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Query: UMLS:C0011849 (diabetes)
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The feasibility of using hospital discharge data to monitor six outcome indicators for diabetes care was assessed by reviewing retrospectively the occurrence of these events recorded in hospital records. The population studied was that of the Orkney Islands (19,500) over a 10-year period (1976-1985). During that time, 230 Orkney diabetic patients were treated in Orkney and/or Aberdeen hospitals. The six outcome indicators were: hospital admission rates for diabetic patients (609 in 230 patients), hospital admission rates specifically for diabetic ketoacidosis (29 in 20 patients), rates of diabetes-related lower limb amputations (36 in 23 patients), perinatal mortality rates related to maternal diabetes (nil), visual loss or blindness (13 eyes in 9 patients) and end-stage renal failure (one patient). Scottish Morbidity Returns (which collect data similar to that in the Hospital In-patient Enquiry in England) were shown by case note review to underestimate these outcomes by 41%. Cardiovascular disease, cerebrovascular disease, and peripheral vascular disease accounted for half of all in-patient bed use by diabetic patients (6077 of 13,951 days). The routinely available Scottish hospital discharge data, which are collected for a different purpose, are not sufficiently accurate or complete to reflect variations in actual diabetic events.
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PMID:Measuring outcome of diabetes: a retrospective survey. 252 76

During the 6-year period 1981-1987, 309 patients started chronic ambulatory peritoneal dialysis (CAPD), of whom 75 (24%) had diabetes. Despite severe peripheral vascular problems (20%), ischaemic heart disease (90%), and complete blindness (21%) the 1-year patient survival on CAPD was 88%. The actuarial patient survival for diabetic patients was similar to that of the non-diabetic cohort over the first 18 months but fell to 48% (compared to 70% in non-diabetic patients) at 3 years. Complications associated with CAPD, including the incidence of peritonitis, were no different between the diabetic and non-diabetic patient populations. Successful treatment for end-stage renal disease (ESRD) in diabetic patients can be achieved and justified in a liberal selection programme for the treatment of diabetic ESRD.
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PMID:The treatment of diabetic renal failure by continuous ambulatory peritoneal dialysis. 252 78

Diabetes mellitus is the second most prevalent chronic disease in children in the U.S. It is associated with severe manifestations which include blindness and circulation deficiencies as well as markedly increased risk of death. The etiology of diabetes mellitus remains a mystery although both genetic and environmental factors have been implicated. The geneticist is confronted with a number of obstacles in his attempts to unravel this problem, including differences in the definition of affected individuals. This matter was certainly clarified by the separation of noninsulin-dependent diabetes (NIDDM) and insulin-dependent diabetes mellitus (IDDM) into two separate disease entities. Twin studies, however, show that IDDM cannot be entirely due to genetic causes as concordance is no more than about 50%. Although the disease is then clearly not inherited per se, the "susceptibility" to diabetes seems almost surely inherited and, provided this susceptibility, the disease can be brought on by environmental factors. Until the underlying mechanism causing IDDM is completely ascertained, we have to rely on genetic markers to approach the study of the inheritance thereof. Since, in the early 1970s, research by Nerup's and Cudworth's groups revealed associations between the HLA-B locus and IDDM, the HLA markers are considered the classical genetic markers for IDDM susceptibility. In this paper, we review the nature of the genetic susceptibility to IDDM and the possible environmental factors which can bring on the disease.
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PMID:Immunogenetics of insulin-dependent diabetes mellitus in humans. 257 May 96

Open-angle glaucoma is a common cause of blindness and visual impairment, and is characterized by elevated intraocular pressure, optic nerve degeneration and visual field loss. Risk factors include increasing age, black race, positive family history and diabetes. Since many high risk individuals are seen periodically by primary care physicians, the office or clinic is a logical site for screening for open angle glaucoma. Tonometry is a useful screening maneuver, but is little used in the primary care setting. If primary care physicians can acquire the necessary skills, ophthalmoscopy may be a simple, safe and inexpensive alternative to tonometry.
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PMID:Open-angle glaucoma. 264 2

Retinal vein occlusion is a serious ophthalmologic condition that requires prompt diagnosis and treatment to avoid permanent vision loss. With acute onset of central vein occlusion, vision loss is sudden, unilateral, and painless. Vision loss from branch vein occlusion is typically less severe. Many chronic medical conditions put the patient at high risk for this problem, among them hypertension, diabetes mellitus, arteriosclerosis, and other types of cardiovascular disease. Primary care practitioners, who ordinarily see many patients with such chronic illnesses, are in an excellent position to diagnose retinal vein occlusion and to participate in its management through opthalmologic referral.
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PMID:An eye disorder caused by chronic cardiovascular disease. 265 Dec 19

Diabetic retinopathy, one of the ocular complications of the metabolic imbalance that characterize diabetes mellitus is a major cause of irreversible blindness. This article reviews the concepts of the pathogenesis of this complex disease. The management of this blinding disease is multifaceted and should be based on the sound understanding of the pathophysiologic mechanisms involved. The rationale, techniques, results and complications of the different treatment modalities including glycemic control, laser photocoagulation and vitrectomy are discussed.
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PMID:Diabetic retinopathy: pathogenesis and management of complications. 266 24

Approximately 5.8 million people in the United States have been diagnosed by a physician as being diabetic, and an additional 4 to 5 million people have undiagnosed diabetes. Although the incidence of diabetes appears to be declining from a peak of 300 per 100,000 population in 1973, to 230 per 100,000 in 1981, its prevalence continues to rise, due to a 19 percent decline since 1970 in deaths caused by diabetes. In 1982, 34, 583 deaths were attributed to diabetes, resulting in diabetes being ranked as the seventh leading underlying cause of death. Medical and surgical complications of diabetes due to macro- and microvascular disease result in 5,800 new cases of blindness, 4,500 perinatal deaths, 40,000 lower extremity amputations and 3,000 deaths due to diabetic coma (ketotic and hyperosmolar) and at least 4,000 new cases of end-stage renal disease. Hyperglycemia is a major if not sole determinant of diabetic glomerulopathy. The exact mechanism underlying diabetic vasculopathy is under intensive study. Experiments in the induced-diabetic rat and dog suggest that small vessel injury may--under defined circumstances--be associated with the polyol (sorbitol) pathway of glucose metabolism, myoinositol deficiency, capillary hypertension, plasma hyperviscosity, stiff erythrocytes, elevated circulating thromboxane, and platelet-derived growth factor(s). As yet, no single hypothesis fits these seemingly disparate pieces together into a unified formulation of the genesis of diabetic complications. Clinical experience sustains the contention that a functioning kidney transplant proffers the uremic diabetic younger than age 60 a higher probability for survival with good rehabilitation than does either peritoneal dialysis or maintenance hemodialysis. Diabetics treated by kidney transplantation require more than the routine preoperative and postoperative attention afforded to nondiabetic ESRD patients. During initial nephrologic evaluation, concurrent extrarenal vascular disease--especially ophthalmic, cardiovascular, cerebrovascular and in the extremities, often demands immediate attention. Inventory of co-morbid risk factors pre-transplant facilitates their management post-transplant, thereby improving chances for rehabilitation. Consultations with an ophthalmologist and podiatrist familiar with management of the uremic diabetic should be obtained prior to transplant surgery. When performed as a component of pre-transplant evaluation, coronary angiography permits identification and correction, in many patients, of potentially fatal coronary artery disease.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Renal failure in diabetes: a substantive problem in provision of health care. 267 7

Retinal involvement from diabetes mellitus is the leading cause of new blindness in the United States. Many diabetic patients, though they have perfect vision and no ocular complaints or symptoms, harbor retinal pathology capable of leading to severe loss of vision. Therefore, all medical personnel caring for the diabetic patient must recognize the importance of dilated pupil retinal examinations by an ophthalmologist or vitreoretinal surgeon. Lack of timely diagnosis and treatment is a major factor leading to blindness from diabetic retinopathy. On a more positive note, prompt laser treatment of diabetic retinopathy can reduce severe visual loss by more than 50%.
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PMID:Diabetic retinopathy. 269 4

It has been confirmed in some prefectures in Japan that severe diabetic retinopathy became the leading cause of blindness. The authors described classification of diabetic retinopathy and discussed that in order to prevent blindness due to diabetic retinopathy, it was absolutely necessary to place fundus examination in the management system of diabetes and also to include photocoagulation therapy in the management system of diabetic retinopathy. Application of fundus examination in the management system of diabetes was described correspondingly in cases with or without retinopathy and in cases of each type of diabetic retinopathy. Indication of photocoagulation for diabetic retinopathy was discussed, according to types of the retinopathy, such as maculopathy, preproliferative retinopathy or early stage of proliferative retinopathy. Standard technique of photocoagulation in each type of the retinopathy was discussed. Particularly it was stressed that the panretinal photocoagulation should not be performed in a single session, but should be performed separately in four or five sessions at one week interval.
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PMID:[Classification of diabetic retinopathy and application standard of photocoagulation]. 269 35

The purpose of the present study was to examine the effects on cataractogenesis of daily sc administration of the Ca2+ antagonist drug verapamil to diabetic rats. Streptozotocin-induced diabetic rats were given verapamil half-way through the 8-week experimental period or during the full 8 weeks of diabetes. Verapamil administration had no effect on the high blood glucose values, low circulating insulin levels, or elevated triglyceride and cholesterol concentrations in the diabetic rats. Untreated diabetic rats had a 90% incidence of cataracts. Four weeks of verapamil administration reduced this incidence to 41%, and a full 8 weeks of drug treatment further lowered the incidence to 20%. Diltiazem, another Ca2+ antagonist, lowered the incidence of cataracts in the diabetic rats to a similar extent. Verapamil administration to the diabetic animals also partially protected against the presence of retinal microangiopathy in the diabetic animals. Lenticular hydration and lipid accumulation were only indirectly related to cataractogenesis in the diabetic rats and its protection by verapamil treatment. Lenticular electrolyte imbalance, particularly Ca2+, in the diabetic animals was closely correlated with cataract formation, and verapamil significantly reduced the alterations in these ion concentrations. The present results demonstrate the efficacy of verapamil as a protective agent against cataractogenesis and some retinal damage in diabetic animals. Most importantly, this occurs in the absence of any change in the glycemic status of the diabetic animals. The findings strongly support a role for lenticular Ca2+ imbalance in cataract development in diabetes and provide initial evidence to suggest its clinical use in the diabetic population at risk for blindness.
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PMID:Cataract formation is prevented by administration of verapamil to diabetic rats. 275 74


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