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

Diabetes mellitus affects all parts of the body, and all aspects of life for the patient. To manage patients effectively, we need a record of who has diabetes, where they are treated, by whom, and with what results. In 1985 we devised a standardised data collection form in our clinic and in 1987 we established a comprehensive register of patients treated in our clinics. Our Diabetes Care Centre serves a population of 287,460 based in an industrial area with high levels of social and economic deprivation. The database includes demographic details, risk factors including smoking and alcohol intake, duration of diabetes, type of treatment, biochemical results including blood glucose, glycosylated haemoglobin, details of blood lipids and renal function. We also record details of diabetic eye disease, foot disease, nerve pathway disease, cardiovascular disease, and skin complications. We record the type of treatment including diet, tablets, and insulin and we audit the incidence of diabetic complications including ketoacidosis, amputation, and blindness due to diabetes. From 1994 onwards we complied a district register of patients including those not seen by us. Our computerised database enables us to monitor our clinics, audit our results, pursue research, set targets, and facilitates contracting for diabetes care with our purchasers.
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PMID:A comprehensive register for diabetic outpatients: experience with desktop computing from 1987-1996. 970 Apr 34

Diabetes is a serious disease that affects millions of people world wide. One of the many complications that may result from this disease is an eye disorder called diabetic retinopathy. This side effect is characterized by the leaching of fluid, mainly blood, into the retinal tissue ultimately killing the rods and cones in the area. Scientists have discovered that by occulating and destroying some of the capillaries near the infected area, further damage may be limited and further vision loss prevented. This procedure is performed on the retina by using a Continuous Wave argon laser to place a pattern of lesions that kill the rods, cones, and underlying capillaries. The "Computer Aided Laser Optics System for Ophthalmic Surgery" or CALOSOS is a system that fully integrates the placement of therapeutic retinal lesions through computer control. To date, two different sub-systems have been used to achieve the desired accuracy needed including lesion placement and depth; an all-digital system and a hybrid analog/digital system. The current tracking system that precisely controls the laser uses a wide-angle lens camera to view the whole retina. The difficulty lies in the fact that the only way to control the depth of the lesion is to measure the central reflectance. The goal of this research is to establish that there is a linear relationship between the reflectance of the lesion and the depth of the lesion when this wide-angle lens is used.
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PMID:Development of an integrated automated retinal surgical laser system. 973 39

Diabetic retinopathy remains the most common cause of blindness in people of working age but the provision of high quality eye screening for diabetic patients is still erratic in many health districts in the UK. National consensus guidelines recommend comprehensive population coverage, high sensitivity (>80%), high specificity (>95%), agreed clinical criteria, referral procedures and centralized data collection to facilitate audit. This study looks at the effectiveness of implementing a prompted recall programme for retinal screening in an inner-city district of North London. The scheme uses trained, accredited optometrists to screen patients with diabetes who are looked after in the community by their general practitioner. During the first 17 months of the scheme, 63 optometrists attended training and gained accreditation. Of the 666 patients recruited, 645 were scheduled for screening and 536 (83%) attended. Fourteen per cent of patients screened were found to have background retinopathy and 2.3% sight-threatening eye disease. In two audits, carried out 15 months apart in a random sample of GP practices, the incidence of recorded dilated fundoscopy increased from 48% at baseline to 56%, an increase of 8% (95% CIs 2%-14%). For referable eye disease, the sensitivity of this screening technique was 100%, the specificity 94% (95% CIs 90%-98%), the positive predictive value 79% (95% CIs 72%-86%) and the negative predictive value 100%. The administrative cost per case screened was Pound Sterling 12.60 (excluding clinical costs and any additional optometry payment).
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PMID:The implementation of prompted retinal screening for diabetic eye disease by accredited optometrists in an inner-city district of North London: a quality of care study. 982 68

Diabetes and thyroid-related eye disease cause significant morbidity. Although these are endocrine disorders, they cause different ocular manifestations. Previously unexamined epidemiologic factors offer new insight to diabetic eye disease. The association of hyperglycemia, systemic medical therapy, and visual loss is reviewed. Although retinopathy remains the leading cause of blindness, multiple "nonretinal" diabetic ocular problems occur and how these correspond with retinopathy is examined. Thyroid-related eye disease, as seen in Graves' ophthalmopathy, is an autoimmune process. This is reexamined and new ultrasound techniques to measure disease activity are described. The advantage of therapies directed against these features is reported.
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PMID:Diabetes and thyroid-related eye disease. 1015 Aug 30

During the past year, the results of the Diabetes Control and Complications Trial became available. This event is expected to influence all future diabetes eye disease research. For this reason, this article starts with a discussion of these results.
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PMID:Diabetes and thyroid-related eye disease. 1016 Apr 21

Diabetes mellitus is a significant cause of visual morbidity worldwide. Progress continues in the identification of cellular elements involved in the pathogenesis of diabetic eye disease. Most notable is a greater elucidation of the role of vascular endothelial growth factor. Studies on the epidemiology and clinical course of diabetic eye disease provide a basis for examination, prognosis, and treatment of affected patients.
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PMID:Ocular manifestations of diabetes. 1038 38

The UKPDS was a 20-year study involving 23 centres in the United Kingdom. More than 5000 patients with Type 2 diabetes were recruited. The aim of the study was to determine the impact of intensive blood glucose control on 21 predetermined clinical endpoints using, in the care of blood glucose control, sulphonylureas or insulin therapy or, in the overweight patient, treatment with metformin. In addition, the study investigated the impact of intensive blood pressure control on macro- and microvascular complications of diabetes and compared captopril treatment with atenolol. UKPDS found that improved control of blood glucose or blood pressure reduced the risk of major diabetic eye disease by one quarter, serious deterioration of vision by nearly one half, early kidney damage by one third, strokes by one third, and death from diabetes-related causes by one third. Blood glucose control had little or no effect on macrovascular events. There was no evidence of a major detrimental effect of the drugs or insulin on survival or outcome other than the expected risk of hypoglycaemia. Metformin appeared to be the drug of choice in obese diabetic patients. The targets of glucose and blood pressure control were often achieved by using several drugs. Many patients at the end of the studies were on four or five drugs for blood glucose and blood pressure treatment. The results and implications of the study are discussed. It is proposed that the results of UKPDS herald a new era of more focused therapy of Type 2 diabetes.
Diabetes Metab Res Rev
PMID:United Kingdom prospective diabetes study (UKPDS): what now or so what? 1039 49

Vision loss among the elderly is a major health care problem. Approximately one person in three has some form of vision-reducing eye disease by the age of 65. The most common causes of vision loss among the elderly are age-related macular degeneration, glaucoma, cataract and diabetic retinopathy. Age-related macular degeneration is characterized by the loss of central vision. Primary open-angle glaucoma results in optic nerve damage and visual field loss. Because this condition may initially be asymptomatic, regular screening examinations are recommended for elderly patients. Cataract is a common cause of vision impairment among the elderly, but surgery is often effective in restoring vision. Diabetic retinopathy may be observed in the elderly at the time of diagnosis or during the first few years of diabetes. Patients should undergo eye examinations with dilation when diabetes is diagnosed and annually thereafter.
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PMID:Common causes of vision loss in elderly patients. 1041 31

Autoimmune responses to the thyrotropin receptor result in Graves' Disease. Evidence is accumulating that the same antigen is implicated in thyroid-associated orbitopathy (TAO) or thyroid eye disease. Progress in the establishment of receptor induced animal models has led to the development of a murine model in which the orbits of affected mice bear striking resemblance to human TAO with disruption of muscle fibres by oedema, accumulation of adipose tissue and infiltration by cells of the immune system.
Exp Clin Endocrinol Diabetes 1999
PMID:Animal model of thyroid-associated orbitopathy. 1061 11

Cigarette smoking greatly increases the risk of thyroid-associated orbitopathy (TAO) (odds ratio 7.7, interval 4.3 to 13.7) and the number of cigarettes smoked per day seems to be a significant independent determinant for the incidence of proptosis and diplopia. The own prospective study showed that soft tissue involvement (ATA activity score) and ocular motility could be influenced less by steroid and irradiation treatment in smokers in comparison to nonsmokers. The mechanisms whereby smoking affects eye disease are widely unknown, cytokines (INF-gamma, TNF-alpha, IL-1), receptors and receptor antagonists have probably a crucial role.
Exp Clin Endocrinol Diabetes 1999
PMID:Risk of smoking in thyroid-associated orbitopathy. 1061 13


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