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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Serum levels of angiotensin converting enzyme (SACE) were measured in 118 diabetic patients divided into the following four groups: 44 insulin-treated diabetic patients with severe retinopathy, 38 non insulin-treated diabetic patients with severe retinopathy, 18 diabetic patients, including both insulin-treated and non insulin-treated subjects with background retinopathy, 18 diabetic patients, insulin-treated and non insulin-treated without signs of retinopathy. Nineteen retinopathic patients non diabetic were also studied in order to verify whether SACE levels are altered when retinopathy is present independently from diabetes. The control group was composed of 44 normal subjects. When the data from the above six groups of subjects were submitted to statistical tests (one-way ANOVA, T-test of Bonferroni and test of Student-Newman-Keuls), the study yielded the following results: i) a remarkable difference between the SACE levels in healthy subjects and those in the three groups of diabetic retinopathic patients considered; ii) a non statistically significant difference of SACE levels between normal subjects and diabetic patients without retinopathy; iii) a non statistically significant comparison of SACE levels of normal subjects versus non diabetic retinopathic patients. Therefore, we concluded that while primitive diseases of the retina are not associated with an increase of SACE levels, yet when diabetes and retinopathy coexist, the SACE levels increase remarkably (in rather an independent way from the type of diabetes, the age of subjects, the stage of retinal disease and the daily average insulin dose), suggesting that most of the enzyme's increase originates from the endothelium of peripheral vasa, widely involved in most of the retinopathic diabetic patients.
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PMID:Serum angiotensin converting enzyme in diabetic retinopathy. 133 20

The relationship between glycemic control and diabetic complications remains unclear. Epidemiological studies reveal that approximately 25% of diabetic individuals do not develop complications, irrespective of degree of glycemic control. Studies of genetic factors, including HLA type, capillary basement membrane thickness, genetic predisposition to hypertension, and familial clustering of diabetic complications, suggest that there is a genetic component to developing the complications of diabetes. On the other hand, clinical trials have demonstrated that the progression of early, mild background retinopathy, microalbuminuria, and parameters of nervous system function are stabilized with improved glycemic control. Other metabolic parameters, such as serum lipoprotein levels, are significantly improved with near normoglycemia. No studies to date have evaluated the effect of blood glucose control on the prevention of diabetic complications. The degree of glycemic control required to impact on diabetic complications is unknown. In addition, achieving near normoglycemia carries increased risk for severe hypoglycemia and weight gain. Further study is needed to determine the long-term benefits of blood glucose control and to weigh that against the risks of improving glycemic control. Further investigation also is needed to address the probable interrelationship of genetic factors and glycemic control on the development of diabetic complications.
Diabetes Care 1992 Sep
PMID:Glycemic control and diabetic complications. 139 11

Forty-eight diabetic patients (82 eyes) were examined with four different colour vision tests and one blood glucose strip-test. The ages of the patients varied from 23 to 65 years (mean 44.3 years +/- 11.4, SD), the duration of diabetes from 13 to 41 years (mean 25.8 +/- 6.2), and the visual acuities from 0.2 to 1.0 (mean 0.8 +/- 0.2). Of the eyes, 77 had had photocoagulation, 25 had small peripheral lens opacities, and 55 had slight background retinopathy. The colour vision tests were: the Standard Pseudoisochromatic Plates part 2 (SPP2), the Lanthony Tritan Album, the Farnsworth Panel D 15 test and the box III of the Farnsworth-Munsell 100 hue (FM 100) test. The blood glucose test was Haemo-Glukotest 1-44. Of the 82 eyes, 38 incorrectly saw Haemo-Glukotest strips. The SPP2 test found 89% of the eyes, the Tritan Album 55%, the Panel D 15 71%, and the box III of the FM 100 test 76%. The strips were correctly interpreted in 44 of the eyes. However, 36% of them failed the SPP2, 16% the Tritan Album, 11% the Panel D 15 test and 18% the box III of the FM 100 test. The Panel D 15 test and the box III of the FM 100 test would be useful in screening those diabetics who cannot correctly interpret the colour-dependent glucose test-strips and would need a blood sugar meter for their blood glucose level testing.
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PMID:Screening of diabetics who read incorrectly colour-dependent glucose test-strips. 147 47

In order to evaluate the applicability of the laser flare-cell meter to diabetic oculopathy, we measured aqueous flare and aqueous "cells" in 84 diabetic eyes of 84 patients and 50 normal control eyes of 50 age-matched subjects. Using fluorescein angiography, diabetic retinopathy was divided into background retinopathy (11 eyes), preproliferative retinopathy (38 eyes), and proliferative retinopathy (35 eyes). In diabetic eyes, the occurrence of both aqueous flare (0.73 +/- 0.39 mg/ml human albumin equivalent) and aqueous cells (mean 2.96, range 0-35.7 cells/0.075 mm3) was significantly greater than in the normal control group (flare 0.14 +/- 0.06 mg/ml, cells 0.39, range 0-2 cells/0.075 mm3, P < 0.0001 and P < 0.0002, respectively). The flare values also showed differences between the diabetic subgroups, with flare values being higher in more advanced stages of diabetic retinopathy. No significant correlation could be found between the flare values and the kind of diabetic therapy, the duration of the diabetes, and the number of or the time interval since previous retinal laser coagulations. A flare value of more than 0.5 mg/ml was found to represent probably a "critical value" indicating a tendency towards preproliferative and or proliferative changes. The laser flare-cell meter is a valuable instrument for noninvasive, quantitative assessment of alterations of the blood-aqueous barrier in diabetes. The increase of flare values seems to parallel the progression of diabetic retinopathy.
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PMID:Quantitative measurement of aqueous flare and aqueous "cells" in eyes with diabetic retinopathy. 148 30

The prevalence and development of retinal microvascular complications in pre-puberty and puberty onset insulin-dependent diabetes mellitus were studied in 109 young patients with an average follow-up of 6 years. The data suggest that the earlier childhood the diabetes began, the later the microvascular abnormalities could be found by fluorescein angiography. First signs of background retinopathy were seen in average 20--22 years of age, almost independently the age at onset of diabetes. Rapid progression of retinal vascular damage occurred mainly in postpubertal but not pubertal subjects. Diabetes with puberty onset meant worse prognosis in the respect of retinal vascular complications than pre-puberty onset. Good glycemic control would be achieved more difficult in subjects with puberty onset diabetes added to a changing hormonal balance. The authors suggest that psychological factors (altered behavior during and after puberty) and other problems of adolescents (changes in social, familial and working conditions) may also contribute to poor glycemic control. Though the effect of prepubertal duration on the risk of retinal complications appears to be smaller than later years, the attendant work in prepubertal years is as important as later.
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PMID:[Retinal microangiopathies in diabetic children and adolescents, occurring in cases of pubertal and prepubertal onset of diabetes]. 150 39

To determine the incidence of and risk factors for the development of proliferative diabetic retinopathy (PDR) in Oklahoma Indians, we performed a cohort follow-up study of 927 Indians who underwent detailed eye examinations between 1972 and 1980. The mean age of participants was 52 yr with a duration of diabetes of 6.9 yr at baseline. At follow-up, 513 (55.3%) were alive, 407 (43.9%) were deceased, and 7 (0.8%) could not be traced. After a mean follow-up time of 12.7 yr, the overall incidence of PDR among those who survived and who underwent follow-up ophthalmic examinations (354 participants) was 18.6%; 45% of those with background retinopathy at baseline developed PDR. Significant independent predictors of PDR, determined by multivariate analysis, were fasting plasma glucose level, duration of diabetes, plasma cholesterol, systolic blood pressure, and therapeutic regimen. A fasting plasma glucose level greater than or equal to 11.1 mM (200 mg/dl) increased the risk of retinopathy to 3.6 times that for a level less than 7.8 mM (140 mg/dl); 74% of those who had background retinopathy and a baseline fasting glucose greater than or equal to 11.1 mM (200 mg/dl) developed PDR. Over half of all participants with plasma cholesterol levels greater than or equal to 7.8 mM (300 mg/dl) developed PDR in the follow-up interval. Elevated systolic blood pressure was a particularly significant risk factor for those with a long duration of diabetes. Proliferative retinopathy poses a serious health threat to Oklahoma Indians and represents a cause of visual impairment that may be preventable by early diagnosis of PDR and intervention with photocoagulation therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
Diabetes 1992 Mar
PMID:Development of proliferative retinopathy in NIDDM. A follow-up study of American Indians in Oklahoma. 155 96

In this multicentre double-blind study, 100 insulin-treated diabetics with background retinopathy were randomly assigned to treatment with either 250 mg ticlopidine b.i.d. (49 patients) or placebo (51 patients). The primary aim of the study was to assess the evolution of retinopathy by fluorescein angiography performed annually for at least 3 years. The metabolic control of diabetes was evaluated by quarterly assessment of the haemoglobin A1 level. Safety parameters, especially haematologic variables were closely monitored. The proportion of patients with favourable results was higher in the ticlopidine group (55.2%) than in the placebo group (36.6%). However, this difference did not reach statistical significance (p = 0.123), most probably because of the too limited number of patients studied. In the placebo group, a significant relationship was found between the unfavourable evolution of diabetic retinopathy and more fluctuating haemoglobin A1 levels. Such a relationship was not observed in the ticlopidine group. This could be regarded as an expression of the therapeutic effect of the compound. The number and nature of side-effects was similar in both treatment groups. However, the proportion of patients who prematurely discontinued study treatment because of side-effects was significantly higher in the ticlopidine group. Mean levels of biological, and in particular haematologic, parameters did not change significantly except for a significant increase in the cholesterol level in the ticlopidine group, which, however, remained within normal limits.
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PMID:Clinical study of ticlopidine in diabetic retinopathy. Belgian Ticlopidine Retinopathy Study Group (BTRS). 157 37

The impact of metabolic control on the development of rapidly progressive severe retinopathy was studied in 14 young type I insulin-dependent diabetes mellitus (IDDM) patients. Glycosylated hemoglobin (HbAlc) levels 45 months prior to and 12 months after the diagnosis of retinopathy were compared with HbAlc levels in 17 type I IDDM patients with no or minimal background retinopathy, matched for age and duration of diabetes. HbAlc levels were generally higher in patients with severe retinopathy (p less than 0.05) from 39 months until 6 months before the diagnosis of retinopathy. Thereafter, there was a gradual decrease in HbAlc levels reaching the same level as in control patients 6 months after diagnosis of retinopathy. Patients with severe retinopathy required higher doses of insulin prior to the diagnosis of retinopathy (p less than 0.05), but the insulin requirement decreased, and 12 months afterward, the insulin dosage was similar to patients with background retinopathy. Systolic blood pressure levels were slightly increased and higher in patients with severe retinopathy compared with control patients from 18 months before to diagnosis of retinopathy (p less than 0.05). Diastolic blood pressure levels likewise differed at 18 and 12 months before and at the time of diagnosis of retinopathy as well as 12 months afterward (p less than 0.05); however, no differences were seen in urinary albumin or serum creatinine levels between the groups. Thus, years of poor metabolic control, drastically improved, preceded the development of irreversible severe retinopathy in these young type I IDDM patients.
J Diabetes Complications
PMID:Irreversible progression of severe retinopathy in young type I insulin-dependent diabetes mellitus patients after improved metabolic control. 848 53

The metabolic disorder in diabetics often results in progressive retinopathy with severe visual impairment. Changes in metabolism can influence corneal autofluorescence. This has led to speculation that diabetic retinopathy might be associated with changes in corneal autofluorescence. Corneal autofluorescence of both eyes was determined by fluorophotometry in 94 insulin-dependent diabetes mellitus patients and in 46 healthy controls to evaluate its correlation with diabetic retinopathy. The modified Airlie House classification was used for grading diabetic retinopathy: (1) no or negligible retinopathy; (2) minimal background retinopathy; (3) background retinopathy; and (4) (pre-) proliferative retinopathy. The corneal autofluorescence values of grade 1 retinopathy patients did not differ significantly from those of the healthy controls (mean +/- standard deviation in ng equivalent fluorescein/ml: 11.6 +/- 3.0 and 11.4 +/- 2.8, respectively; P = 0.8). The means of grade 2, 3, and 4 retinopathy patients (mean +/- standard deviation in ngEq fluorescein/ml: 16.2 +/- 4.4, 16.7 +/- 4.3, 20.9 +/- 5.4, respectively) were significantly higher than the means of grade 1 patients and healthy controls (P less than 0.004). The mean values of patients with grade 4 were significantly higher than those of patients with grades 2 and 3 (P less than 0.01). The sensitivity and specificity of corneal autofluorescence as a screening test for diabetic retinopathy were 80% and 76%, respectively; the positive predictive value for the presence of retinopathy was 90%. The values for screening on (pre-) proliferative diabetic retinopathy were 68%, 72%, and 58%, respectively. These data show corneal autofluorescence to be an adequate indicator of diabetic retinopathy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Corneal autofluorescence: an indicator of diabetic retinopathy. 173 May 50

The polyol pathway has long been associated with diabetic retinopathy. Glucose is converted to sorbitol with the aid of the enzyme aldose reductase. Aldose reductase inhibitors can prevent changes induced by diabetes. A total of 30 patients with minimal background retinopathy were randomly divided into a ponalrestat-taking group and a placebo-taking group. All were followed for 6 months and twenty-three were followed for 12 months. The baseline microaneurysm count was 2.6 +/- 1.9 (mean +/- SD) for the ponalrestat group and 3.5 +/- 2.9 for the placebo group. At 6 months the counts were 3.1 +/- 3.5 and 2.9 +/- 3.6 and after 12 months 3.0 +/- 4.1 and 2.9 +/- 3.4. There is no statistically significant difference between the groups at 0, 6 or 12 months of study. The change in retinopathy severity level did not significantly differ between the two groups at either 6 or 12 months. Ponalrestat administration at a dosage of 600 mg daily for 12 months has no significant effect on the course of minimal retinopathy in diabetic patients.
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PMID:The effects of an aldose reductase inhibitor on the progression of diabetic retinopathy. 179 Jul 35


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