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

We report a series of 33 consecutive hospitalized geriatric diabetic patients who were referred for evaluation of diabetic nephropathy, defined as proteinuria greater than or equal to 1 g/d (1,000 mg/24 h) or a serum creatinine concentration greater than or equal to 177 mumol/d (greater than or equal to 2 mg/dL). The study population was 60 years old or older (mean age, 68 +/- 6 years), was comprised mainly of women (24 of 33, 72.7%), and was predominantly black (25 of 33, 75.8%). All patients had type II diabetes. A family history of diabetes in parent or sibling was elicited in 24 (72.7%) patients. There were eight patients undergoing maintenance hemodialysis and 25 with less severe nephropathy (mean proteinuria, 2.7 g/d [2,700 mg/24 h]; mean creatinine clearance, 0.57 mL-s [34 mL/min]). Cardiac disorders were noted in the majority of patients: congestive failure in 20 (60.6%), myocardial infarction in eight (24.2%), and active angina in five (15.2%). Other comorbid diseases were present in both hemodialysis patients and the subset of nondialyzed azotemic-proteinuric patients, and consisted of peripheral neuropathy in 31 (93.9%), gastroparesis in 16 (48.5%), retinopathy in 28 (84.8%), and legal blindness in 11 (33%). We conclude that geriatric diabetic nephropathy in type II diabetes is similar in presentation and severity of comorbid extrarenal complications to the syndrome described in younger adults. This inference must be tempered by both the small size and the limitation imposed by the demographics of the study population, which is predominantly composed of black patients receiving treatment at inner city hospitals.
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PMID:Geriatric diabetic nephropathy: an analysis of renal referral in patients age 60 or older. 222 Jul 76

Data from the Wisconsin Epidemiologic Study of Diabetic Retinopathy from persons with diabetes of older onset whose average age was 65.4 years indicate that 9.9% of the men and 13.3% of the women had some degree of visual impairment, and 1.4% of men and 1.7% of women were legally blind (with an visual acuity of 20/200 or worse in the better eye). Poorer visual acuity was strongly associated with increasing duration of diabetes, but age was also an important factor, with rates of legal blindness increasing markedly after the seventh decade of life in groups of any duration. Conditions responsible for legal blindness were diabetic retinopathy or maculopathy, cataracts, glaucoma, and macular degeneration. Incidence of blindness 4 years after the initial evaluation was related to insulin use, younger age at examination, longer duration of diabetes, and more severe retinopathy at baseline. Worsening of vision was related to higher levels of glycosylated hemoglobin and the presence of macular edema on diabetic retinopathy at baseline. These data indicate that there is a high prevalence of ocular problems among people with diabetes of older onset. The practitioner should suggest to these patients that, soon after the diagnosis of diabetes, they have an ophthalmologic evaluation to determine whether asymptomatic problems are present. This action may lead to timely intervention to prevent loss of vision in some patients.
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PMID:Ocular problems in older Americans with diabetes. 222 49

Diabetic eye disease, particularly diabetic retinopathy, is the leading cause of new cases of legal blindness in people 20-74 yr of age in the United States. The prevalence and rate of diabetes in this age-group are higher in Blacks than in Whites. The rate of blindness from diabetic eye disease is also higher in Blacks than in Whites. Severe macular edema, the most frequent cause of decreased vision in diabetic retinopathy, appears to be more common in Blacks. Risk factors for developing macular edema include poorly controlled hypertension, hyperglycemia, and duration of disease. The higher prevalence of hypertension in Blacks may contribute to the increased severity of diabetic retinopathy. Further evaluation is necessary to determine the influence of race on the severity of diabetic retinopathy.
Diabetes Care 1990 Nov
PMID:Diabetic retinopathy in blacks. 226 43

About 5% of total world population is affected by diabetes mellitus syndrome, with an expected increasing trend in the next years. Retinopathy, among the different diabetic complications, is the second cause (being cataract the first) of legal blindness in the industrialized countries. The range of results obtained from prevalence studies, mainly conducted in Anglo-saxon countries, varies from 5% to 70% in connection with the following risk factors: patient's age at the diagnosis date, duration of disease, metabolic control, arterial hypertension and lipidoproteinosis. Smoke and alcohol do not seem to be statistically relevant. The most probable mechanisms causing the retinopathy onset have been identified in the tissue hypoxia and in the vascular occlusion: the former is induced by the HA1c increase associated with hyperglycaemia; this is due to structural and hemorheologic alterations associated with diabetes syndrome. This study analysis the relations between diabetic retinopathy and beta-cellular reserve and cardio-vascular risk factors. 181 diabetics have been considered, subdivided into three groups: Type I diabetics and Type II diabetics and Type II diabetics (both without considering the duration of disease) and diabetics with over 10 years of disease. In each group the correlations between retinopathy severity and cardiovascular risk factors and beta-cellular reserve have been investigated. The results confirm that patient's age, duration of disease and metabolic control are statistically significant in relation to retinal lesion severity. The investigation on beta-cellular reserve, even though the results are not statistically significant, presents a trend towards lower values in more severe retinopathy.
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PMID:[Epidemiology of diabetic retinopathy]. 248 33

Diabetic retinopathy is a common, and potentially blinding or visually disabling complication of diabetes. Nearly all diabetic subjects will have some degree of retinopathy after 20 years of diabetes, and 50% of those with insulin dependent diabetes will have proliferative retinopathy after 15 years. Macular oedema frequently produces central vision loss and legal blindness, most commonly in non-insulin dependent diabetics. In recent years, several therapeutic modalities have been demonstrated to be effective on the basis of large-scale randomized, controlled clinical trials. These include panretinal photocoagulation (PRP), using the argon laser or xenon arc, for proliferative retinopathy, and focal photocoagulation for macular oedema. Vitrectomy surgery is effective for diabetic vitreous haemorrhage and traction retinal detachment, producing improved vision in most patients, but only a relatively small percentage of patients so treated recover good visual acuity (greater than or equal to 6/12). Other therapeutic modalities, such as hypophysectomy for severe retinopathy, remain controversial, while still others, such as rigorous blood glucose control and aldose reductase inhibitors, are currently under investigation. The primary care physician who deals with diabetic patients should be familiar with the lesions of diabetic retinopathy and with current therapeutic modalities. He should perform an examination of the posterior retina with the direct ophthalmoscope on each diabetic patient at each visit, and should institute prompt referral to an ophthalmologist at the first sign of change. Periodic examination of all diabetic patients by an ophthalmologist should be conducted at the intervals recommended in the previous section. Definitive evaluation and treatment of diabetic retinopathy should be carried out by the ophthalmologist.
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PMID:Diabetic retinopathy: current concepts of evaluation and treatment. 353 6

Diabetic eye disease is the leading cause of new cases of legal blindness in American adults under the age of 65 yr. Diabetic persons are at risk for visual loss due to diabetic retinopathy, glaucoma, and cataracts. Better understanding of the natural histories of these complications and recent advances in treatment have provided a rationale for developing an approach to prevent visual loss. This approach requires that diabetic patients who are at high risk for visual loss, and not under the care of ophthalmologists, be systematically screened, referred, and treated.
Diabetes Care
PMID:An approach to the prevention of blindness in diabetes. 636 Jun 2

The course of diabetic retinopathy was investigated in 215 out of 227 insulin-treated diabetics in a one year epidemiological cohort study. Twelve diabetics, all with an onset age greater than or equal to 30 years, could not be re-examined due to deaths in 11 diabetics and deny in 1 diabetic. At the one year follow-up no change (P greater than 0.10) occurred in the prevalence of background retinopathy (50.0% vs 51.6%) or of proliferative retinopathy (16.3% vs 18.6%). The one year incidence of newly developed background retinopathy was 3.7% and of deteriorated retinopathy 10.7%. Newly developed proliferative retinopathy was found in 2.3% of the diabetics after one year. Deterioration of pre-existing background retinopathy developed most frequently among diabetics with a diabetes duration above 10 years. Deterioration of both background retinopathy and proliferative retinopathy showed a sudden onset in some diabetics. Partial sight and legal blindness caused by diabetic retinopathy developed in 3.7% of the diabetics, respectively.
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PMID:Diabetic retinopathy I. The course of retinopathy in insulin-treated diabetics. A one year epidemiological cohort study of diabetes mellitus. The Island of Falster, Denmark. 637 64

Australian legal blindness is defined as bilateral corrected visual acuity less than 6/60; if visual acuity is better than this, collateral visual impairments may be included. Persons thus affected qualify for the Invalid Pension (Blindness). From October 1975 to June 1982, I studied clinical data of 311 persons assessed as legally blind, and recorded diagnoses. I personally examined 259 of these persons and a medical colleague examined 52. Examinees were resident in Brisbane (or environs), Australia. Eleven persons had asymmetrical conditions (analysed separately), and 300 had symmetrical conditions. Causes of the latter were genetically transmissible (20.3%), adult maculopathy (18%), congenital (12.7%), vascular (non-diabetic) (8.7%), adult glaucoma (8.3%), diabetes (7.3%), trauma (6%), and others (18.7%). Of 61 symmetrical genetic cases causes were retinitis pigmentosa (34.4%), congenital cataracts (16.4%), retinal dystrophy and maculopathy (13.1%), Leber's optic atrophy (9.8%), and others (26.3%). These results suggest that more attention should be directed to genetic counselling.
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PMID:Causes of binocular legal blindness in an australian metropolitan community. 666 5

Diabetic retinopathy is a major cause of morbidity and the leading cause of legal blindness in working-age persons in the United States. Retinopathy affects both juvenile-onset and noninsulin dependent diabetics. Most visual loss occurs in patients because they are seen late in the course of their disease. Several clinical trials have aided in establishing recommended screening and referral guidelines for patients with diabetes mellitus. Treatment strategies based on clinical trials are reviewed as well as the importance of control of both hyperglycemia and hypertension. Ocular findings are illustrated and discussed. The primary care physician can substantially reduce the risk of blindness and visual impairment in diabetic patients by prompt recognition of the ocular findings and understanding the importance of timely ophthalmologic evaluation.
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PMID:Diabetic retinopathy. Preserving your patients' sight. 804 60

Diabetic retinopathy is the leading cause of legal blindness in the working adult population of the United States. The longer the duration of diabetes, the greater the likelihood retinopathy will develop. The proper classification of retinopathy is critical to the appropriate choice of therapeutic intervention and to the frequency of follow-up office visits. Monitoring of the patient must be a cooperative, team approach and requires early referral to an ophthalmologist experienced in the care of diabetics. The mainstay of current treatment is prevention through improved glucose control, early detection and, when necessary, intervention with timely laser photocoagulation and/or vitrectomy surgery. Based upon increased knowledge of the pathophysiology of diabetic retinopathy, the future may hold the ability to treat it with biological interventions at an earlier point in the course of the disease.
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PMID:Diabetic retinopathy. Background, classification, pathophysiology. 804 61


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