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In this prospective study, the 10- and 15-year incidence and course of retinopathy were examined in relation to medical risk indicators from 3.1 +/- 1.9 (mean -/+ SD) years diabetes duration and onwards in 29 adult type 1 diabetic patients treated under routine care. A total of 28 patients were followed for 10 years and 20 patients for 15 years diabetes duration. After 10 years diabetes duration, 11 patients had developed any retinopathy (ten patients background retinopathy and one patient clinically-significant macular oedema). After 15 years diabetes duration, 16 patients had developed any retinopathy (12 patients developed background retinopathy and four patients developed potentially sight-threatening retinopathy, i.e. clinically significant macular oedema (n = 2) or severe non-proliferative retinopathy (n = 2)). None of the patients developed proliferative retinopathy. No differences were seen in mean HbA1c values between patients without any retinopathy and patients with background retinopathy, whereas patients who developed potentially sight-threatening retinopathy had higher mean HbA1c levels than patients without any retinopathy. Patients who developed potentially sight-threatening retinopathy had higher levels of mean HbA1c both after 10 (9.7 +/- 1.6 vs 6.9 +/- 1.5%; P < 0.05) and 15 years diabetes duration (9.3 +/- 1.2 vs 7.1 +/- 1.3%; P < 0.05), compared to patients without any retinopathy. They also had higher levels of mean HbA1c than patients with background retinopathy after 15 years diabetes duration (9.3 +/- 1.2 vs 7.7 +/- 1.1%; P < 0.05). There were no differences in blood pressure levels between patients who developed retinopathy and those who did not. Only two patients developed clinical signs of nephropathy (urinary albumin 320-1590 mg/l) after 12 and 13 years diabetes duration, respectively. At those time points, both patients had already developed background retinopathy since 2 years. In conclusion, the present study shows that the incidence of retinopathy is associated with the duration of diabetes and that there is a strong association between the degree of metabolic control and development of potentially sight-threatening retinopathy. The study also indicates that the development of retinopathy does not seem to be associated with hypertension or clinical signs of nephropathy.
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PMID:The temporal development of retinopathy and nephropathy in type 1 diabetes mellitus during 15 years diabetes duration. 1049 81

Diabetes is associated with a hypercoagulable state. Blood hypercoagulability may accelerate atherosclerosis and the diabetic microvascular complications. Thrombin-antithrombin III complex (TAT) and fibrinogen levels are parameters of coagulation and fibrinolysis. In the present study, we examined the risk factors for the diabetic microangiopathy including TAT and fibrinogen levels. To investigate the relationship between the clinical parameters and microangiopathy in type 2 diabetic patients, the clinical parameters of subjects with microangiopathy were compared with those of subjects without microangiopathy. The clinical parameters were as follows: age at examination, duration of diabetes, fasting plasma glucose (FPG) level, HbA(1C) level, insulin level, TAT level, fibrinogen level, lipoprotein (a) (Lp(a)) level, total cholesterol level, triglyceride level, HDL cholesterol level and existence of hypertension. The plasma TAT and fibrinogen levels were significantly higher in patients with retinopathy or nephropathy than in patients without these complications. Moreover, fibrinogen levels of patients with microalbuminuria or background retinopathy were significantly higher than those of patients with normoalbuminuria or no retinopathy. The duration of diabetes was significantly longer in patients with any microangiopathy than in patients without it. Multiple regression analyses showed that duration and fibrinogen level were independent factors associated with the existence of retinopathy or nephropathy. Our data show that the disorder of coagulation and fibrinolysis is significantly associated with diabetic retinopathy and nephropathy and exists at the early stage of microangiopathy.
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PMID:Elevation of fibrinogen and thrombin-antithrombin III complex levels of type 2 diabetes mellitus patients with retinopathy and nephropathy. 1098 19

The magnitude of diabetic retinopathy, its determinants, and coverage of laser treatment for diabetic retinopathy among registered people with diabetes in Oman are presented. 2249 randomly selected subjects representing 5564 registered diabetics were examined. WHO recommended definitions of diabetes, retinopathy, and other related conditions were used. Physicians reported the profile of the diabetes while ophthalmologists reported ocular profile and the eye care provided to them. The prevalence of diabetic retinopathy was 14.39% (95% CI 13.46 to 15.31). Men had significantly higher rate of retinopathy than women. The retinopathy rate was higher in age groups 50-59 years and 60-69 years. The rates of background retinopathy, proliferative retinopathy, and diabetic maculopathy were 8.65%, 2.66%, and 5.12%, respectively. The rate was higher among subjects with longer duration of diabetes than those with a shorter duration. Those with an HbA(1c) level more than 9% had significantly higher rates of diabetic retinopathy than those with an HbA(1c) level less than 9%. The retinopathy rate was higher in cases with hypertension, nephropathy, and neuropathy. Of those with diabetic retinopathy who were advised to have treatment at the time of registration, only 20% were treated with laser therapy.
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PMID:Diabetic retinopathy in Oman: a hospital based study. 1292 65

We evaluated the outcome of pregnancies followed between 1990 and 2000 in 93 women with type 1 diabetes, treated with conventional intensive insulin therapy (n=68) or continuous subcutaneous insulin infusion (n=25). We evaluated metabolic control (fasting and 1-hour post-prandial plasma glucose and HbA1c levels), spontaneous or induced abortions, time and mode of delivery, maternal outcome (pregnancy-induced hypertension, preeclampsia, placental insufficiency, hydramnios, hypoglycemic coma, ketoacidosis) and fetal outcome (weight, hypoglycemia, hypocalcemia, hyperbilirubinemia, fetal distress, asphyxia, hyaline membrane disease, polycythemia, shoulder dystocia, malformations). Patients treated with insulin pump more frequently had background retinopathy and clinical neuropathy. No significant differences were observed between the two groups in metabolic control and maternal outcome. Glycemic control, non-optimal in the prepregnancy state, improved significantly during pregnancy, as shown by the progressive reduction in HbA1c levels. As regards fetal outcome, no differences were observed between the two groups in morbidity and especially in malformation rate. Patients with malformed babies did not have optimal metabolic control at conception. Thus, maternal and perinatal outcomes were comparable in patients treated with insulin pump and continuous subcutaneous insulin therapy, and depended on metabolic control. In patients in higher White's class and with more unstable glycemia, we achieved metabolic control and outcomes comparable with those of women of lower White's class and more stable glycemic values using the insulin pump. Our data suggest that insulin pump therapy is useful in problematic, complicated cases of women who want a baby.
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PMID:Analysis of outcome of pregnancy in type 1 diabetics treated with insulin pump or conventional insulin therapy. 1460 71

Fifty type 2 diabetes patients (25 of them being hypertensive) who had no cardiac symptoms had their left ventricular function assessed. There were 24 female and 26 male diabetes patients evaluated, along with a control group of 50 healthy subjects. The patients and controls underwent full clinical evaluation, which included physical examination, blood biochemistry (urea and electrolyte; creatinine, creatinine clearance; fasting blood and two-hour postprandial glucose levels, lipid profile), electrocardiograph, chest radiograph, and echocardiograph. The hypertensive diabetes patients had higher cholesterol levels, and 50% had levels >5.0 mmol/L. Sixteen patients had cataracts, 14 had background retinopathy, 12 had peripheral neuropathy, and 7 had peripheral vascular disease. The subjects had significantly lower ejection fraction than controls, and fractional shortening showed a similar pattern. Eight patients had ejection fraction <50% compared to none of the controls. Sixty-six percent of the subjects and 30% of the controls had diastolic dysfunction (reverse E/A ratio, prolonged deceleration time, and lower deceleration rate), respectively, but the diabetes patients did not show any difference. Diastolic dysfunction correlated significantly with age, fasting blood glucose, and two-hour postprandial glucose. The subjects had higher left ventricular mass (LVM) than controls. The LVM correlated significantly positively with diastolic blood pressure, systolic blood pressure, and pulse pressure. Subclinical diabetic cardiomyopathy exists in our patients; in addition, other risk factors for cardiomyopathy and coronary artery disease exist, including hypertension, hypercholesterolemia, and obesity.
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PMID:Left ventricular function in type 2 diabetes patients without cardiac symptoms in Zaria, Nigeria. 1626 87

Two hundred and seventeen diabetic patients attending the eye clinic were examined to determine the prevalence of retinal changes, and the association between diabetic retinopathy and risk factors. A detailed fundus examination was done, after dilating the pupils, using 90 D lens and slitlamp biomicroscope. Diabetic retinopathy was detected in 112 patients (51.6%). Background retinopathy was seen in 40 out of 217 (18.4%), pre-proliferative retinopathy in 11 (5.1%), proliferative retinopathy in 61 (28.1%) and maculopathy in 58 (26.7%) patients. Factors significantly associated with occurrence of retinopathy were duration of diabetes, presence of hypertension and presence of systemic complications (diabetic foot ulcer, lower limb amputation, nephropathy, and peripheral neuropathy).
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PMID:Prevalence and risk factors for diabetic retinopathy--a study of 217 patients from University of Malaya Medical Centre. 1724 23

A case of a 26-year-old patient with acute myocardial infarction and hypertension, hyperlipidaemia as well as type 1 diabetes from 18 years complicated by background retinopathy and nephropathy in the state of proteinuria is described. State of metabolic compensation of the diabetes was poor. The patient did not perform regular self-monitoring of glycaemia, smoked, and used oral contraception. Early diagnosis of vascular lesions in young persons with long-lasting of type 1 diabetes as well as the introduction of proper preventive and treatment methods may improve prognosis in these high-risk patients.
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PMID:[Myocardial infarction in a 26-year-old patient with diabetes type 1]. 1805 87

The number of Hispanic people in the United States with diagnosed diabetes mellitus is projected to increase by 107% by 2020. The author presents the case of a 62-year-old obese Hispanic man, with newly diagnosed type 2 diabetes mellitus (T2DM), diabetic peripheral neuropathy, background retinopathy, and diabetic nephropathy. The patient also had diagnosed hypertension, peripheral vascular disease, and hyperlipidemia. The treatment plan for this patient included the following medications: pioglitazone hydrochloride (a thiazolidinedione, 30 mg/d); irbesartan (an angiotensin receptor blocker, 150 mg/d titrated to 300 mg/d); hydrochlorothiazide (an antikaliuretic agent, 12.5 mg/d); and aspirin (325 mg/d). Sitagliptin phosphate (a dipeptidyl peptidase IV inhibitor, 50 mg/d) was added to the treatment regimen to improve glycemic control. Simvastatin (20 mg/d) and niacin (1 g/d) were used for lipid management. Therapy also included a low-protein diet and walking program. At 6-month follow-up, the patient showed substantial improvement in his glycosylated hemoglobin level, lipid profile, blood pressure, creatinine clearance rate, and urine albumin level. There were also improvements in his peripheral vascular disease and diabetic peripheral neuropathy. Furthermore, the patient demonstrated encouraging progress in diet and lifestyle modification and in mental attitude.
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PMID:Treating Hispanic patients for type 2 diabetes mellitus: special considerations. 1851 40

To determine the prevalence of concomitant microvascular and macrovascular complications of diabetic nephropathy we retrospectively reviewed the medical records of all 1,952 type 2 diabetic patients followed-up at Security Forces Hospital, Riyadh, Saudi Arabia from January 1989 to December 2004. There were 626 (32.1%) patients (294 (47%) were males) who developed diabetic nephropathy. Their mean age was 66.9 +/- 11.4 years, mean duration of diabetes was 15.4 +/- 7.5 years, mean age at the onset of nephropathy was 61.5 +/- 12.4 years, and mean duration of nephropathy was 3.9 +/- 3.8 years. Concomitant diabetic complications included cataract (38.2%), acute coronary syndrome (36.1%), peripheral neuropathy (24.9%), myocardial infarction (24.1%), background retinopathy (22.4%), stroke (17.6%), proliferative retinopathy (11.7%), foot infection (7.3%), limb amputation (3.7%) and blindness (3%). Hypertension was documented in 577 (92.2%) patients, dyslipidemia in 266 (42.5%) and mortality from all causes in 86 (13.7%). There were 148 (23.6%) patients with one complication, 81 (12.9%) with two, 83 (13.3%) with three, and 61 (9.7%) with four or more. Deterioration of glomerular filtration rate was observed in 464 (74%) patients and doubling of serum creatinine in 250 (39.9%), while 95 (15.2%) developed end-stage renal disease (ESRD) at the end of study and 79 (12.6%) required dialysis. Complications were significantly more prevalent among males with greater number reaching ESRD level than females (P< 0.05). Relative risks of developing complications were significant after the onset of nephropathy; ACS (1.41), MI (1.49), stroke (1.48), diabetic foot (1.6), amputation (1.58) and death (1.93). We conclude that complications of diabetes are aggressive and progressive including high prevalence of diabetic nephropathy. Careful monitoring and proper institution of management protocols should be implemented to identify diabetic patients at high risk for complications and mitigate progression into ESRD.
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PMID:Concomitant macro and microvascular complications in diabetic nephropathy. 1941 42


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