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

In a population-based survey of diabetic persons, retinopathy was detected by stereoscopic color fundus photography in 70% of persons under 30 years of age at diagnosis and taking insulin (Group YO), in 62% of persons 30 years of age or older at diagnosis and taking insulin (Group OO-I) and in 36% of persons 30 years of age or older at diagnosis not taking insulin (Group OO-N). The mean duration of known diabetes was 14.6 years in Group YO, 11.0 years in Group OO-I and 6.9 years in Group OO-N. After 20 years of diabetes, proliferative retinopathy was present in about 50% of Group YO, about 25% of Group OO-I and about 5% of Group OO-N. After 15 years of diabetes, macular edema was present in about 18% of Group YO, about 20% of Group OO-I and about 12% of Group OO-N. When present, macular edema tended to be associated with more hard exudate in Group OO-N.
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PMID:The Wisconsin Epidemiologic Study of Diabetic Retinopathy. A comparison of retinopathy in younger and older onset diabetic persons. 403 19

Recurrent vitreous hemorrhage associated with proliferative retinopathy can occur in eyes that do not satisfactorily respond to argon laser pantretinal photocoagulation. To evaluate the effect of relatively low-risk surgical intervention, we performed peripheral retinal cryopexy on 24 eyes of 23 diabetic patients with proliferative diabetic retinopathy and vitreous hemorrhage. In most cases, cryopexy followed complete or nearly complete panretinal photocoagulation which did not prevent subsequent vitreous hemorrhage. Existing vitreous hemorrhage cleared postoperatively in 23 of 24 eyes. The best corrected visual acuity improved in 15 eyes, remained unchanged in five, and worsened in four. Four postoperative anterior segment complications resolved completely within a short time. One patient, a 68-year-old woman who had had diabetes for 18 years, postoperatively had a macular hole in one eye and macular edema with tractional retinal detachment in the other.
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PMID:Anterior retinal cryotherapy in diabetic vitreous hemorrhage. 403 33

While only a small proportion of adult-onset diabetic patients develop vision threatening retinopathy, this group makes up a major portion of those diabetics seeking ophthalmologic care. Fifty-three percent of patients having fundus photographs at the W.P. Beetham Eye Unit of the Joslin Clinic developed diabetes at the age of 20 or over, and almost 30% at the age of 40 or over. Twenty-two percent of all patients seen with proliferative retinopathy were in this latter group. Ten of 54 patients with proliferative retinopathy in the greater than or equal to 40 onset group were not taking insulin. The older onset patients who developed proliferative retinopathy did so after shorter durations of diabetes and with more visual disability than younger onset patients. Macular edema was more common in adult-onset patients, and its presence in a patient less than 50 years old was usually associated with proliferative or preproliferative retinopathy.
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PMID:Diabetic retinopathy in Joslin Clinic patients with adult-onset diabetes. 616 24

Retinal branch vein occlusion is one of the most common diseases of the retinal vessels. In this retrospective study, 27 affected eyes were reviewed to determine the natural history, complications, and visual prognosis. Retinal branch vein occlusion most often involves temporal retinal veins at the arteriovenous crossing. The precise cause is unknown, but a high degree of association with systemic hypertension and diabetes mellitus is known. The clinical and fluorescein angiographic appearance of acute and chronic retinal branch vein occlusion is described and illustrated. The most common complications affecting visual acuity are macular edema and preretinal neovascularization. It is imperative that collateral channels be distinguished from neovascularization. If the patient's initial visual acuity is good, the prognosis is excellent, but if the initial acuity is poor, the visual outcome is less certain.
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PMID:Retinal branch vein occlusion. 617 6

We have measured plasma von Willebrand factor (VWF) as the factor VIII-related antigen, plasma fibronectin, and two of the serum somatomedins, insulin-like growth factor I (IGF I) and IGF II, in 51 diabetic patients and 25 nondiabetic control subjects. VWF was significantly higher in the diabetic group than in the controls (173 +/- 9% SEM versus 101 +/- 9%, P less than 0.001), as has been reported by others. However, within the diabetic group there was no significant difference in VWF between those patients without retinopathy, those with background or proliferative retinopathy, or those with macular edema. There was also no difference in VWF between the diabetic subjects with and those without proteinuria. These results rule against a previously advanced hypothesis that the increase in VWF in patients with diabetes is secondary to microangiopathy. No significant difference was observed in fibronectin, IGF I, or IGF II between the diabetic and control groups, between the diabetic group without retinopathy and the retinopathic subgroups, and between the diabetic subjects with and without proteinuria. In the diabetic patients, there was no correlation between diabetic control as assessed by glycosylated hemoglobin and glycosylated serum protein, and the plasma levels of VWF, fibronectin, IGF I, or IGF II. The results of this study strongly suggest that neither plasma VWF, fibronectin, IGF I, nor IGF II plays an important primary role in the pathogenesis of diabetic microvascular disease, although one or more of these factors might play a permissive role.
Diabetes 1984 Feb
PMID:Von Willebrand factor (VIII R:Ag), fibronectin, and insulin-like growth factors I and II in diabetic retinopathy and nephropathy. 636 66

The prevalence of macular edema and its relationship to a number of risk factors were examined in a population-based study in southern Wisconsin. Macular edema was determined from its presence on stereoscopic fundus photographs or from past history as recorded and documented in clinic records and photographs. For participants whose age at diagnosis of diabetes was less than 30 years and who were taking insulin (n = 919), prevalence rates of macular edema varied from 0% in those who had diabetes less than 5 years to 29% in those whose duration of diabetes was 20 or more years. In these persons, macular edema was associated with longer duration of diabetes, presence of proteinuria, diuretic use, male gender and higher glycosylated hemoglobin. For those whose age at diagnosis was 30 years or older (n = 1121), prevalence rates of macular edema varied from 3% in those who had diabetes less than 5 years to 28% in those whose duration of diabetes was 20 or more years. In these persons, presence of macular edema was associated with longer duration of diabetes, higher systolic blood pressure, insulin use, higher glycosylated hemoglobin, and presence of proteinuria.
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PMID:The Wisconsin epidemiologic study of diabetic retinopathy. IV. Diabetic macular edema. 652 86

Seven women with insulin-dependent diabetes (mean age, 26 years; mean duration of diabetes, 15.4 years) had minimal or no retinopathy before becoming pregnant but developed severe macular edema associated with preproliferative or proliferative retinopathy during the course of their pregnancies. The edema was associated with significant macular capillary nonperfusion, and often with significant proteinuria and mild hypertension. Although proliferation was controlled with panretinal photocoagulation, the macular edema continued to worsen until delivery in all cases and was often aggravated by the photocoagulation. Macular edema and retinopathy both regressed after delivery in some patients but persisted in others, causing significant visual loss. Pregnant women with retinopathy, nephropathy, or hypertension should undergo ophthalmoscopy at least once a month. If proliferative retinopathy develops, panretinal photocoagulation should be applied even if the macular edema is aggravated.
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PMID:Macular edema and pregnancy in insulin-dependent diabetes. 669 26

Visual acuity was measured in a population-based study of diabetic retinopathy in southern Wisconsin. Persons diagnosed prior to 30 years of age and taking insulin (younger onset, n = 996) and those diagnosed at 30 years of age or older (older onset, n = 1370) were examined. Best corrected visual acuity was determined using the Early Treatment of Diabetic Retinopathy Study protocol. In the younger onset group, 1.4% had moderate visual impairment (best corrected visual acuity in the better eye of 20/80 to 20/160) and 3.6% were legally blind (visual acuity in the better eye of 20/200 or worse). Visual impairment in this group was associated with older age at examination, longer duration of diabetes, presence of proliferative retinopathy, and presence of senile cataracts. In the older onset group, 3.0% had moderate visual impairment and 1.6% were legally blind. Visual impairment in this group was associated with older age at examination, longer duration of diabetes, presence of senile cataract, presence of macular edema, and proliferative diabetic retinopathy. When assigning causes of impaired vision, diabetic retinopathy was responsible in part for 86% of eyes with visual acuity of 20/200 or worse in younger onset persons and for 33% in older onset persons.
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PMID:Visual impairment in diabetes. 670 12

We report four children aged 11-18 1/2 yr first seen 7-14 yr after the diagnosis of insulin-dependent diabetes. At presentation, all had marked short stature, two had hepatomegaly, and the older three had delayed adolescence. They had been severely underinsulinized. Initial funduscopy demonstrated only occasion microaneurysms in two children and a single intraretinal hemorrhage in another. The youngest was normal. Improved control required large increases in insulin dosage. Growth rate improved significantly and hepatomegaly regressed. Puberty progressed rapidly in two older patients with poor final height. Paradoxically, with improved control, retinopathy progressed rapidly with appearance of multiple microaneurysms, nerve fiber layer infarctions, intraretinal microangiopathic changes, hemorrhages, exudates, and macular edema in all the patients and severe proliferation changes in three. One child with proliferative retinopathy in both eyes developed vitreous hemorrhage and blindness in one eye. Two required panretinal photocoagulation with no further progression of their retinopathy. These rapidly progressive retinal changes remain unexplained. We advise caution when correcting metabolic derangements of diabetic patients who have been poorly controlled for a prolonged period.
Diabetes Care
PMID:Progressive retinopathy with improved control in diabetic dwarfism (Mauriac's syndrome). 704 12

In this report, we propose new International Classification of Diseases (ICD) codes that could be incorporated into computer-based patient records or administrative data to monitor and improve diabetes care. Neither the ICD, 9th Revision, nor its imminent replacement, the ICD, 10th Revision, has specific codes for foot examinations and funduscopic examinations in the asymptomatic person, high-risk diabetic foot status, or clinically significant macular edema. Adoption of official codes for these procedures and conditions implemented in conjunction with computerized databases could be used for surveillance, program planning, and quality of care assessment. Computerized medical records could use the codes to monitor care and issue reminders to patients and providers. Payors could offer reimbursement incentives to encourage compliance with standard recommendations. These codes for care procedures could be linked to outcomes, such as amputations and blindness, to improve our understanding of the etiology of blindness and the relationship between process and outcome. The uniform adoption of these codes would facilitate comparison between health care systems, geographic regions, and nations. The diabetes community should encourage the National Center for Health Statistics to adopt new codes that could be used to monitor diabetes preventive care practices.
Diabetes Care 1995 Mar
PMID:A call for specific codes for diabetes foot and eye care. 755 92


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