الفهرس 
Type 1 Diabetes Mellitus & Diabetic RetinopathyOnly 14 pages are availabe for public view
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Abstract
ABSTRACT
Introduction: Despite being uncommon before adulthood, the pathogenesis of diabetic retinopathy (DR) starts during childhood. Optical coherence tomography angiography (OCTA) permits non-invasive visualization of retinal microcirculation. Fibroblast growth factor-21 (FGF21) plays an important role in glucose and lipid homeostasis and diabetic microangiopathy. Aim: to assess early OCTA changes among children and adolescents with T1DM, compared to fundus and correlate them to diabetes-duration, glycemic control and FGF21; hence, determine their value in early detection of DR. Methodology: Hundred children and adolescents with T1DM, regularly attending the Pediatrics and Adolescents Diabetes Unit (PADU) were assessed for diabetes-duration, insulin therapy, glycated-hemoglobin (HbA1c), hypoglycemia and diabetic ketoacidosis frequency, Tanner staging, fasting lipids, urinary albumin/creatinine ratio (UACR) and serum FGF21. OCTA and fundus were done for the studied patients and 100 age, gender and Tanner matched healthy controls. Results: The mean age of the children and adolescents with T1DM was 10.84 years, their mean diabetes-duration was 3.27 years and their median serum FGF21 was 150 pg/ml. Serum FGF21 was significantly higher among children and adolescents with T1DM than controls (p<0.001). Children and adolescents with T1DM had significantly larger foveal avascular zone (FAZ) and lower peripapillary and inside-disc capillary densities (p<0.05); with no significant fundus difference (p=0.155) than controls. FAZ was positively correlated and peripapillary and inside-disc capillary densities were negatively correlated with diabetes-duration, HbA1C, FGF21 and Tanner stage. Multivariate-regression revealed that FAZ is independently associated with diabetes-duration, HbA1C and FGF21. Conclusion: Children and adolescents with T1DM exhibit OCTA changes early in the course of diabetes; long before the fundus changes. These changes are correlated with diabetes-duration, puberty, glycemic-control and FGF21.