Prevalence of Diabetic Retinopathy in Children Aged ≥10 Years with Type 1 Diabetes Mellitus Attending the Diabetic Clinic at Kassala Teaching Hospital, Sudan: A Cross-Sectional Study, August–December 2025

High blood sugar is a relentless force that, over time, can wear down the delicate machinery of the human body. When a person has diabetes, their blood contains too much glucose, and this excess sugar acts like a slow-acting acid on the tiny blood vessels that nourish the eyes. These vessels, which are thinner than a human hair, can become damaged, leak fluid, or grow abnormally, leading to a condition called diabetic retinopathy. For decades, doctors believed this damage was a problem that only adults faced after living with diabetes for many years. However, as more children are diagnosed with type 1 diabetes—a condition where the body stops making insulin entirely—doctors are beginning to see signs of this eye damage in younger patients. The question has shifted from whether children can develop these complications to how often it happens and what factors might speed it up. Understanding this is critical because once vision is lost to this disease, it is often impossible to restore.

In a quiet corner of eastern Sudan, researchers set out to answer these questions for a population that had never been studied in this way. Between August and December 2025, a team of doctors and scientists gathered at the Kassala Teaching Hospital to examine the eyes of children and teenagers living with type 1 diabetes. They focused on 115 young people, all aged ten or older, who were already receiving care for their condition. The goal was simple but vital: to see if diabetic retinopathy was present, to measure how well these children were managing their blood sugar, and to understand if they were getting the eye checks they needed. The team did not rely on guesswork or old records alone; they performed a thorough, hands-on examination of every participant. After using eye drops to widen the pupils, they looked deep into the back of each child's eye using specialized lights and lenses, and for those with any signs of trouble, they used a high-resolution camera to take cross-sectional images of the retina to confirm exactly what was happening.

The results of this careful inspection revealed a story of both relief and concern. Out of the 115 children examined, only two were found to have diabetic retinopathy. This means that just 1.7 percent of the group showed signs of the disease. One of these two children, an 18-year-old, had a moderate form of the condition where the retina had begun to swell with fluid, a complication known as macular edema that can blur central vision. The other, a 14-year-old, had a milder form characterized by tiny leaks and small hemorrhages in the eye. Both of these children had lived with diabetes for more than ten years, suggesting that the length of time a person has the disease is a significant factor in whether these eye problems develop. For the other 113 children, the inside of their eyes looked healthy and normal, with no signs of damage from high blood sugar.

While the number of children with eye damage was small, the study uncovered a much larger problem lurking in the background: the management of blood sugar itself. The researchers found that the vast majority of these children were not keeping their blood sugar levels within a safe range. More than half of the participants had levels that were dangerously high, and only a tiny fraction had achieved the target levels recommended for good health. Despite this, the study found no statistical link between a single high blood sugar reading and the presence of eye disease in this specific group, largely because so few children had the disease to begin with. However, the two children who did have eye damage both had a history of poor blood sugar control, reinforcing the idea that keeping levels stable is the best way to protect the eyes.

Perhaps the most striking discovery was not about the disease itself, but about the care these children were receiving. Nearly all of the participants, 96.5 percent, had never had their eyes checked for diabetic retinopathy before this study. They had been visiting the hospital regularly for their diabetes, yet no one had looked inside their eyes to see if damage was starting. The reasons for this gap were clear: many families were unaware that eye checks were necessary, and others faced financial barriers or simply did not have visual symptoms to prompt a visit. The researchers noted that most of the children felt fine and saw clearly, which is exactly why the disease is so dangerous; it often causes no pain or vision loss until it is too late to prevent permanent damage.

The study concluded that while diabetic retinopathy is currently rare in this group of Sudanese children, it is not impossible, and it can appear in those who have had diabetes for a long time. The low number of cases does not mean the risk is gone; rather, it highlights a missed opportunity for prevention. The researchers emphasized that the high rate of uncontrolled blood sugar and the near-total lack of eye screening create a dangerous situation. If these children continue without regular eye exams, the few cases of damage seen today could multiply tomorrow. The path forward, according to the authors, involves integrating routine eye checks into the standard care for every child with diabetes, educating families about the silent nature of the disease, and working harder to keep blood sugar levels under control. By doing so, doctors hope to catch any early signs of trouble before they can steal a child's sight.