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

From a telephone survey of the health status of a random sample of the general population of Utah, we identified 255 people with adult onset diabetes. We compared them to 622 non-diabetic controls, matched for age, sex, and urban/rural country of residence. We examined diabetes as a risk factor for heart diseases, stroke, and blindness and its interaction with other known risk factors. Diabetes interacted with smoking history so as to increase the risk of stroke, heart disease, and blindness. Diabetes also interacted with hypertension in their effect on the prevalence of blindness and, to a small extent, heart disease. Among the diabetics, duration of diabetes was associated with macrovascular and microvascular complications developing after the diagnosis of diabetes. Those with longer duration of disease showed an increase in risk for microvascular (kidney disease, blindness) and macrovascular (heart disease, stroke, amputations) complications. Although the estimates were imprecise, the effect of duration on macrovascular complications was greater among diabetics with a history of hypertension; the effect on microvascular complications was greater among smokers. The findings are compared to previous studies and the utility of diabetes prevalence data is discussed.
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PMID:Diabetes in Utah among adults: interaction between diabetes and other risk factors for microvascular and macrovascular complications. 340 19

The occurrence of blindness was evaluated in a population-based group of Danish patients with insulin-treated diabetes diagnosed before the age of 30 years (N = 727), identified by means of insulin prescriptions. The study comprised a retrospective cross-sectional investigation, a longitudinal observation during the subsequent approximately 8 years, and a cross-sectional ophthalmological examination of all patients still alive at the end of the 8 year observation period. Prevalence rates of registered blind at base line were 3.4 and 2.6% for men and women, respectively. The overall incidence rate for blindness was found to be approximately 1.0 per 100 person years. At the ophthalmological examination 88% of blind patients were registered by the Danish Society for the Blind. The cause of blindness in the majority of patients was proliferative retinopathy. Blindness was found to be a significant problem in insulin-dependent diabetes, with a 50-80 times higher risk of blindness than the background population.
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PMID:Blindness in insulin-treated diabetic patients with age at onset less than 30 years. 349 52

While the prevention of acute metabolic decompensation is no longer a serious problem in treating patients with non-insulin-dependent diabetes mellitus (NIDDM), target organ complications can have serious consequences, including blindness, renal failure, neuropathy, amputation, coronary artery disease, and stroke. The bulk of current evidence suggests that these complications can be minimized or perhaps even avoided by carefully monitoring and controlling the patient's blood glucose levels. Although criteria and standards of control differ widely in various centers, in general acceptable-to-good control in the NIDDM patient would consist of average fasting blood glucose (FBG) levels of less than 140 mg/dL and peak postprandial glucoses of less than 220 to 250 mg/dL. Treatment aimed at attaining these blood glucose levels should begin with dietary management and exercise prescription. General health measurements such as control of blood pressure and avoidance of smoking are especially important in the diabetic patient. When these approaches prove ineffectual, the addition of an oral hypoglycemic agent, preferably a second-generation sulfonylurea is indicated. Glipizide and glyburide are both excellent drug choices, although glyburide may cause hypoglycemia in older patients due to its longer half-life and especially in those with renal insufficiency because of accumulation of biologically active metabolites. In certain well-selected cases, the addition of insulin to oral sulfonylurea therapy may offer improved results over the use of either therapeutic modality alone. The advent of self blood glucose monitoring and periodic glycohemoglobin assessments, now well established in diabetic management, represents a major step forward in the endeavor to optimize standards of blood glucose control in the diabetic population.
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PMID:Monitoring and controlling the patient with non-insulin-dependent diabetes mellitus. 354 18

Diabetic retinopathy is a leading cause of blindness. The two forms of retinopathy are background (nonproliferative) and proliferative. Risk for retinopathy increases with the duration of diabetes. Therefore, diabetics need to have regular eye examinations, including specific techniques, to detect subtle retinal changes. Timely ophthalmologic referral is crucial to maximize potential visual results. Patients with macular edema may be candidates for focal laser therapy. Those with proliferative retinopathy may be treated with panretinal laser photocoagulation, which causes regression of neovascularization, or vitrectomy to remove vitreous hemorrhage and repair complicated retinal detachments.
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PMID:Diabetic retinopathy. Still an important complication. 357 92

In a population study of all insulin-treated diabetics and a random sample of those treated with oral antihyperglycaemic agents (OHA) in Gotland, Sweden, the visual acuity (VA) was determined. The prevalence rates of visual impairment (VA 0.1-0.2) and blindness (VA less than 0.1) in the insulin-treated group were 4.9 and 4.4%, respectively, and in OHA-treated diabetics 7.2 and 1.4%. The impairment and blindness were due to diabetic retinopathy (Rp) in 72% of the insulin-treated group, but only in 14% of the OHA-treated diabetics in whom cataract and age-related maculopathy were the predominant causes. Blindness was four times more frequent among insulin-treated females than males. On simple logistic regression test VA correlated with Rp, age at examination, age at onset of diabetes, duration of diabetes and sex. However, on multiple logistic regression analysis the only significant relationships with VA were in the insulin-treated group, a correlation with Rp and age; and in the OHA-treated group, a correlation with age only. Thus the higher frequency of blindness in insulin-treated women was explained by Rp and age. When standardizing for age, the fraction of blind patients was found to be significantly higher among the insulin-treated than in the OHA-treated diabetics (6.7 vs 1.4%).
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PMID:Visual acuity in a diabetic population. 360 7

Diabetic retinopathy is a leading cause of blindness in the United States. Photocoagulation has been shown to reduce visual loss from macular edema and proliferative retinopathy. Because serious diabetic retinopathy may be asymptomatic and its detection difficult, several recommendations have been made by the National Diabetes Advisory Board for routine ophthalmologic examinations to ensure timely treatment. In geographic areas devoid of ophthalmologists, alternate approaches are necessary. These include intensive training of primary-care physicians in ophthalmoscopy, use of objective recording of retinopathy by fundus photography with interpretation of fundus photographs by retinal specialists, and better communication between primary-care physicians and retinal specialists.
Diabetes Care
PMID:New management concepts for timely diagnosis of diabetic retinopathy treatable by photocoagulation. 367 85

We determined the underlying aetiology of blindness for the registered blind population of the Province of Newfoundland and Labrador. In both 1981 and 1984 single-gene disorders accounted for 30% of total blindness and congenital defects for another 10-11%. Genetically determined conditions, diabetes, and senile macular degeneration (SMD) were the three leading causes of registration in each year, 1980-4. We calculated mean ages of registration and mean ages of death over the last four years for five major aetiological groups. Patients with genetic conditions were registered at a much younger age and had a correspondingly longer duration of blindness (21 years as compared with 5 years for either diabetes or SMD). Total 'person-years of blindness' was then calculated from the product of this duration of blindness and the total numbers registered in each group. This index shows that the overall individual and population impact of monogenic blindness is overwhelmingly greater than that of other causes (6849 person-years compared with 270 for diabetes and 430 for SMD). In view of this frequency and duration of monogenic blindness, and also of the substantial hereditary liability to relatively common causes of blindness such as glaucoma, diabetic retinopathy, and high myopia, we suggest that more attention needs to be paid to elucidating the genetic contribution to blindness.
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PMID:The burden of genetically determined eye disease. 375 27

The long-term health consequences of chronic physical activity for patients with type I diabetes are unknown. In the current study, the association of physical activity to diabetic complications was assessed in 696 type I diabetic individuals diagnosed between 1950 and 1964. Participation in team sports in high school or college was not associated with a decreased prevalence of severe retinopathy or blindness later in life. There was, however, a suggestion of a negative association between physical activity and both cardiovascular disease and overall mortality, ie, individuals who participated in team sports were somewhat less likely to report macrovascular disease at follow-up or to have died than nonparticipants. The relationship between physical activity and diabetic complications only appeared in male subjects. The results suggest that activity early in life by patients with type I diabetes does not appear to be associated with an adverse health effect and may, in fact, be beneficial.
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PMID:Pittsburgh Insulin-Dependent Diabetes Mellitus Morbidity and Mortality Study: physical activity and diabetic complications. 378 27

We examined 15 patients with cortical blindness, reviewed the records of 10 others, and compared these 25 patients to those in previous studies of cortical blindness. Although cerebrovascular disease was the most common cause in our series, surgery, particularly cardiac surgery, and cerebral angiography were also major causes. Only 3 patients denied their blindness, although 4 others were unaware of their visual loss. Electroencephalograms (EEGs) were performed during the period of blindness in 20 patients and all recordings were abnormal, with absent alpha rhythm. Visual evoked potentials recorded during blindness were abnormal in 15 of 19 patients, but did not correlate with the severity of visual loss or with outcome. Bioccipital lucencies were found in computed tomographic (CT) scans of 14 patients; none of the 14 regained good vision. Recovery of vision was poor in all 8 patients who had a spontaneous stroke, but fair or good in 11 of the other 17 patients. Prognosis was best in patients under the age of 40 years, in those without a history of hypertension or diabetes mellitus, and in those without associated cognitive, language, or memory impairments. We conclude that the prognosis in cortical blindness is poor when caused by stroke; EEGs are more useful than visual evoked potentials for diagnosis; and bioccipital abnormalities shown on CT scan are associated with a poor prognosis.
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PMID:Cortical blindness: etiology, diagnosis, and prognosis. 382 23

Conventional insulin treatment fails to prevent the development of disabling and fatal complications in most patients with Type I diabetes. Improved metabolic control is achievable today with fractional insulin doses, or wearable pumps permitting continuous subcutaneous insulin infusion. None of the euglycemia regimens in hand for 1984 are easy or successful uniformly. Careful insulin administration by pumps or in fractional daily doses demands that the patient make expensive and time-consuming multiple finger stick blood glucose measurements each day. But, considering the high stakes involved in the gamble to permit suboptimal glucose regulation, it seems no longer rational to regard hyperglycemia as any more inevitable in the diabetic, than was "laudable pus" in the post-operative patient of yesteryear. Nearly constant euglycemia can be attained in many informed Type I diabetics. There are few complications in a tight control regimen, and patients feel better when their blood glucose level approaches the normal range most of the time. Should the long-term control versus complications trials now beginning show that the effort to maintain euglycemia was futile, little will have been lost. But, by stark contrast, if the euglycemia regimen is efficacious, how shall we console this generation of diabetics who, under "poor" glucose regulation, were the last to progress to uremia and blindness when trials now in progress are completed?
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PMID:Defensive medicine in diabetic nephropathy. 386 80


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