Earlier Age of Diabetes Diagnosis Linked with Worse DR Development, Progression

Subgroup analyses revealed the protective effect seen of older age at diagnosis only existed in specific demographics, notably non-insulin users and those with clinical indicators within the normal range, like with vitamin D and other markers. Photo: Mohammad Rafieetary, OD. Click image to enlarge. A recent investigation published in Scientific Reports elucidated the relationship between diabetes onset and worsening of its ocular manifestations. The study included data from the National Health and Nutrition Examination Survey (NHANES).After analysis of the NHANES data (n=877), it was found that the diabetic retinopathy (DR) group had a significantly younger age of diabetes diagnosis than the DR-free group displayed. It was also found that there was a significant negative association between age of diagnosis and DR prevalence, which Mendelian randomization analysis further supported. Yet another kind of analysis revealed peak DR occurrence probability to be at ages 24.5 and 24.2 in two separate approaches. What’s more, younger age at diagnosis was linked with increased DR severity across all categories. Taken together, older age of diagnosis was associated with a protective effect against both development and progression of retinopathy.The authors of the investigation broadly state that these findings “underscore the importance of increased vigilance and more frequent screening for DR in patients diagnosed with diabetes at a young age.”In the discussion section of their paper, the researchers explain possible mechanisms for the effect of older age offering protection against DR. One possibility may be due to younger patients experiencing more rapid b-cell function deterioration, in turn leading to prolonged periods of poor glycemic control, which is a known risk factor for DR. Another explanation may lie in that angiogenic factors, especially VEGF, decrease with age. Younger patients may respond more robustly to VEGF, with the possibility of accelerating retinal vascular complications. A third explanation may be caused by hormonal changes that take place during puberty and adolescence, exacerbating complication risk in early-onset diabetes. This is because sex steroids and growth hormone elevated at this time can overstimulate b-cells and add to insulin resistance. Finally, this subset of patients may have lower adherence to treatment regimens and hence worse glycemic control.The authors then elaborate that their findings support these proposed mechanisms, as they observed that decreasing age of diabetes onset also coincided with trends of lower education level, higher BMI and waist circumference, elevated HbA1c levels, longer diabetes duration, higher proportion of insulin use and increased energy intake. This reflects other reports, one of which indicated those with diabetes who were ≤45 years old had significantly higher HbA1c levels and a higher proportion of insulin injections than those diagnosed at an older age. The authors particularly note that their mediation analysis revealed HbA1c and insulin use mediated the relationship between age at diagnosis and DR risk, with insulin use displaying a greater mediation effect. They caution that “this underscores the critical role of glycemic control and early insulin dependence in the development of DR among younger-onset diabetes patients.” Click here for the journal source.  Li H, Wang B, Liu C. Association between age at diabetes diagnosis and the development and progression of diabetic retinopathy. Sci Rep. 2025(15):13827.