Type 2 diabetes in adolescent people puts their eyes at risk

Karl, 16, is seen for the first time in my optometry practice. He was referred to me because of fluctuating vision. During the examination, I noticed signs that he might have diabetes, which could explain the fluctuating vision. This suspicion became a reality when his GP confirmed the diagnosis. Karl’s world was turned upside down.

As an optometrist, I invite you to immerse yourself in a reality that should concern us all.

What is diabetes?

Diabetes is an insidious disease. Its symptoms (thirst, frequent need to urinate, fatigue, weight loss, darkening of skin areas on the neck and armpits) often go unnoticed, at least in the early stages of the disease.

Diabetes affects life one in 14 people in Canada (7%) and one in 10 in North America (10%).

There are two types of diabetes:

• Type 1which is insulin dependent and develops when the body is unable to produce the insulin needed to metabolize the sugars we eat and that feed our tissues

• Type 2which develops when insulin is produced, but not in sufficient amounts. Sometimes the insulin that is produced is not effective in doing its job.

Type 1 diabetes is usually associated with the development of the disease in childhood and adolescence. Type 2, the most common, usually develops later in life, often after 50.

A Counterintuitive, but Not Uncommon Diagnosis

From this definition, it would be logical to conclude that Karl had type 1 diabetes, the course of which is well-controlled and treated by doctors. However, in his case, after performing the required tests, the doctor diagnosed him with type 2 diabetes. This diagnosis is counterintuitive and poses sedate challenges. The speed of onset, initial severity of the disease, and the mechanisms of resistance or reduced insulin secretion may be different in patients who develop the disease at a younger age. than in adults.

In addition, treatment options, which involve trial and error, become more convoluted due to the much longer duration of this type of disease when it begins at a adolescent age. Both enormous and petite changes which affect the blood vessels in patients with type 2 diabetes can have sedate and complex to predict consequences, as treatment can last from 40 to 60 years.

However, Karl’s situation is not unique. More and more young people and teenagersespecially those who are overweight, obesity and sedentary lifestylesuffers from type 2 diabetes. Almost 75 percent of them parents or siblings with diabetes.

Although at first glance this confirms that genetics is a risk factor for developing the disease, in this particular case it was more of a consequence bad lifestyle habits, especially eating habits and lack of physical activitywhich are often used by the whole family.

Effect on eyesight

The fact that Karl developed type 2 diabetes earlier in life, rather than later, also puts him at greater risk for eye complications. article this topic has recently come to my attention. This study analyzed data from 1,362 people with diabetes living in Minnesota, North America, and then extrapolated it to Canada. The data was collected between 1970 and 2019, which also allows us to measure the evolution of the situation over the past decades.

The results are astonishing: adolescent people with type 2 diabetes (compared to type 1 diabetics of the same age) are 88 times more likely to develop retinopathy (abnormal blood vessels and/or hemorrhages in the retina). In addition, the risk of this retinopathy becoming “proliferative,” and therefore sight-threatening, increases 230-fold. There is also a 49-fold enhance in the risk of fluid accumulating in the retina (macular edema) and a 243-fold enhance in the risk of developing mature cataracts at a adolescent age. The latter requires surgery, which is riskier in adolescent people than for age-related cataracts.

What should we remember from this? That the major problems, which often require surgical intervention to save vision, appear much sooner in adolescent type 2 diabetics than in those afflicted with type 1 diabetes. Therefore, these patients need to be monitored more closely. Indeed, almost one in two type 2 diabetics will develop some form of retinopathy within one to eight years of diagnosis. By comparison, one in three type 1 diabetics will develop retinopathy within six to 10 years of diagnosis.

Crucial repercussions

The incidence (number of cases) of type 2 diabetes in adolescent people is expected to have increased significantly over the past 10 years. quadrupled by 2050. This forecast is most alarming for health care providers, but also for policymakers and managers of public health agencies. The lifetime direct medical care costs for a single patient with diabetes aged 25–44 years amounted to $125,000 in 2013. These costs have since risen, and many more dollars must be added to cover the 15 to 25 years that are not taken into account. Indeed, if 20 percent of the youth population develops diabetes by 2050, our governments will have to spend millions (perhaps billions?) of health care dollars to treat them.

The long-term quality of life of people with diabetes also declines. Another studythis time adolescent people with type 1 diabetes, shows that their disease has a negative impact on their lives. They have to spend a lot of time caring for them (lack of activity with friends). And the burden of the disease on their loved ones weighs on their shoulders. The fear of hypoglycemia (a lack of sugar that can lead to coma) or the development of sedate complications of the disease also affects them. Achieving autonomy is more complex for these teenagers, and their quality of life is proportional to the freedom they can or cannot exercise.

Eat fit, exercise and see your eye doctor

Type 1 diabetes is complex to prevent, mainly because we do not know all the causes of its occurrence and we cannot actively detect it. The situation is different for type 2 diabetes, which is strongly associated with an unhealthy lifestyle in adolescent people. A fit diet, regular exercise and combating a sedentary lifestyle, including limiting screen time (to less than two hours per day), are good ways to avoid or delay the onset of diabetes in adolescent people. Screen time is also associated with insulin resistance AND obesity in adolescent people. In other words, a fit lifestyle must be promoted and especially shared within the family.

When it comes to your eyes, regular visits to an optometrist or ophthalmologist can aid detect early signs of diabetic complications (symptoms are apparent in 30% of patients shortly after diagnosis). These health professionals can also detect other eye and vision problems resulting from the disease, such as: loss of ability to focus close up (accommodation), partial paralysis of some eye muscles causing double vision, delayed healing of corneal surface lesions, dry eye or glaucoma. Tests need to be carried out at the time of diagnosis of diabetesor in people at high risk (heredity, obesity, sedentary lifestyle).

Since fit habits are an integral part of treating the disease, it is not too tardy for Karl to enjoy a happier future. However, it is significant not to neglect regular check-ups with your doctor and repeated visits to your family optometrist.