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Query: UMLS:C0011849 (diabetes)
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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 retinopathy is a leading cause of visual impairment and blindness. The disease is more likely in patients with insulin-dependent diabetes mellitus, and the incidence is higher in diabetes of long duration. In background diabetic retinopathy, the vascular changes are confined to the retina; in proliferative retinopathy, vessels grow onto the posterior vitreous surface or wedge between the retina and the vitreous. Diagnostic accuracy is more likely with an ophthalmologic consultation. A team approach between the ophthalmologist and the primary care physician is recommended for effective overall management of these patients.
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PMID:Managing diabetic retinopathy. 222 45

Non-insulin-dependent diabetes mellitus (NIDDM) is characterized by insulin resistance and beta-cell dysfunction. This review focuses on the beta-cell, what defects occur when and why. Two major anatomic observations have been made in NIDDM. The beta-cell mass is mildly reduced, especially when obesity is taken into account. Also, amyloid deposits are frequently observed in the islets. It is unclear whether these changes are genetically mediated or result secondary to the loss of glucose homeostasis. Many studies have looked at some aspect of insulin secretion in NIDDM, and two types of distinct abnormalities have been described. Early on, there is a marked disruption in pulsatile insulin delivery, which is potentially an important contributor to the insulin resistance. It is unclear whether the loss of pulsatile delivery is acquired or genetically induced. Later, after glucose intolerance has started, several other secretory abnormalities develop coincident with loss of beta-cell glucorecognition. The net result is further deterioration in timing of insulin delivery and postprandial hyperglycemia. A second important consequence of the glucose blindness is that the inherent compensatory beta-cell mechanisms that guard against hyperglycemia are bypassed. We propose that the loss of glucose responsiveness is a direct result of an elevated glucose concentration (so-called glucotoxicity) and have generated substantial data in rat models that support this idea. The logical conclusion is that beta-cell function in NIDDM can be maximized by achieving the best metabolic control possible.
Diabetes Care 1990 Sep
PMID:Natural history of beta-cell dysfunction in NIDDM. 222 13

The risk of blindness in diabetes may be significantly reduced by a suitable ophthalmic therapy. In order to apply this therapy in due time to the population at risk, all diabetics should be referred to ophthalmological follow-up examination at regular intervals. A rapid progression of a retinopathy may occur in young patients, especially during puberty and pregnancy, after change from oral antidiabetics to insulin and, temporarily, following strict control of blood glucose. Besides normoglycemia, the prevention of a high blood pressure is an important prerequisite of an efficient treatment of diabetic retinopathy. Retinal photocoagulation has been proven the most effective mode of therapy. The correct indication and stage-depending dosage of retinal laser coagulation in diabetes is a demanding task which should be reserved to well-trained specialists in this field. Diabetic vitreous bleeding and retinal traction detachment are complications of advanced proliferative diabetic retinopathy, which can be treated successfully in 60-70% of the cases by modern techniques of vitreoretinal surgery.
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PMID:[Diabetic retinopathy]. 223 47

Macular edema can occur early, especially in maturity onset diabetics. These patients will usually have blurred vision. An examination (through dilated pupil) will reveal fuzziness or hard exudates in the central retina. The ETDRS proved focal laser treatment to leaking blood vessels reduces vision loss. Proliferative retinopathy occurs after 12-15 years or more of diabetes in juvenile diabetics and any time in maturity onset diabetics. Proliferative disease may be completely asymptomatic until there is a vitreous hemorrhage or retinal detachment. The DRS showed scatter laser treatment reduces severe visual loss by at least 50% in patients with proliferative disease. If proliferative disease is not treated, it almost always causes blindness. We must shout this message to all primary care physicians and diabetics. If we are successful, we can eliminate preventable blindness in Iowa's diabetics.
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PMID:Diabetic retinopathy. 225 70

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

Diabetic retinopathy is the leading cause of blindness between the ages of 24-64 years. The first half of this period corresponds to peak fertility and the childbearing years. The effects of pregnancy on diabetic retinopathy are unclear, but recent studies suggest that pregnancy may be less harmful to the retina of the diabetic subject than was thought previously. Nevertheless, there is reason to believe that at least some women experience a worsening of their retinopathy as a result of pregnancy. Thus, careful ophthalmic evaluation and follow-up are essential for the pregnant woman with diabetes. This should include a minimum of one complete eye examination every trimester and within 3 months postpartum. Color fundus photography and laser treatment are safe, whereas fluorescein angiography, although commonly used to evaluate retinal vascular disease, can usually be avoided during pregnancy.
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PMID:Diabetic retinopathy in pregnancy: a review. 240 23

Between 1960 and 1976 117 patients underwent pituitary implantation with yttrium-90 (90Y) for treatment of proliferative retinopathy at the Hammersmith Hospital, London. Mean age at operation was 35 +/- 11 years (mean +/- SD), and mean duration of diabetes 18.6 +/- 10.0 years. Mean insulin dosage prior to implant was 67.2 +/- 24 units, falling to 30.4 +/- 14.9 units post-implant. Thirty-two per cent of patients are still living, 60% are deceased and 8% are lost to follow-up. The 5-year survival rate was 82%. Of the causes of death, 21% died of infection, adrenal insufficiency or hypoglycaemia, 12% of renal failure, and 47% of myocardial or cerebral vascular disease. Ophthalmological follow-up was carried out on the 100 patients operated on between 1965 and 1976. The mean age of this group at implant was 35 +/- 10.5 years, and mean duration of diabetes 17.2 +/- 8.7 years. Visual acuity in the better eye at operation was 6/12 or better in 84% of patients, and this percentage remained similar at the time of the 5 and 10 year follow-up. Blindness (6/60 or worse) in both eyes was present in 12% of patients at the time of 5 and 10 year assessments. By 5 years new vessels on the disc had improved from a mean grading of 2.7 +/- 1.6 to 0.8 +/- 1.2 (p less than 0.001), and by 10 years there was no disc neovascularisation in any eye. There was a similar improvement in the grading of hard exudates, microaneurysms and haemorrhages, but there was an increase in fibrous retinitis proliferans.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Long-term follow-up of patients who underwent yttrium-90 pituitary implantation for treatment of proliferative diabetic retinopathy. 243 1

Many serious disorders that threaten eyesight can now be treated with vitreoretinal surgery. As there was no regional facility for this treatment a service was developed to provide it. Among the first 100 patients treated over half had diabetic vitreoretinal disease. The remainder had ocular trauma (15), non-diabetic vasculopathy (10), rhegmatogenous retinal detachment (10), and miscellaneous disorders including diagnostic procedures (14). Sight was improved in most cases, 27 diabetic and 21 non-diabetic patients regaining navigating vision. Few patients were made worse: one only of the 49 non-diabetic patients and 12 of the 51 diabetic patients, and none whose vision was better than the ability to count fingers before operation. The many indications for this procedure, the size of the population that could benefit (an estimated minimum of 3800 operations per year in the United Kingdom in patients with diabetes alone), and the great potential benefit of the procedure all suggest the need for regional services. These would be cost effective in preventing blindness.
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PMID:A vitreoretinal service. 250 82

Diabetic retinopathy is an important cause of blindness in the Western World. A review of the randomised trials of laser photocoagulation of the retina as a method of preventing blindness from this disorder showed that this treatment is very effective, reducing the risk of blindness by 61% in a treated eye. As only one eye is needed for sight the reduction in blindness in a population will be greater than 61% because the effect of treatment in one eye is not always identical with the effect in the other eye. For analysis this reduction was taken as 73%, representing the average of the minimum and maximum estimates (61% and 85%). The effectiveness of this treatment suggests that there is the potential for a national screening programme to bring about a major reduction in blindness from this cause. A quantitative assessment of the effect of screening indicated that a programme in which patients with diabetes mellitus are systematically referred to ophthalmic opticians for a retinal examination could detect 88% of all diabetics with serious retinopathy and that 87% of these cases would be treatable. Screening and early treatment of retinopathy would prevent deterioration of visual acuity and could reduce the risk of blindness due to diabetic retinopathy by an estimated 56% (0.73 X 0.88 X 0.87). The findings suggest that an effectively managed community based screening programme encompassing detection, referral, treatment, and follow up would prevent about 260 new cases of blindness in diabetics under the age of 70 each year in England and Wales. This would represent over 10% of all cases of blindness in adults in this age group.
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PMID:Prevention of blindness by screening for diabetic retinopathy: a quantitative assessment. 251 83


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