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

We review epidemiological data on primary blepharospasm (BSP). There is a large variation in the stated prevalence of BSP, with crude estimates ranging from 16 to 133 per million in different studies. A large proportion of this variability may be the result of differences in physician education on BSP. Age and female gender may increase the risk of developing BSP. The few case-control studies focusing on adult dystonias including BSP showed an increased risk in association with family history of dystonia and/or postural tremor, prior head and face trauma, and prior eye disease (e.g., blepharitis and keratoconjunctivitis), and a decreased risk associated with cigarette smoking. No association was found with age-related medical conditions such as hypertension and diabetes, family history of parkinsonism, and a history of anxiety or depression. Broocks et al. [Am J Psychiatry, 1998;155:555-557] found a significantly higher frequency of obsessive-compulsive symptoms in BSP than hemifacial spasm despite the clinical similarity. Among putative risk factors for BSP, age at onset, female gender, and prior head or face trauma may affect spread of dystonia to adjacent body regions. While limited, the body of epidemiological data support the idea that environmental and familial, possibly genetic, factors may both be important in the etiology of BSP.
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PMID:Epidemiology of primary blepharospasm. 1183 33

Diabetic retinopathy (DR) and diabetic maculopathy (DMP) are the most frequent and most serious complications of diabetes mellitus (DM). At present the adverse development of these microvascular complications of DM can be very successfully delayed by available therapeutic methods. The success of the therapeutic procedure depends in particular on early treatment of DR and DMP by laser coagulation and/or pars plana vitrectomy, which presumes detection of early stages of the disease. The authors evaluate the priorities of DR screening, the final effect of which is a decline of blindness caused by DM. Conditions for screening of diabetic eye disease are the diagnosis of DR by simple and safe procedures, classification of DR on the basis of the dynamics of retinal changes and standards of treatment. An integral part of the ophthalmological screening programme is professional collaboration of ophthalmologists, diabetologists, general practitioners and specialists in internist medicine. Successful screening of DR makes it possible to involve the subject in preventive and therapeutic care, education of the patient, regular lifelong follow up and early treatment of DR and DMP. By the method of screening of DR we reduce the risk of a decline of visual acuity and prevent severe functional losses as a result of diabetic ophthalmological complications.
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PMID:[Screening for diabetic retinopathy in the Czech Republic--guideline]. 1185 51

Diabetes is a potentially devastating disease with a high morbidity and mortality. There is an excess risk of both microvascular and macrovascular complications with diabetes [1]. Recent studies have emphasised and illustrated how we might be able to limit these diabetic complications. The Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS) found that improved control of blood glucose reduced the risk of major diabetic eye disease by 25%, serious deterioration of vision by nearly 50%, and early kidney damage by 33%. Other studies including the UKPDS have demonstrated the importance of blood pressure control and reduced cholesterol in addition to the use of aspirin in limiting progression of macrovascular disease. Diabetes is no longer viewed as a disease of sugar alone; a more holistic approach is required if our patients are to benefit from the information we have acquired through these recent studies. Some of the most recent developments in the field are presented in this review.
Diabetes Metab Res Rev
PMID:An introduction to new advances in diabetes. 1192 23

The purpose of this study was to evaluate the need for, and efficacy of, community-based culturally specific eye disease screening clinics for urban African Americans with diabetes. The study employed a variety of culturally specific methods in the design and performance of 43 community-based eye disease screening clinics in southeastern Michigan. One thousand, thirty-seven subjects were recruited for the study. Of that number, 817 identified themselves as African Americans and are the focus of this report. Of the 817 African-American patients screened, 84 (10%) needed to be examined by an ophthalmologist immediately (< 30 days), and 180 (22%) needed to be examined soon (within 1 to 3 months), while 544 (67%) were advised to return for another exam a year later. The project demonstrated that it was possible to use culturally specific techniques to identify a significant number of urban African Americans with diabetes in need of eye screening and treatment. However, lack of health insurance proved to be the primary barrier to receiving needed treatment. Although the project was successful, it is not a solution to what is essentially a health systems problem, ie, inadequate access to appropriate diabetes care for a significant number of our population.
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PMID:Conducting community-based, culturally specific, eye disease screening clinics for urban African Americans with diabetes. 1214 13

Diabetes mellitus is a risk factor for eye disease that can lead to blindness. There have been both concerns that aspirin use might worsen diabetic retinopathy, as well as hopes that aspirin might be beneficial in treating it. We investigated whether there are beneficial effects of aspirin alone and in combination with other antiplatelet agents in the treatment of diabetic retinopathy, and the relative hazards for the development of high-risk proliferative retinopathy following aspirin treatment. We conducted a sensitive search for randomized controlled trials combined with index terms for identifying studies on aspirin treatment in diabetic retinopathy in the Cochrane Library (issue 4, 2001) and Medline (1966 to October, 2001). We examined randomized controlled clinical trials in diabetic patients with (non) proliferative diabetic retinopathy and aspirin treatment alone or in combination with dipyramidole versus placebo administration. Two independent reviewers judged trial eligibility, collected details of study population, interventions, and outcomes using a standard data extraction form. One reviewer assessed the quality of trial reporting. We identified six publications pertinent to our objective. Aspirin dosages ranged from 650 mg to 990 mg daily, the dose of dipyridamole, used in only one trial, was 225 mg per day. Studies lasted 8 weeks to 5 years. All trials showed that aspirin alone or in combination with dipyridamole neither lowered nor increased the risk of the development of diabetic retinopathy. The results suggest that there are no ocular contraindications to taking aspirin if required as part of a treatment for cardiovascular diseases or other medical indications.
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PMID:Aspirin in diabetic retinopathy. A systematic review. 1222 31

iabetic retinopathy is the leading cause of low vision and blindness in developed countries. Optometrists have an important role in the detection of diabetic-related eye disease. They are also well-placed to manage patients with reduced vision due to diabetes. In 1998, visual rehabilitation information was analysed from 590 visually impaired patients attending the multidisciplinary Low Vision Clinic at Kooyong in Melbourne, Australia. Diabetes was the primary cause of vision loss in 43 (7.3 per cent) of the patients. This paper investigates the characteristics of these 43 patients and the strategies employed to assist them. In doing so we hope to assist practitioners in managing patients with low vision due to diabetes.
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PMID:A practical guide to low vision management of patients with diabetes. 1236 27

Diabetes is a chronic and costly disease, which is increasingly affecting Australians of all ages. It imposes a personal and public health threat. Every health care provider will encounter numerous people with diabetes in the course of practice and will have the opportunity to influence the course of diabetes in individual patients. Optometrists have recognised technical training and expertise in detecting diabetic eye disease but can also be effective in helping to improve overall diabetes outcomes by adopting strategies which can assist in: 1. the earlier detection of undiagnosed diabetes, 2. earlier referral to appropriate services for people with established diabetes and who may be experiencing problems and 3. greater patient awareness of recommendations for optimal diabetes care. This article provides an overview of the way diabetes services are currently provided in Australia and the role of non-medical providers in the management of diabetes. Suggestions are made for greater involvement of optometrists as members of the multi-disciplinary diabetes team.
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PMID:The optometrist's role in the multidisciplinary diabetes team: towards a more holistic approach. 1248 93

BACKGROUND: Diabetes mellitus is an important cause of visual loss, which can be moderated by treatment at specific stages of diabetic retinopathy. Existing monitoring for retinopathy has been shown to fall short of ideal, resulting in unnecessary visual loss. Using appropriate guidelines, optometrists should be well-placed to contribute to the management of patients having diabetic eye disease. METHOD: The underlying pathology of diabetic retinopathy is reviewed as a basis for recognising the various stages of diabetic retinopathy, including macular oedema and risk of progression of disease. These stages are detailed in terms of classification, prevalence and appropriate examination techniques. An illustrated guide summarises these features and provides a suggested management regimen for continued monitoring, reporting, referral and ongoing management by optometrists. CONCLUSIONS: The majority of optometrists have the diagnostic skills and the clinical equipment required for efficient monitoring of diabetic retinopathy. Inclusion of optometrists in the team providing health services for diabetes is an economic and practical solution to improving the primary eye care of people having diabetes and ensuring a significant reduction of unnecessary visual loss caused by diabetic retinopathy.
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PMID:Diabetic retinopathy: classification, description and optometric management. 1248 94

Flickering light stimulation of retinal photoreceptors induces retinal vessel dilation in humans. In the present study the effect of high blood glucose levels on this neuro-vascular mechanism was investigated in 12 healthy young male subjects. Blood glucose levels were consecutively increased during 30 min to 100, 200 and 300 mg/dl and kept at the respective level for the following 30 min using hyperglycemic insulin clamps. Eight Hertz flickering light was applied to the fundus at the end of each glucose plateau during continuous retinal vessel diameter measurements with the Zeiss retinal vessel analyser (RVA). During normoglycemia (100 mg/dl) flickering light induced a significant vasodilation of retinal arteries (+2.8+/-0.4%, p<0.0001) and veins (+2.6+/-0.4%, p<0.0001). At 300 mg/dl blood glucose the flicker response in retinal veins was significantly decreased by 55% (p=0.015 versus 100 mg/dl). The modified RVA employed in the present study provides high sensitivity and is capable of studying flicker-induced retinal vasodilation. Using this technique the present study confirms that flickering light stimulation of the human retina induces vasodilation in retinal vessels in healthy subjects. In addition, our data indicate that the retinal vessel response to flickering light stimulation is significantly reduced during hyperglycemia in humans. The relevance of this finding for diabetes-related eye disease remains to be shown.
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PMID:Hyperglycemia affects flicker-induced vasodilation in the retina of healthy subjects. 1276 16

IGF-1 has been associated with the pathogenesis of diabetic retinopathy, although its role is not fully understood. Here we show that normoglycemic/normoinsulinemic transgenic mice overexpressing IGF-1 in the retina developed most alterations seen in human diabetic eye disease. A paracrine effect of IGF-1 in the retina initiated vascular alterations that progressed from nonproliferative to proliferative retinopathy and retinal detachment. Eyes from 2-month-old transgenic mice showed loss of pericytes and thickening of basement membrane of retinal capillaries. In mice 6 months and older, venule dilatation, intraretinal microvascular abnormalities, and neovascularization of the retina and vitreous cavity were observed. Neovascularization was consistent with increased IGF-1 induction of VEGF expression in retinal glial cells. In addition, IGF-1 accumulated in aqueous humor, which may have caused rubeosis iridis and subsequently adhesions between the cornea and iris that hampered aqueous humor drainage and led to neovascular glaucoma. Furthermore, all transgenic mice developed cataracts. These findings suggest a role of IGF-1 in the development of ocular complications in long-term diabetes. Thus, these transgenic mice may be used to study the mechanisms that lead to diabetes eye disease and constitute an appropriate model in which to assay new therapies.
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PMID:Increased ocular levels of IGF-1 in transgenic mice lead to diabetes-like eye disease. 1508 94


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