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

Ocular signs and symptoms provide clinical clues to many of the more common metabolic and nutritional disorders seen in older adults. Diabetes mellitus can affect all parts of the eye and orbit. Complications include refractive visual loss, macular edema, retinopathy, increased risk of fungal infection, and diplopia. In patients with gout, urate crystals may precipitate in the eye and cause conjunctivitis, uveitis, or scleritis. Other problems are seen with Wilson's disease, hyperlipidemia, and albinism. Nutritional disorders usually arise from malabsorption, gastrointestinal surgery, and alcohol abuse. Deficiencies in vitamins A, B1 (thiamine), B12, and C may be manifest in the eye.
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PMID:Clues in the eye: ocular signs of metabolic and nutritional disorders. 760 60

Erythropoietin was administered to five anemic azotemic diabetic subjects for 1 year to assess the effect of increasing red cell mass on clinical well-being and the course of renal functional decline. None of the subjects manifested worsened hypertension or cerebrovascular or cardiovascular complications despite an increase in mean hematocrit from a baseline mean of 29.6% to a mean of 39.5%. The serum creatinine concentration after 1 year of treatment with erythropoietin was 3.7 mg/dL, which was unchanged from the baseline value of 3.5 mg/dL. Plasma viscosity remained constant as red cell mass increased. Although the viscosity of whole blood rose as the hematocrit increased, it was within the range of normal blood viscosity for an equivalent hematocrit. The favorable impact of erythropoietin treatment on three diabetic subjects who had macular edema and anemia is described. One hypothesis to explain the benefit of a raised hematocrit on both diabetic nephropathy and retinopathy is that the metabolic, hormonal, and hemodynamic components of the diabetic syndrome, in concert, produce tissue and cellular hypoxia that is ameliorated in part by the greater oxygen-transporting capacity of a raised red cell mass. The pseudohypoxia of diabetes may be implicated in the pathogenesis of diabetic neuropathy, retinopathy, muscular dysfunction, and nephropathy.
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PMID:Erythropoietin in diabetic macular edema and renal insufficiency. 761 Dec 53

We randomized 102 patients with insulin-dependent diabetes to intensified treatment (n = 48 at baseline, n = 42 after 7.5 years) or standard treatment (n = 54 at baseline, n = 47 after 7.5 years). As has previously been reported, intensified treatment resulted in a retardation of retinopathy, nephropathy, and neuropathy. For the purpose of the present study, all patients were analyzed, and the complications related to the mean glycosylated hemoglobin (HbA1c) level. Patients with mild retinopathy at onset did not develop serious retinopathy, visual deterioration, or manifest nephropathy if their mean HbA1c during 7.5 years was below 7% (normal range, 3.9%-5.7%). Neuropathy only rarely developed in patients with HbA1c below 7%. Visual acuity in the patient group with more advanced retinopathy at baseline was also better preserved if the patient had lower HbA1c; also whereas these patients needed photocoagulation treatment just as often as the patients with higher HbA1c because of proliferative retinopathy or sight-threatening macular edema. The risk for the development of serious and disabling microvascular complications seems to be small in patients with insulin-dependent diabetes mellitus if they start intensified treatment when they have mild retinopathy, and achieve mean HbA1c levels below 7% (1.2 times the upper normal limit).
J Diabetes Complications
PMID:Are there any glycemic thresholds for the serious microvascular diabetic complications? 773 40

We present the results of a population based study designed to estimate the prevalence of diabetic retinopathy in a series of 284 type 2 diabetics residing in low income areas of Mexico City. These patients were identified in a survey performed between February 1990 and October 1992 (The Mexico City Diabetes Study). We located 214 (75.35%) of the original 284 patients and invited them to attend a clinic where they were interviewed and had a complete ophthalmologic examination. All participants had, in addition to the retinal examination by a certified ophthalmologist, seven fields stereo fundus photographs taken with a Topcon 50X retinal camera. Photos were taken using ASA 100 Kodak film and processed in their laboratory. All photographs were read and graded for quality and level of diabetic retinopathy (DR) in the Reading Center of the Department of Ophthalmology of the University of Wisconsin. A total of 37 (43.5%) men and 69 (53.5%) women had no evidence of DR. In 16 (18.8%) men and 21 (16.3%) women there was background DR. In 25 (29.4%) men and 30 (23.3%) women there was preproliferative DR. In 5 (5.9%) men and in 7 (5.4%) women there was proliferative DR. Macular edema was diagnosed in 7 (8.2%) men and 6 (4.7%) women, of these in 3 (3.5%) men and in 5 (3.9%) women the macular edema was central. This complication is associated with duration of diabetes, chronic poor metabolic control and microalbuminuria. A very significant proportion of cases with sight threatening DR remains undiagnosed and untreated. Consequently there is a significant number of cases developing into blindness that could have been prevented.
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PMID:Diabetic retinopathy in Mexico. Prevalence and clinical characteristics. 780 88

All persons with diabetes are at risk of retinal complications, although persons with type I (insulin-dependent) diabetes face a greater danger of severe vision loss than persons with type II (noninsulin-dependent) diabetes. Retinopathy has two stages: the nonproliferative stage, which includes intraretinal microaneurysms, hemorrhages, and soft and hard exudates, typically occurs well before the more serious proliferative stage, which is characterized by neovascularization and fibrovascular growth from the retina or optic nerve. Macular edema, a serious development, can occur in either stage. Untreated neovascularization and macular edema are the two major retinal complications that lead to blindness. Good glycemic control has been shown to reduce the development of retinopathy by 76 percent in diabetic patients and to slow progression by 54 percent in those with early retinopathy. Effective hypertension control and diabetic therapy, regular ophthalmologic examinations and properly timed focal laser treatments for macular edema and proliferative retinopathy can markedly reduce the risk of vision loss.
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PMID:Management of diabetic retinopathy. 788 46

Macular edema is the main cause of visual impairment in diabetic patients. It occurs in about 10% of the diabetic population and in 30% of patients with up to twenty years of diabetes. Macular edema usually progress very slowly. Several studies have shown that almost 50% of the eyes affected displayed no change in vision during a two-year follow-up. Macular edema may spontaneously resolve, and probably responds to correction of glycemic and systemic anomalies, thus indicating that it does not require urgent treatment. The treatment of macular edema is based on argon green laser photocoagulation. Extra macular focal photocoagulation delivered to the center of circinate exudates results in exudate resorption and is indicated when ever the exudates enter the macular area. The treatment of cystoid macular edema consists of grid photocoagulation in the perifoveolar area. In most cases, it results in the disappearance of CME and visual stabilization, but rarely in visual improvement.
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PMID:[Diabetic maculopathy:classification, epidemiology, spontaneous outcome, treatment]. 805 21

The existence of a linkage between retinal and renal microvascular complications in type 2 diabetes has been so far little investigated. For this purpose we evaluated the presence and degree of renal dysfunction in the most serious clinical conditions of diabetic retinopathy. On the basis of the alterations evidenced by fluorescein angiography 73 type 2 diabetic patients were recruited and divided into the following groups: 19 patients were affected by "clinically significant" Macular Edema (ME), 25 subjects had Preproliferative Retinopathy (PrePR) and 29 patients showed Proliferative Retinopathy (PR). Mean values (M +/- SD) of glycosylated hemoglobin, plasma basal C-peptide, lipid profile, blood pressure, glomerular filtration rate, body mass index, age and known duration of diabetes were similar between the groups. Urinary albumin excretion rate (UAE) was determined for each patient on three consecutive overnight collections (pg/min). Even though the distribution of normo (UAE < 20 micrograms/min), micro (UAE:20-200) and macroalbuminuric (UAE > 200) patients did not significantly differ between the groups, mean values of UAE increased significantly in PrePR (371.1 +/- 532.2) and PR (300.7 +/- 717.3) with respect to ME (35.4 +/- 73.1; p < 0.05). The evaluation of all patients recruited for the study, independently of the kind of retinal alteration, showed that 56.8% of them had no sign of even incipient renal dysfunction, in spite of the advanced retinal damage. When considering those patients affected by both retinal and renal complications (43.2%) the prevalence of renal involvement resulted different in the three conditions investigated.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Severe diabetic retinopathy and renal function in non-insulin-dependent (type-2) diabetes mellitus]. 853 94

Diabetic retinopathy is a leading cause of loss of vision in the United States. Results of recent population-based studies and randomized controlled clinical trials suggest that glycemic control can lower the incidence and prevent the progression of retinopathy and loss of vision associated with diabetes. In addition, data from clinical trials showed that timely photocoagulation treatment of severe proliferative retinopathy or clinically significant macular edema prevents loss of vision. This report reviews the epidemiology of diabetic retinopathy and highlights areas in need of further epidemiologic research.
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PMID:Diabetic retinopathy. 872 21

The risk of blindness from retinopathy and macular edema is significantly greater in people with diabetes than in the general public. Annual dilated funduscopic examinations are recommended for early detection and treatment before these problems become serious and threaten vision. Yet national health survey data indicate that only about half of patients with diabetes obtain an annual dilated funduscopic examination. This study surveyed optometrists listed in the NYNEX Yellow Pages (for the Bronx, NY) to assess their knowledge, attitudes, and practices related to dilated funduscopic examinations for patients with diabetes. Over half of the optometry practices in the survey indicated that dilated funduscopic examinations were available at a relatively modest cost. However, the optometrists reported that less than one fourth of the patients they saw with diabetes had knowledge about the purpose of an annual dilated examination. Optometrists are readily available through yellow-page listings. Their role as primary eye care providers in retinopathy screening may increase with managed care.
Diabetes Educ
PMID:Local survey of optometrists about dilated funduscopic examinations for patients with diabetes: making use of phone book yellow-page listings. 897 Feb 91

To study the frequency of diabetic retinopathy in relation to age at diagnosis, treatment, duration of diabetes and glycemic control as measured by means of HbA1c levels, we performed a cross-sectional, registered-based study in the Helsingborg area of southern Sweden, comprising 2232 diabetic patients. Of the known diabetic population < 75 years old, approximately 70% were estimated to be included. We graded retinopathy according to the alternative classification of the Wisconsin study. With an age at diagnosis < 30 years (19% of patients) the prevalence of retinopathy was 64%, whereas with an age at diagnosis > or = 30 years the prevalence of retinopathy was 57% in insulin-treated, and 26% in non-insulin treated patients. Levels of glycated hemoglobin and duration of diabetes were associated with retinopathy in the group with younger onset. In the older-onset group, there was a relationship between retinopathy and duration of diabetes and insulin treatment; glycated hemoglobin had a relationship which was of borderline significance with any retinopathy, but clearly significant with the pooled group: severe non-proliferative, proliferative retinopathy and/or macular edema. Hyperglycemia and duration of diabetes were thus associated with retinopathy in both younger- and older-onset diabetes, but hyperglycemia less so in the older-onset group.
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PMID:Prevalence of diabetic retinopathy in relation to age at onset of the diabetes, treatment, duration and glycemic control. 901 34


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