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

The ocular complications of diabetes mellitus are numerous and include retinopathy, cataract, uveitis, and neurophthalmic disorders. A review of the current literature shows that the emphasis has changed from the laser and surgical management of pre-existent retinopathy to the development of cohesive multidisciplinary screening and education programs, and to a better understanding of the cellular and molecular mechanisms that underlie disease. The role of associated and potentially modifiable systemic factors is also now recognized. Early intervention with systemic and local therapies may soon provide hope for the better management of diabetic eye disease.
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PMID:Ocular manifestations of diabetes mellitus. 1066 55

Management decisions for patients with diabetic eye disease can remain difficult despite the presence of guidelines. The cases below illustrate the dilemmas about the timing of instituting insulin in patients needing laser photocoagulation for improvement of glycaemic control. The use of angiotensin-converting enzyme inhibitors for diabetic eye disease is also discussed.
Diabetes Metab Res Rev
PMID:Difficult therapeutic decisions in the management of diabetic retinopathy. 1075 53

Retinopathy is a common complication of insulin-dependent (IDDM) and non-insulin-dependent (NIDDM) diabetes, but serious visual loss may be prevented or delayed with sufficiently early diagnosis and treatment. Screening for early signs of retinopathy is clearly beneficial for some people, but there is no established consensus about who should be screened, by whom, by what technique and with what frequency, especially for NIDDM. The model described in this paper simulates the development of eye disease in a population of NIDDM patients and the effects of different screening schemes in terms of years of sight saved and the numbers of people prevented from suffering severe visual loss. The initial results indicate that blanket screening of all NIDDM patients may not be effective.
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PMID:Evaluating screening policies for the early detection of retinopathy in patients with non-insulin dependent diabetes. 1091 90

In the city of Wolfsburg, an annual screening to detect diabetic complications was introduced. In this model, project internists and general practitioners were remunerated for the documentation of diabetic complications. Ophthalmologists were remunerated for the documentation of screening for diabetic eye disease. The patients received a copy of the results. 1,563 patients (2.57% of 60,800 persons insured by the Volkswagen health insurance in the city) received ophthalmologic examination. 1,554 patients (2.6%) were examined by internists and general practitioners (58 practices). Out of 2,879 eyes examined in no retinopathy was detected 80.9%. In 14.1%, mild or moderate retinopathy was observed as well as 3.3% severe non-proliferative retinopathy and 1.3% proliferative retinopathy. 32 amputations were documented. Three of them were not related to diabetes. 32 patients had diabetic foot ulcers (75% males). The implementation of screening for diabetic complications was very successful. Based on the results, an evidence based disease management programme can be started focussing especially on improved tertiary prevention of diabetic complications.
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PMID:[Preventive care for early detection of diabetes mellitus complications: a model project in Wolfsburg]. 1093 54

The purpose of this study was to explore progress, in the adaptation to community screening for blinding eye disease, of digital imaging devices and technology for storage and transmission. Available imaging systems were compared to gold standard clinical photography in terms of sensitivity and specificity for diagnosis of common blinding eye conditions. Since the use of expensive non-portable imaging devices is likely to be limited for widespread community screening purposes, a portable fundus camera (Nidek, Chiyoda-ku, Japan) and a prototype monocular digital indirect ophthalmoscope constructed at the Lions Eye Institute (LEI) were selected for comparative trials for the screening of optic disc cupping, glaucoma and clinical signs of diabetic retinopathy. Fifty-one eyes of 27 consecutive patients being assessed at the LEI clinic for glaucoma were dilated and photographed with a Zeiss retinal camera, and digital images were taken with the portable Nidek NM100 fundus camera (Carl Zeiss, Oberkochen, Germany) or with a prototype digital monocular indirect ophthalmoscope. Vertical cup: disc ratios (VCDR) were measured on the disc photographs by one ophthalmologist while three other clinicians were presented with compressed digital images in random order to estimate VCDR. Field trials were also carried out to demonstrate the practicality of compression, local storage and then transmission by mobile telephone ISDN lines and satellite, of optic discs and fundus images of patients with diabetes in either rural Western Australia or Surabaya, Indonesia. Kappa values of correlations of measurement of agreement between measured and estimated VCDR were 0.87, 0.45 and 0.84, respectively, for the three observers, corresponding to a specificity of 79-97% and a sensitivity of 70-95%. The portable Nidek fundus camera was also assessed for specificity and sensitivity in the diagnosis of diabetic retinopathy in comparison to standard Zeiss fundus camera photographs. Of 49 eyes in 25 consecutive patients attending the LEI clinic for assessment of diabetic retinopathy, three ophthalmologists assessed photographs and images in random order. When used for screening diabetic retinopathy, the digital images of the Nidek camera were graded as adequate quality in only 56% of eyes compared to 93% of the photographs. The kappa value of agreement in analysis of diabetic retinopathy was only 0.30. The prototype digital monocular indirect ophthalmoscope compared favourably with the Nidek camera. At 1:5 compression, images of size 36 kB transmitted from Surabaya to Perth took 29 s on the mobile telephone, while uncompressed images took 170 s. Images compressed 1:5 were transmitted in 60 s using the satellite telephone, while the uncompressed images took 240 s. Satellite transmission was more expensive but the lines were more stable than telephone connections from Indonesia. Digital imaging is becoming a powerful tool for ophthalmology in clinical records, teaching and research, and interoffice diagnostic opinions. It also has enormous potential for community screening for blinding eye diseases, such as glaucoma and diabetic retinopathy. Inexpensive portable imaging devices that are easy to use, and on which local health workers might be trained, must be developed and validated in terms of sensitivity and specificity of performance. The technology of image capture, image compression, transmission, data base storage and analysis is rapidly evolving and becoming less expensive.
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PMID:Fred Hollows lecture: digital screening for eye disease. 1098 79

The attributes of Release 3.0 of the user friendly version (UFV) of the global diabetes model (GDM) are described and documented in detail. The GDM is a continuous, stochastic microsimulation model of type 2 diabetes. Suitable for predicting the medical futures of both individuals with diabetes and representative diabetic populations, the GDM predicts medical events (complications of diabetes), survival, utilities, and medical care costs. Incidence rate functions for microvascular and macrovascular complications are based on a combination of published studies and analyses of data describing diabetic members of Kaiser Permanente Northwest Region, a non-profit group-model health maintenance organization. Active risk factors include average blood glucose (HbAlc), systolic blood pressure (SBP), low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), triglycerides, smoking status, and use of prophylactic aspirin. Events predicted include diabetic eye disease, diabetic nephropathy, peripheral neuropathy amputation, myocardial infarction, stroke, peripheral artery disease, congestive heart failure, coronary artery surgery, coronary angioplasty, and death.
Diabetes Res Clin Pract 2000 Nov
PMID:The global diabetes model: user friendly version 3.0. 1108 May 61

Diabetic retinopathy is a common cause of blindness, and screening can identify the disease at an earlier, more treatable stage. However, rural individuals with diabetes may have limited access to needed eye care. The objective of this project was to demonstrate the feasibility of a diabetic retinopathy screening program using a state-of-the-art nonmydriatic digital fundus imaging system. The study involved a series of patients screened in primary care and public health locations throughout seven predominantly rural counties in eastern North Carolina. Images of each fundus were obtained and sent to a retinal specialist. The retinal specialist reviewed each image, recorded image quality, diagnosed eye disease and made recommendations for subsequent care. Of 193 volunteers with a history of diabetes mellitus, 96.3 percent reported that they were very comfortable or comfortable with the camera. Eighty-five percent of images were rated as good or fair by the retinal specialist. The retinal specialist also reported being very certain or certain of the diagnosis in 84 percent of cases. Image quality correlated highly with the certainty of diagnosis (Spearman's rank order correlation coefficient = 0.79; P < 0.001). The average time since the previous examination by an eye care specialist for diabetic subjects was two years. Approximately 62 percent of diabetic patients had diagnosable eye conditions, the most common of which was diabetic retinopathy (40.9 percent). In this convenience sample, African Americans, despite similar age and disease duration, were more likely to have retinopathy. Digital imaging is a feasible screening modality in rural areas, may improve access to eye care, and may improve compliance with care guidelines for individuals with diabetes mellitus.
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PMID:Screening for diabetic retinopathy in rural areas: the potential of telemedicine. 1135 19

Laser retinal photocoagulation represents the primary therapy for the potentially blinding manifestations of diabetic retinopathy. Advances in laser therapy for diabetic eye disease have arisen from the convergence of laser technology and clinical ophthalmology. In this review, the basis of laser therapy in diabetic retinopathy is discussed. Included are the clinical characteristics, classification, and pathogenetic mechanisms of diabetic retinopathy. The principles of laser technology, variety of lasers currently available for therapy, and mechanisms of laser actions on retinal target tissues are introduced. The milestone clinical trials establishing the efficacy of laser therapy and the parameters for its clinical application in diabetic retinopathy are outlined.
Diabetes Technol Ther 1999
PMID:Lasers and diabetic retinopathy: the art of gentle destruction. 1147 90

Australia's rural and remote residents experience considerably higher hospitalisation and death rates due to diabetes than their metropolitan counterparts. There is clearly a need for improved diabetes care services in these areas and interventions that target conditions associated with diabetes will yield beneficial results for the community. All people with diabetes are at risk for diabetic retinopathy, which can cause vision loss and blindness. Although vision loss and blindness due to diabetes is nearly 100% preventable through regular eye examinations, 35% of Victoria's rural population with diabetes do not have their eyes examined on a regular basis. A pilot, mobile screening program for the early detection of diabetic eye disease was conducted in rural Victoria and proved to be a successful model of adjunct eye care for people with diabetes. Actual costs from the pilot screening were applied to a permanent model for rural eye care. At A$41 per participant, costs for mobile screening were competitive with Medicare rebate costs for eye examinations. The model addresses barriers of accessibility and availability, targets a portion of the rural population with diabetes that is not otherwise having eye examinations, and is cost-saving to the Government.
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PMID:Costs of mobile screening for diabetic retinopathy: a practical framework for rural populations. 1148 3

Retinal neovascularization characterizes proliferative diabetic retinopathy (PDR). Pigment epithelium-derived factor (PEDF) has been shown to be a major antiangiogenic growth factor in the mammalian eye. PEDF expression is suppressed by hypoxia, and changes in PEDF have been correlated to the development of retinal neovascularization in animal models of hypoxic eye disease. However, whether this concept of a reduced angiogenesis inhibitor holds true in humans is as yet unclear. In this study, we analyzed the in vivo regulation of PEDF in patients with and without hypoxic eye disease. We used immunoblots to measure PEDF in ocular fluids obtained from 64 nondiabetic and diabetic patients. In addition, immunohistochemistry of PEDF was carried out in specimens of normal human retinas and retinas with various degrees of diabetic retinopathy. The PEDF concentrations in patients with PDR (P < 0.001) or extensive nondiabetic retinal neovascularization caused by retinal-vein occlusion (P < 0.001) were lower than in control patients. Levels of PEDF were replenished in PDR patients with previous retinal scatter photocoagulation compared with PDR patients without previous photocoagulation (P = 0.01). Immunohistochemistry revealed an interstitial staining pattern as expected for a secreted protein, with an intense staining in retinas of patients without proliferative eye disease. However, in patients with PDR, little or no staining was detectable. Our data strongly support the concept that retinal angiogenesis is induced by loss of the major angiogenesis inhibitor in the eye, PEDF, in combination with an increased expression of angiogenic growth factors such as vascular endothelial growth factor. Our findings suggest that substitution of angiogenesis inhibitors may be an effective approach in the treatment of PDR.
Diabetes 2001 Dec
PMID:Loss of the antiangiogenic pigment epithelium-derived factor in patients with angiogenic eye disease. 1172 44


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