Development and Progression of Diabetic Retinopathy in Adolescents and Young Adults With Type 2 Diabetes: Results From the TODAY Study
Open accessPublished version of a preprint
Abstract
OBJECTIVE: The Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study reported a 13.9% prevalence of diabetic retinopathy (DR) in youth with mean ± SD type 2 diabetes duration of 4.9 ± 1.5 years. After 7 years of additional follow-up, we report the risk factors for progression of DR in the TODAY cohort. RESEARCH DESIGN AND METHODS: Retinal photographs (n = 517) were obtained in 2010–2011 and again in 2017–2018 (n = 420) with standard stereoscopic seven-field digital fundus photography. Photographs were graded centrally using the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. A total of 367 patients with gradable fundus photographs in at least one eye at both assessments were included in analyses of progression of DR, defined as an increase of three or more steps on the ETDRS scale. RESULTS: With mean ± SD age of 25.4 ± 2.5 years and diabetes duration of 12.0 ± 1.5 years, there was a 49% prevalence of any DR among participants. Prevalence by DR stage was as follows: 39% for very mild or mild nonproliferative DR (NPDR), 6% moderate to severe NPDR, and 3.8% proliferative DR. Compared with nonprogressors, participants who progressed three or more steps had significantly lower BMI, higher HbA1c, higher blood pressure, increased triglycerides, decreased C-peptide, and higher prevalence of other comorbidities. Multivariate analysis demonstrated that HbA1c was the dominant factor impacting DR progression. CONCLUSIONS: Poor glycemic control of youth-onset type 2 diabetes imparts a high risk for progression of DR, including advanced, sight-threatening disease by young adulthood.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Patients diagnosed with hypertension are at higher risk for poor visual outcomes.
“Patients diagnosed with kidney disease, hypertension, and covered under Medicaid insurance are at higher risk for poor visual outcomes13–24.”
From Autonomous AI-assisted diabetic retinopathy screening at primary care is associated with increased presentation to eye care by at risk patients (2026) · cites this paper as [15]
The Risk Factors for Progression of DR section reports that hypertension was associated with a two- to fourfold higher likelihood of retinopathy progression in participants with youth-onset type 2 diabetes. The claim extends that finding to patients generally and to poor visual outcomes broadly; the paper measured retinopathy progression, and hypertension was not a significant predictor in its multivariate analysis. (LLM, conf=0.85)
Experimental — accuracy not yet measuredPatients diagnosed with kidney disease are at higher risk for poor visual outcomes.
“Patients diagnosed with kidney disease, hypertension, and covered under Medicaid insurance are at higher risk for poor visual outcomes13–24.”
From Autonomous AI-assisted diabetic retinopathy screening at primary care is associated with increased presentation to eye care by at risk patients (2026) · cites this paper as [15]
The Risk Factors for Progression of DR section reports that kidney disease was associated with a two- to fourfold higher likelihood of diabetic retinopathy progression in the TODAY cohort. This supports a higher risk of worsening retinal disease, but the study concerns young people with type 2 diabetes and does not establish poorer visual outcomes for patients with kidney disease generally. Page numbers were not available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPatients covered under Medicaid insurance are at higher risk for poor visual outcomes.
“Patients diagnosed with kidney disease, hypertension, and covered under Medicaid insurance are at higher risk for poor visual outcomes13–24.”
From Autonomous AI-assisted diabetic retinopathy screening at primary care is associated with increased presentation to eye care by at risk patients (2026) · cites this paper as [15]
The Risk Factors for Progression of DR section reports associations for hypertension and kidney disease, but does not address Medicaid coverage. Searches for Medicaid, insurance coverage, and socioeconomic status found no passage linking Medicaid insurance to retinopathy progression or poor visual outcomes. (LLM, conf=0.75)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Prevalence of Diabetic Retinopathy in the United States, 2005-2008
Zhang, X., Saaddine, J. B., Chou, C.-F., Cotch, M. F., Cheng, Y. J., Geiss, L. S., Gregg, E. W., Albright, A. L., Klein, B. E. K., & Klein, R. (2010) · JAMA · doi:10.1001/jama.2010.1111 · Cited by 1,196 · see citing works
Flagged first, then by citations
Research works printed but not linked: 22
- Lee R, Wong TY, Sabanayagam C. Epide- miology of diabetic retinopathy, diabetic macular edema and related vision loss. Eye Vis (Lond) 2015;2:17
- UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with con- ventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998;352:837-853
- Hainsworth DP, Bebu I, Aiello LP, et al.; Diabetes Control and Complications Trial (DCCT)/ Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group. Risk factors for retinopathy in type 1 diabetes: the DCCT/EDIC study. Diabetes Care 2019;42:875-882
- Chew EY, Davis MD, Danis RP, et al.; Action to Control Cardiovascular Risk in Diabetes Eye Study Research Group. The effects of medical mana- gement on the progression of diabetic reti- nopathy in persons with type 2 diabetes: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Eye Study. Ophthalmology 2014;121: 2443-2451
- RISE Consortium; RISE Consortium Invest- igators. Effects of treatment of impaired glucose tolerance or recently diagnosed type 2 diabetes with metformin alone or in combination with insulin glargine on b-cell function: comparison of responses in youth and adults. Diabetes 2019; 68:1670-1680
- Arslanian S, Kim JY, Nasr A, et al. Insulin sensitivity across the lifespan from obese adolescents to obese adults with impaired glucose tolerance: who is worse off? Pediatr Diabetes 2018;19:205-211
- Copeland KC, Zeitler P, Geffner M, et al.; TODAY Study Group. Characteristics of adol- escents and youth with recent-onset type 2 diabetes: the TODAY cohort at baseline. J Clin Endocrinol Metab 2011;96:159-167
- TODAY Study Group. Retinopathy in youth with type 2 diabetes participating in the TODAY clinical trial. Diabetes Care 2013;36:1772-1774
- Bjornstad P, Drews KL, Caprio S, et al.; TODAY Study Group. Long-term complications in youth- onset type 2 diabetes. N Engl J Med 2021;385: 416-426
- Zeitler P, Hirst K, Pyle L, et al.; TODAY Study Group. A clinical trial to maintain glycemic control in youth with type 2 diabetes. N Engl J Med 2012;366:2247-2256
- Zeitler P, Epstein L, Grey M, et al.; TODAY Study Group. Treatment options for type 2 diabetes in adolescents and youth: a study of the comparative efficacy of metformin alone or in combination with rosiglitazone or lifestyle inter- vention in adolescents with type 2 diabetes. Pediatr Diabetes 2007;8:74-87
- The effect of intensive diabetes treatment on the progression of diabetic retinopathy in insulin- dependent diabetes mellitus. The Diabetes Con- trol and Complications Trial. Arch Ophthalmol 1995;113:36-51
- White NH, Sun W, Cleary PA, et al. Prolonged effect of intensive therapy on the risk of retinopathy complications in patients with type 1 diabetes mellitus: 10 years after the Diabetes Control and Complications Trial. Arch Oph- thalmol 2008;126:1707-1715
- Levey AS, Eckardt KU, Dorman NM, et al. Nomenclature for kidney function and disease- executive summary and glossary from a Kidney Disease: Improving Global Outcomes (KDIGO) consensus conference. Eur Heart J 2020;41: 4592-4598
- Eppens MC, Craig ME, Cusumano J, et al. Prevalence of diabetes complications in ado- lescents with type 2 compared with type 1 diabetes. Diabetes Care 2006;29:1300-1306
- Nagi DK, Pettitt DJ, Bennett PH, Klein R, Knowler WC. Diabetic retinopathy assessed by fundus photography in Pima Indians with impaired glucose tolerance and NIDDM. Diabet Med 1997;14:449-456
- Scott A, Toomath R, Bouchier D, et al. First national audit of the outcomes of care in young people with diabetes in New Zealand: high prevalence of nephropathy in Maori and Pacific Islanders. N Z Med J 2006;119:U2015 19. Dabelea D, Stafford JM, Mayer-Davis EJ, et al.; SEARCH for Diabetes in Youth Research Group. Association of type 1 diabetes vs type 2 diabetes during childhood and adolescence with complications during teenage years and young adulthood. JAMA 2017;317:825-835
- TODAY Study Group. Postintervention effects of varying treatment arms on glycemic failure and b-cell function in the TODAY trial. Diabetes Care 2021;44:75-80
- Rodr ıguez-Poncelas A, Mundet-Tudur ı X, Miravet-Jim enez S, et al. Chronic kidney disease and diabetic retinopathy in patients with type 2 diabetes. PLoS One 2016;11:e0149448 23. Stratton IM, Kohner EM, Aldington SJ, et al. UKPDS 50: risk factors for incidence and progression of retinopathy in type II diabetes over 6 years from diagnosis. Diabetologia 2001;44:156-163
- Shoeibi N, Bonakdaran S. Is there any correlation between diabetic retinopathy and risk of cardiovascular disease? Curr Diabetes Rev 2017;13:81-86
- McClintic BR, McClintic JI, Bisognano JD, Block RC. The relationship between retinal microvascular abnormalities and coronary heart disease: a review. Am J Med 2010;123:374.e1- 374.e7
- Witt N, Wong TY, Hughes AD, et al. Abnormalities of retinal microvascular structure and risk of mortality from ischemic heart disease and stroke. Hypertension 2006;47:975-981
Cited by
Sorted by citations
12. Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes—2025
American Diabetes Association Professional Practice Committee, ElSayed, N. A., McCoy, R. G., Aleppo, G., Balapattabi, K., Beverly, E. A., Briggs Early, K., Bruemmer, D., Callaghan, B. C., Echouffo-Tcheugui, J. B., et al. (2025) · Diabetes Care · doi:10.2337/dc25-s012 · Cited by 176 · see citing works
Diaz, E. A., Seifert, M. L., Gruning, V., Stadnick, N. A., Lugo-Butler, E., Servin, A. N., Rodríguez-Rosales, C. I., Geremia, C., Ramachandra, C., Bhaskaranand, M., et al. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.38114 · Cited by 9 · see citing works
Leong, A., Wolf, R. M., Channa, R., Wang, J., Lehmann, H., Abramoff, M. D., & Liu, T. Y. A. (2026) · npj Digital Medicine · doi:10.1038/s41746-026-02460-5 · Cited by 3 · see citing works
- Authors
- TODAY Study Group, Tryggestad, J. B., Kelsey, M. M., Drews, K. L., Chernausek, S. D., Escaname, E. N., Isganaitis, E., Macleish, S., McKay, S., Sprague, J., & Willi, S.
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2021-09-16
- Volume
- 45
- Issue
- 5
- Pages
- 1049-1055
- ISSN
- 0149-5992 (ISSN-L)
- PMC
- PMC9174974
- OpenAlex
- W4251173987
- Cited by
- 48
- References
- 1
- Citations by year
- 2026: 10 · 2025: 15 · 2024: 11 · 2023: 10 · 2022: 2
- FWCI
- 5.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5k24hl145076-02)
- National Heart, Lung, and Blood Institute (K24-HL145076)
- National Institute of Diabetes and Digestive and Kidney Diseases (U01DK061239, U01DK061212, U01DK061254, U01DK061242, U01DK061230, P30DK116073)
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
- Keywords
- diabetic retinopathy, type 2 diabetes, adolescents and young adults, disease progression, HbA1c, glycemic control, risk factors, non-proliferative diabetic retinopathy, proliferative diabetic retinopathy, TODAY study, comorbidities, C-peptide, triglycerides, blood pressure
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
