Recent reports indicate that up to 45% of children, principally minority youth, with newly diagnosed diabetes have diabetes mellitus type 2 (DM2). This disease was previously thought to occur only in adults and is distinct from other types of diabetes: immune-mediated diabetes type I(DMI), maturity onset diabetes of the young (MODY), and atypical diabetes. The emerging epidemic of DM2 among minority youth presents an urgent need for an assessment of their ocular health. The urgency for a systematic evaluation of retinopathy in Hispanic children is further heightened by data from adults with DM2 that indicate that Mexican Americans in San Antonio have a threefold increased risk of severe retinopathy due to diabetes relative to non-Hispanic whites. To date, no studies have systematically evaluated the extent and magnitude of diabetic eye disease in this new at-risk group. Accordingly, we will perform intensive ophthalmologic examinations and stereoscopic fundus photography of children with diabetes type 2 and compare them to children with diabetes type 1. The project has several objectives: 1) to obtain clinical and photographic data on the prevalence of retinopathy in these at-risk populations, 2) to correlate the retinal microaneurysm count with glucose control (Hgb Alc) in each group, 3) to examine for risk factors for vision-threatening retinopathy very early in the course of the disease, and 4) to establish cohorts for prospective, longitudinal analyses. Patients will benefit individually from an assessment of their ocular health early in the disease. On a wider scale, data gathered in this study will guide refinement of standards for monitoring and treating DM2 in pediatric, adolescent, and early adult patients, as well as serve as foundation for future targeted epidermiologic investigations, clinical interventions in diabetic eye disease, and public health projections in pediatric DM2. It is reasonable to suspect that pediatric DM2 patients will develop overt vision loss earlier in their lives (and therefore suffer from it longer) than the stereotypical middle-aged adult with DM2. The explosion of diabetes type 2 diagnoses in children, especially among minorities, highlights the urgency for addressing this emerging public health crisis.
