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

The level of adherence with recommended standards for ophthalmic examinations was assessed in a purposive sample of diabetic patient charts (n = 350) from four clinics in medically underserved areas. All of the clinics referred patients with diabetes to off-site services for comprehensive eye examinations (dilation, visual acuity, and intraocular pressure); adherence with the standard of care was defined as a chart note indicating a referral for an ophthalmic examination. Overall, 86% of the patients were from high-risk minority groups (black or Hispanic) for diabetes and its complications. Mean age and duration of diabetes were 57.7 and 8.8 years, respectively. Referrals for ophthalmic exams were noted in 18% of the charts during the year preceding the review and in 28.6% of the charts during the 2 preceding years. Annual referrals in the preceding 2 years were noted in 3.1% of the charts. Eye disease was noted as a diagnosis in 22%. Patients who had a diagnosis of eye disease noted in their charts had a 7.5-fold increase in the odds of having a referral noted. The increased likelihood of being referred in patients with known eye disease may be due to follow-up of current eye problems.
J Diabetes Complications
PMID:Ophthalmic referral rates for patients with diabetes in primary-care clinics located in disadvantaged urban communities. 773 44

The purpose of this study was to document the self-care behaviors of patients with type I diabetes, identify their concerns about having diabetes, and measure their level of control (HbA1c). A 20-point questionnaire was mailed to 105 young adults with type I diabetes. Fifty-nine (56%) returned the questionnaire (33 males, mean age 23.2 years; 26 females, mean age 22.7 years). Duration of diabetes was 5 months to 25 years (mean = 11.28 years). HbA1c range was 5% to 13.9% (mean = 7.85%, normal < 6.6%). Sixty-eight percent performed at least one blood glucose test per day and 12% reported not testing at all. The number of insulin injections per day ranged from 2 to 5, and 83% regularly adjusted their insulin dose. Confidence in adjusting insulin was not related to duration of diabetes, age, or sex. Insulin manipulation to control weight was reported by 38% (24 females, 2 males). The long-term complications they were concerned about were eye disease (35%), pregnancy and childbirth (27%), hypoglycemia (13%), and loss of independence (5%). Hypoglycemia was always recognized by 35%, although 50% sometimes confused it with stress, tiredness, and high blood glucose. All subjects reported that hypoglycemia affected their lifestyle.
Diabetes Educ
PMID:Young-adult perspectives of insulin-dependent diabetes. 783 6

Early detection and treatment of diabetic eye disease can prevent blindness, yet many persons with diabetes lack regular eye care. This study followed 569 people with diabetes participating in blindness prevention programs during 1985 through 1987; it was found that 35% of subjects received dilated eye examinations before entering the programs, in comparison with 60% afterward. About 85% of participants referred for proliferative retinopathy treatment began such treatment, and, of these, 85% completed treatment. A lack of knowledge about the disease and limited finances were primary reasons for nonadherence. To improve the effectiveness of prevention programs, eye care providers and program staff must strive to eliminate these educational and financial barriers.
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PMID:Patient adherence to guidelines for diabetes eye care: results from the diabetic eye disease follow-up study. 794 94

The aim of this study was to compare the intensity of typical late complications in diabetic patients (n = 65, 28 type I, 37 type II) who were not on glycoside drugs with low vs. high serum levels of digoxin-like immunoreactive factor (DLIF: group I, n = 42, DLIF < or = the detection limit of 0.2 ng ml-1; and group II, n = 23, mean +/- SEM: 1.17 +/- 0.31 [0.25-4.96] ng ml-1). For detection of nephropathy, urinary albumin excretion (24 h) and creatinine clearance tests were used. For coronary heart disease a questionnaire and standard ECG; for peripheral occlusive vascular disease a questionnaire; for eye disease a fundoscopy; for neuropathy a neurological score system; and for autonomic neuropathy a standardized test battery was employed. Patients with high DLIF levels showed better test results in vibratory perception (95.7 +/- 1.5 vs. 82.8 +/- 3.8%, normal finding = 100%, 2p = 0.016), had better percentile localizations concerning maximal pupillary area in darkness (28.4 +/- 6.6 vs. 8.1 +/- 1.8%, 2p = 0.0004), contraction velocity at 1 s (21.5 +/- 5.8 vs. 8.0 +/- 2.2%, 2p = 0.012), and dilation velocity at 6 s (23.0 +/- 6.8 vs. 10.5 +/- 2.5%, 2p = 0.041), had less retinopathy (with retinopathy: 26.1% vs. 64.3%, 2p = 0.0028), and better percentile localizations in the respiratory sinus arrhythmia test (68.4 +/- 7.3 vs. 44.1 +/- 4.9%, 2p = 0.0064). There was no difference concerning nephropathy, blood pressure, coronary heart disease and peripheral vascular disease. Separate analysis according to the type of diabetes confirmed the results in each group.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Influence of digoxin-like immunoreactive factor on late complications in patients with diabetes mellitus. 795 6

In an open label, two period cross-over study we compared the ocular tolerability of NODS vs. Isopto-NaturaleR eye drops. Thirty healthy volunteers were asked to rate the application system they were using for ocular discomfort, utilizing a visual analog scale in which 100 = no ocular discomfort and 0 = severe ocular discomfort. In addition each subject had to answer a questionnaire and underwent a full ophthalmic control before, at day 7, at day 14 and at day 21 of the study. Each application form had to be applied to one eye only once a day for 7 days, followed by a washout period of 1 week. The type of application form was then changed and again had to be applied to one eye only for 7 consecutive days, followed by a final ophthalmic examination. The mean irritation score was recorded at day 7 and at day 21 of the study. Volunteers had no history of eye disease, no acute pathology of the eye, no contact lenses, no conditional foreign body of the cornea within the last four weeks prior to the study or within the study, no local therapy, no systemic therapy, no diabetes, no pregnancy. Informed consent was obtained. At day 1 one of the two application forms was given to each volunteer in a randomized order. 29 volunteers finished the protocol (16 male, 13 female); mean age: 26 years (range 20-32 years). The mean irritation score of NODS: 35 (2-81); the mean irritation score of Isopto-NaturaleR: 80.4 (45.5-99).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The ocular tolerability of a new ophthalmic drug delivery system (NODS). 796 Apr 9

Chronic complications in diabetes mellitus are angiopathy and neuropathy. The appearance of microangiopathy on angiographical examination with fluorescein has been understood to be a very important prognostic sign in cases of juvenile diabetes mellitus. There are few reports of changes in the retinal nerve fiber layer or optic disc. In 20 patients with juvenile diabetes mellitus, 20 eyes were examined by retinal nerve fiber layer photography, biomorphometry of the optic disc, fluorescein angiography and automated perimetry. Age, time of disease onset and the actual Hba1c value in the blood were noted for each patient. Pathologic changes could not be found in any of the ophthalmological examinations listed above. Statistical evaluation provided a relatively high (r = 0.53) correlation between the neuroretinal rim area and the actual Hba1c values. However, further evaluation indicated that this was caused by the covariance of the relation between neuroretinal rim area and disc area. Date of disease onset showed no correlation with topographical disc parameters. Our findings did not indicate increasing endoneuronal fluid pressure depending on glucose levels as an early sign of diabetic eye disease.
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PMID:[Retinal nerve fiber layer photography and papillometry in juvenile diabetes mellitus]. 808 54

The objective of this study was to examine the feasibility and utility of screening for eye disease and hypertension in a group of diabetic patients. A sample of 338 outpatients in Santa Barbara County were included and had non-mydriatic retinal photography and measurement of blood pressure and visual acuity. Each patient completed a questionnaire including age, type of diabetes (type I or type II), duration of diabetes, and smoking history. Photographs were read by an internist and ophthalmologist, and grouped into one of five categories: (1) normal, (2) background retinopathy, (3) preproliferative retinopathy, (4) proliferative retinopathy, and (5) other abnormality. Patients with abnormalities were referred for treatment. Thirty-two percent of the population had retinopathy, and 16% had disease requiring urgent referral for treatment. Mean systolic blood pressure (MSBP) was found to be higher in patients with all types of retinopathy (132 mm Hg versus 124 mm Hg, p < 0.001). The relationship remained significant when smokers and nonsmokers were considered separately. No significant difference was found in MSBP between patients with severe retinopathy (preproliferative or proliferative) and those with background changes (133 mm Hg versus 131 mm Hg, respectively, p > 0.5). The other factor found to be related to retinopathy was the duration of diabetes. Type I patients with retinopathy had diabetes for 19 years versus 12 for those without (p < 0.01). Type II patients with retinopathy had diabetes for 10 years versus 6 for those without retinopathy (p < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
J Diabetes Complications
PMID:The Santa Barbara County diabetic retinopathy screening feasibility study: significance of diabetes duration and systolic blood pressure. 816 88

A pilot study was carried out to determine the prevalence of ophthalmic disease in the Indian community of Southall and to ascertain the best methods applicable for a larger formal study. Three sites were chosen for the study, a Sikh gurdwara, a mosque and a Hindu temple. The subjects were volunteers aged 30 years and over who had visited the appropriate place of worship at least twice in the previous month. A total of 184 subjects were examined. The prevalence of blindness was 2.7% by the World Health Organization (WHO) criteria, while 9.8% had uniocular blindness. The prevalence of glaucoma and ocular hypertension was 2.7% and 7%, respectively. Of the 184 subjects examined, 58% had cataract and 3.8% had age-related maculopathy. The prevalence of visually disabling trachomatous eye disease was 9.7%. The prevalence of diabetes mellitus was 17.9%, and that of hypertension 22.8%. This small study suggests that people with origins from the Indian subcontinent have a higher prevalence of ophthalmic disease than the Caucasian population.
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PMID:A pilot study into the prevalence of ophthalmic disease in the Indian population of Southall. 819 34

While many systemic diseases have ophthalmic manifestations with visible pathological features affecting the fundus, diabetic eye disease is of particular interest. There are many advantages in using digital image analysis to quantify the extent of retinal pathology in diabetes particularly to monitor its progression. However, the usual method of imaging involves photographing the retina using a fundus camera. Not only does this require that the photographs be digitized prior to analysis, but the resulting illumination across the image is non-uniform and this creates problems in digital image analysis. This paper describes the construction of a scanning laser ophthalmoscope interfaced to a computer, which has a number of significant advantages for digital retinal imaging. Firstly, it has better uniformity of illumination than the fundus camera and operates at much lower light levels. Secondly, it permits imaging at various wavelengths with no consequent degradation in image quality; in particular, the value of imaging at infrared wavelengths to give greater tissue penetration is demonstrated. Finally, by introducing the capability for confocal imaging, tomographic images can be taken, improving the perceptibility of features situated deep in the retina. Typical images are shown to demonstrate the potential of this instrument.
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PMID:Digital fundus imaging using a scanning laser ophthalmoscope. 847 32

In the light of the prevalence of diabetes mellitus there is a need for its inclusion in future health targeting and also for a national screening programme to detect diabetic eye disease. Screening will enable early treatment, contribute to reduced demands on resources and influence positively the lowering of the incidence of new blindness.
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PMID:The screening imperative for ophthalmic care in diabetes. 855 97


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