Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul;16(7):1254-1262.
doi: 10.1111/jdi.70027. Epub 2025 Apr 10.

Prevalence, incidence, and risk factors of diabetic retinopathy and macular edema in patients with early and late-onset type 2 diabetes mellitus

Ching-Kit Tsui  1 , Andina Hu  1 , Yuntong Li  1 , Wenyong Huang  1 , Wei Wang  1 , Kaiqun Liu  1 , Liqiong Xie  1 , Yuting Li  1 , Nathan Congdon  1   2   3 , Xiaoling Liang  1 ; GDES Group
Affiliations

Prevalence, incidence, and risk factors of diabetic retinopathy and macular edema in patients with early and late-onset type 2 diabetes mellitus

Ching-Kit Tsui et al. J Diabetes Investig. 2025 Jul.

Abstract

Aims: To compare the prevalence, incidence, and factors of diabetic retinopathy (DR) and macular edema (DME) in patients with early-onset (EOD) and late-onset diabetes (LOD).

Methods: Participants with type 2 diabetes mellitus (T2DM) were recruited from a community-based study conducted in southern urban China. Participants were followed up for 2 years. The prevalence and incidence of DR and DME were compared between EOD (≤40 years) and LOD (>40 years) groups, and potential factors were evaluated using multivariate logistic regression.

Results: Among 2,703 participants, 173 (6.4%) with EOD had a higher prevalence of DR than 2,530 (93.6%) with LOD (27.8% vs 15.5%, P < 0.001). Participants with EOD had a higher incidence of DR, although this difference was not statistically significant (EOD: 8.1% vs LOD: 3.6%, P = 0.12). Insulin use and higher HbA1c levels were significantly associated with DR in both EOD and LOD groups (both P < 0.05). Additionally, longer diabetes duration, higher systolic blood pressure, and the presence of albuminuria independently associated with the presence of any DR in LOD patients (all P < 0.05). For DME, HbA1c level was a significant association in EOD, while in LOD, age, BMI, insulin use, and albuminuria were significant factors (all P < 0.05).

Conclusions: A higher prevalence of DR was observed among patients with early-onset T2DM in urban southern China. Timely diagnosis of DR and regular eye care services are needed for early-onset T2DM.

Keywords: Diabetic Macular Edema; Diabetic Retinopathy; Early‐Onset.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Approval of the research protocol: The research protocol was approved by the Zhongshan Ophthalmic Center Medical Ethics Committee (2017KYPJ094) at Sun Yat‐Sen University.

Informed consent: The written informed consent was obtained from all participants.

Registry and the registration no. of the study/trial: The study was registered with ISRCTN (registration number: 15853192) on April 13, 2020.

Animal studies: N/A.

Figures

Figure 1
Figure 1
Flowchart of the study.
Figure 2
Figure 2
Prevalence of diabetic retinopathy and diabetic macular edema for all, early‐onset, and late‐onset diabetes mellitus. Any DR, VTDR, and DME of EOD and LOD were compared using the chi‐square test. P‐values are shown. DME, diabetic macular edema; DR, diabetic retinopathy; EOD, early‐onset diabetes mellitus; LOD, late‐onset diabetes mellitus; ns, not statistically significant, P > 0.05; VTDR, vision‐threatening diabetic retinopathy.
Figure 3
Figure 3
Cumulative incidence of diabetic retinopathy and diabetic macular edema for all, early‐onset, and late‐onset diabetes mellitus. Any DR, VTDR, and DME of EOD and LOD were compared, with the P‐value shown if significant. DME, diabetic macular edema; DR, diabetic retinopathy; EOD, early‐onset diabetes; LOD, late‐onset diabetes; ns, not statistically significant, P > 0.05; VTDR, vision‐threatening diabetic retinopathy.
Figure 4
Figure 4
Factors (Odds ratio, 95% CI) for prevalence of diabetic retinopathy using multivariate logistic regressions in early‐onset and late‐onset diabetes mellitus. Only factors with P < 0.05 are shown in the figure. CI, confidence intervals; EOD, early‐onset diabetes mellitus; HbA1c, glycosylated hemoglobin; LOD, late‐onset diabetes mellitus; OR, odds ratio; SBP, systolic blood pressure.
Figure 5
Figure 5
Factors (Odds ratio, 95% CI) for the prevalence of diabetic macular edema using multivariate logistic regressions in early‐onset and late‐onset diabetes mellitus. Only factors with P < 0.05 are shown in the figure. BMI, body mass index; CI, confidence intervals; EOD, early‐onset diabetes mellitus; HbA1c, glycosylated hemoglobin A1c; LOD, late‐onset diabetes mellitus; OR, odds ratio; SBP, systolic blood pressure.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Saeedi P, Petersohn I, Salpea P, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the international diabetes federation diabetes atlas. Diabetes Res Clin Pract 2019; 157: 107843. - PubMed
    1. Yang W, Lu J, Weng J, et al. Prevalence of diabetes among men and women in China. N Engl J Med 2010; 362: 1090–1101. - PubMed
    1. Wang L, Gao P, Zhang M, et al. Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013. JAMA 2017; 317: 2515–2523. - PMC - PubMed
    1. Zou X, Zhou X, Ji L, et al. The characteristics of newly diagnosed adult early‐onset diabetes: A population‐based cross‐sectional study. Sci Rep 2017; 7: 46534. - PMC - PubMed
    1. Group TS . Long‐term complications in youth‐onset type 2 diabetes. N Engl J Med 2021; 385: 416–426. - PMC - PubMed