient's systemic co-morbidities and ocular outcomes were then compared across each group. Procedural (e.g. intravitreal injections) and surgical interventions (e.g. pars plana vitrectomy) were documented as performed by the treating physician.

Results

2795 patients were screened from 12,456 patients diagnosed with diabetes younger than age 40 (22.4 %). Of these, 1496 patients were diagnosed with type 2 DM. 1084 (72.4 %) of patients presented without DR, 307 (20.5 %) presented with non-proliferative diabetic retinopathy (NPDR), and 105 (7.0 %) of patients presented with proliferative diabetic retinopathy (PDR). Increasing presenting diabetic retinopathy severity was associated with longer duration of diabetes, greater systemic comorbidities (e.g. diabetic foot disease, neuropathy, chronic kidney or end stage renal disease), worse baseline and final visual acuity, and required more procedural and surgical interventions.

Conclusions

Worse presenting DR severity in patients young-onset type 2 diabetes was associated with greater comorbid systemic and ocular disease with worse visual acuity outcomes. <1 % of patients without diabetic retinopathy or with mild NPDR were likely to progress to PDR. Diabetic kidney disease was an independent risk factor for developing neovascular glaucoma and retinal detachments. Prompt evaluation and intervention in patients with YO-DM2 may help reduce the associated systemic and ocular morbidity.

中文翻译：

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早发 2 型糖尿病患者的全身和眼部结局

目的

根据糖尿病视网膜病变 (DR) 的分级，分析早发 2 型糖尿病 (YO-DM2) 患者的全身和眼部结局。

方法

回顾性队列研究分析了 2017 年 1 月 1 日至 2021 年 1 月 7 日期间在洛杉矶卫生服务部接受视网膜病变筛查的 2 型糖尿病 <40 岁患者。根据眼底照片或临床检查确定的 DR 严重程度对患者进行分层。然后比较各组患者的全身合并症和眼部结果。由治疗医生执行的程序（例如玻璃体内注射）和手术干预（例如平坦部玻璃体切除术）被记录下来。

结果

从 12,456 名 40 岁以下诊断为糖尿病的患者中筛查了 2795 名患者（22.4%）。其中，1496 名患者被诊断患有 2 型糖尿病。1084 名 (72.4%) 患者没有出现 DR，307 名 (20.5%) 患者出现非增殖性糖尿病视网膜病变 (NPDR)，105 名 (7.0%) 患者出现增殖性糖尿病视网膜病变 (PDR)。糖尿病视网膜病变严重程度的增加与糖尿病病程较长、全身合并症（例如糖尿病足病、神经病变、慢性肾病或终末期肾病）、基线和最终视力较差有关，并且需要更多的手术和手术干预。

结论

年轻发病的 2 型糖尿病患者的 DR 严重程度更严重，与更严重的全身性疾病和眼部疾病相关，视力结果更差。没有糖尿病视网膜病变或轻度 NPDR 的患者中，<1% 的患者可能进展为 PDR。糖尿病肾病是发生新生血管性青光眼和视网膜脱离的独立危险因素。对 YO-DM2 患者进行及时评估和干预可能有助于减少相关的全身和眼部发病率。