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Diabetes Care 24:1699, 2001
© 2001 by the American Diabetes Association, Inc.

Letters: Comments and Responses
Letter

Response to Ehrlich

John I. Malone, MD

Diabetes Center, Health Sciences Center, University of South Florida, Tampa, Florida

Dr. Ehrlich’s (1) point is well taken. The Diabetes Control and Complications Trial data did not include subjects under the age of 13 years. Our study (2) was not intended to deal with the subject of retinal exams for prepubertal children. Most physicians who care for children with diabetes agree with Dr. Ehrlich, who stated "retinal changes are almost never present in children before puberty." This claim seems to overlook the Wisconsin Epidemiologic Study of Diabetic Retinopathy (3), a population-based study that reported that 4 of 26 children (15.4%) aged 0–9 years and 23 of 42 children (54.8%) aged 10–12 years, or 27 of 68 children (40%) aged 0–12 years, had retinopathy on retinal color photographs. This widely accepted study suggests that retinopathy does occur before puberty. If knowledge of the presence of microvascular disease in a patient is not important before it becomes vision-threatening, as suggested by Dr. Palmberg (4), then exams before puberty may be unnecessary. One should not believe, however, that microvascular disease does not exist in prepubertal children who have diabetes.

FOOTNOTES

Address correspondence and reprint requests to John I. Malone, MD, Diabetes Center, Health Sciences Center, University of South Florida, 12901 Bruce B. Downs Blvd., MDC 45, Tampa, FL 33612. E-mail: jmalone{at}hsc.usf.edu.

References

  1. Erlich RM: Response to Malone et al. (Letter). Diabetes Care 24:1698, 2001[Free Full Text]
  2. Malone JI, Morrison AD, Pavan PR, Cuthbertson DD: Prevalence and significance of retinopathy in subjects with type 1 diabetes of less than 5 years’ duration screened for the Diabetes Control and Complications Trial. Diabetes Care 24:522–526, 2001[Abstract/Free Full Text]
  3. Kline R, Klein BEK, Moss SE, Davis MD, DeMets DL: The Wisconsin Epidemiologic Study of Diabetic Retinopathy. IX. Four-year incidence and progression of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmology 107:237–243, 1989[Abstract]
  4. Palmberg P: Screening for diabetic retinopathy (Editorial). Diabetes Care 24:419–420, 2001 [Free Full Text]

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This Article
Right arrow Extract Freely available
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