Ophthalmologist examining an older Black, male patient's eyes to carry out retinal imaging to look for diabetic retinopathy.
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Research led by the Cleveland Clinic in Florida shows that rates of diabetic retinopathy are increasing, most rapidly in younger people and in Black and Hispanic populations.

Diabetic retinopathy, a vascular disorder affecting the retina in the eye, is a significant cause of blindness in the U.S. Anyone with diabetes, type 1, type 2 or even less common types such as gestational diabetes, can develop retinopathy as a complication of their condition.

A paper published in 2021 suggests that just over a quarter of people with diabetes (around 9.6 million people) in the U.S. have diabetic retinopathy and, of these, around a fifth have sight threatening disease.

The current study, published in JAMA Ophthalmology, looks at how rates of diabetic retinopathy changed between 2015 and 2022 in the U.S. The cross-sectional study used data from the TriNetX Analytics health research network including 56 health care organizations and 359,126 people with type 1 or type 2 diabetes and retinopathy.

Overall, prevalence of retinopathy associated with type 1 diabetes increased by 15 percent and with type 2 diabetes by seven percent between 2015 and 2022.

However, lead author Rishi Singh, vice president and chief medical officer, Cleveland Clinic Martin North and South Hospitals, and colleagues noted significant differences between population groups.

For example, people with type 1 diabetes between the age of 20 and 29 years had a 4.7-fold increase in retinopathy prevalence in 2022 versus 2015. Similarly, the 30–39 years group with type 1 diabetes had a 1.96-fold increase. Increases in prevalence in older groups were smaller and ranged between 1.06 and 1.17-fold. Overall, White men with type 1 diabetes had the highest rates of retinopathy, followed by White women with the condition.

In people with type 2 diabetes, younger groups also had a more significant increase in retinopathy prevalence than older groups, although the difference was not as striking as for type 1 diabetes.

Population groups had a stronger impact in people with type 2 diabetes. Compared with White women with type 2 diabetes, Hispanic men and women with the condition were 4.08- and 2.49-fold more likely to have retinopathy in 2022, respectively, followed by Black men and women at respective 2.23- and 2.0-fold increases. White men with type 2 diabetes had a greater prevalence of retinopathy than White women with the condition, but less than Black or Hispanic people with type 2 diabetes.

“These findings support diabetic retinopathy screening in young adults and for type 2 diabetic retinopathy interventions specifically designed for racial and ethnic minoritized patients most affected by disease,” write the authors.

Writing in an accompanying commentary article in the same journal, David Rein, a researcher at the University of Chicago, and his co-author comment: “The increase in diagnosed DR prevalence observed [in this study] is complex and likely affected by multiple factors.”

“These factors may include increased recognition of the need to screen for and identify diabetic retinopathy in younger adults with diabetes, increased attention to diabetic retinopathy among all patients with diabetes since the introduction of new effective pharmacological treatments, increased access to health insurance via the Affordable Care Act and COVID-19 public health emergency declarations, and potential increases in rates of diabetic retinopathy incidence among people with diabetes. However, this last factor remains unknown and requires additional study.”

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