Diabetes mellitus is an autoimmune metabolic disease characterized by the destruction of pancreatic β cells (CD4 + and CD8 + T cells and infiltration of macrophages in the pancreatic islets), usually associated with insulin deficiency, resulting in a pathological concentration of glucose in the blood.
Type 1 diabetes mellitus (DM1) is one of the most common chronic diseases in children, onset at the age of 20 and represents a major challenge to global public health.
Although children and adolescents with type 1 diabetes are daily threatened by acute complications of hypoglycemia and ketoacidosis, it is the long-term microvascular and macrovascular alterations that expose them to the risk of major multi-organ complications (liver, eye, heart, kidney).
As for the visual apparatus, the most serious complication is diabetic retinopathy (RD), which can occur in all types of diabetes and lead to severe visual damage and even blindness if not treated in time with the correct therapies.
The percentage of risk and the age at which the ocular pathology manifests itself are variable elements, although it is not uncommon that a form of RD may already be present at the time of the first diagnosis of diabetic disease.
A Danish prospective study that followed children and adolescents with DM for 1 years reported the prevalence of RD (at different stages) in 8% of patients in the age group 17.7 to 12 years and 15% in those aged between 45,4 and 16 years, up to 20% after 67,6 years. Based on other studies conducted in England and Canada, it has been shown that the risk of developing RD depends on the age of onset of diabetes that often precedes the diagnosis of the disease and on the extent of hyperglycemia over time. A study conducted in Australia found that 20% of children and adolescents with DM24 develop RD 1 years after the onset of the disease.
How to prevent?
The management of small patients with DM1 can be improved by making use of the new non-invasive diagnostic technologies available today. Insulin pumps, digitization and sharing of biomedical data, and real-time analysis of results have resulted in significant improvements in glycemic control. It is good to remember that blood pressure and lipid control is also necessary, and that collaboration between the various medical figures involved (diabetologist, nephrologist, endocrinologist, ophthalmologist, primary care pediatrician and nutritionist) is essential.
With regard to the periodic check-up by the ophthalmologist of the patient with DM1, the use of diagnostic technologies is essential to monitor any pathological changes in the retinal vascular network, macula, optic nerve and lens over time.
Fundus retinography with Wide Angle for the study of the peripheral retina, Optical Coherence Tomography (OCT) to exclude the presence of diabetic macular edema and non-contact biometry to highlight the metabolic changes of the lens that may occur during the course of the disease, are fundamental tests in the monitoring of ocular clinical conditions and must be repeated in follow-up once a year.
An early diagnosis and teamwork between the different specialties can make the life of young patients simple, making the diabetic pathology an easy element for them to manage and control, living a peaceful life knowing that sight, supreme valuable asset, it is safe.
