[Application of a method for the early detection of diabetic retinopathy in Primary Health Care]

Cocoa olein glycerolysis with lipase

In this paper we present the valorization of cocoa olein obtained from the acid fat-splitting of soapstocks. The aim is to develop a solvent free process (enzymatically catalyzed) to maximize the production of a final product with high content of monoglycerides (MAG) and diglycerides (DAG). The effect of the enzyme dose, glycerol content, reaction times as well as the modification of the raw material and pressure were studied. The yield of the reaction increased up to 90-95% when using a vacuum of 2-3 mbar at 65 °C, enough to evaporate the water which is generated as a by-product, an enzyme dose of 1% and molar ratio oil:glycerol of 1:2. The highest yield in terms of MAG and DAG production was obtained by starting from a raw material which was rich in free acidity (FFA), rendering oil with 33.4 and 44.2% MAG and DAG, respectively. Short reaction times (6-8 h) were observed compared to previously reported results (24 h).

Diabetic Retinopathy: Focus on Minority Populations

Diabetic retinopathy is a major cause of blindness in the United States. With rise of the epidemic of obesity and diabetes in the USA and around the globe, serious and common diabetic complications are evolving as a major public health problem, particularly among minority populations. These populations are disproportionately affected by diabetes and 2-3 times more likely to develop visually significant complications. In this highly illustrated review article, we discuss the diabetic epidemic, highlighting the biology and the pathophysiologic mechanisms of this disorder on the anatomy of the eye. We also discuss the risk factors and the implications for minority populations. For the health care providers, we provide cutting edge information and imminently relevant information to help evaluate, manage, and know when to refer their patients to a specialist in ophthalmology to quell the tide of the epidemic.

[Screening for ophthalmic disease in the diabetic patient: eye fundus examination by non-mydriatic retinography with or without examination of visual acuity and intraocular pressure]

OBJECTIVE

To screen for eye disease in diabetic patients by performing only an eye fundus examination with non-mydriatic retinography, or a more extensive ophthalmological examination including visual acuity (VA) and ocular tonometry.

DESIGN

A cross-sectional multicentre study with cohort comparison.

SUBJECTS

Diabetic patients who attended 6 Primary Health Care Centres (PCC).

INTERVENTIONS

complete ophthalmological examination of patients in 3 PCC: VA examination, intraocular pressure (IOP) measurement and eye fundus examination with non-mydriatic retinography (egphNMC). Partial examination of patients of the other 3 PCC: only an eye fundus examination with non-mydriatic retinography. Patients with a suspicion of eye disease were referred to the Ophthalmology Department.

RESULTS

A complete ophthalmological examination was carried out on 938 patients (71%) and a partial examination in 383 (29%).

DIAGNOSIS

a) suspicion of diabetic retinopathy (DR): 123 cases (9.3%), with no differences between the complete examination (9.1%) and partial examination (9.3%); b) suspicion of glaucoma: 89 cases (8.1% in complete examination and 3.4% in partial (suspicion due to papillary alteration in egphNMC)); c) VA changes: 169 cases (18%) in complete examination. Referral to ophthalmology service was made in 41% of patients with complete examination and 18% in patients with partial examination.

CONCLUSIONS

Using only back of the eye examination with a non-mydriatic camera, a high percentage of diabetic patients were not diagnosed with an eye disease distinct to diabetic retinopathy (VA and IOP alterations), which are probably associated to a higher percentage of cataracts and glaucoma in this group.

[Retinography and tonometry in primary care: techniques incorporated into routine nursing practice]

OBJECTIVES

To determine the frequency of eye fundus examinations during the study period compared to the previous year. To find out the prevalence of diabetic retinopathy and the level of agreement between the primary care doctor and the ophthalmologist in the interpration of retinographies performed. To determine the relationship of the different variables with the prevalence of retinopathy. To describe the problems detected in the handling of the digital retinograph. And finally to determine the prevalence of increased intraocular pressure (IOP) in diabetic patients.

METHODS

In the wellness area S. Gormaz Esteban (Soria, Spain) we performed a descriptive observational study on patients with diabetes. The nurse conducted a visual screening that included retinography and tonometry.

RESULTS

There was moderate agreement in interpretation of retinographs. The coverage of diabetes who have undergone eye screening has increased to 50% (133). Some degree of retinopathy was seen in 38% (44) of the patients studied and the quality of images obtained in 67% (88) was good. The type of diabetes and treatment, the presence of dyslipidemia and nephropathy and years of evolution and elevated glycated haemoglobin are statistically significant variables. The mean IOP was 14.66 mmHg, and 5% (6) had levels >21 mmHg.

CONCLUSIONS

The implementation of comprehensive eye screening for diabetic patients should be consolidated as an intervention in primary care and referring only patients with specialized referral criteria, doubtful cases and technical failures.

[Ophthalmic disease in diabetes mellitus: management from primary health care]

OBJECTIVE

To study the feasibility of a basic ophthalmological examination for the eye disease in diabetic patients by Primary Health Care (PHC).

PATIENTS AND METHODS

A multi-centre prospective study. A sample of 712 type 2 diabetics.

INTERVENTIONS

Visual acuity examination, intraocular pressure measurement and the eye fundus photograph with a non-mydriatic camera taken by an optometrist. The interpretation and subsequent referral to an ophthalmology department by ophthalmologists and general practitioners (GP).

RESULTS

Visual acuity deficiency: GP, 43.7%; ophthalmologist, 36.1%; concordance, 70%; glaucoma suspicion: GP, 8.8%; ophthalmologist, 7.6%; concordance, 94%; diabetic retinopathy: GP, 28.2%; ophthalmologist, 13.4%; concordance, 78%. Ophthalmology Department referral: GP, 56.8%; ophthalmologist, 41.3% (P=0.001).

CONCLUSIONS

Agreement between GP and ophthalmologist leads to a reliable ophthalmological examination of the diabetic patient in PHC. Despite an over-diagnosis and 16% of non-justified referrals by the GP, Ophthalmology Department referral is avoided in almost half of the diabetic patients.

[The non-mydriatic camera as a screening method in diabetics in Tarragona]

OBJECTIVE

The aim of the study is to present the results of the first year of using a non-mydriatic fundus camera. We performed an evaluation of its usefulness and problems.

METHODS

During the first year of using the non-mydriatic fundus camera we evaluated 3,272 type II diabetic patients who were not being controlled in the hospital.

RESULTS

The diabetic retinopathy was observed in 164 patients (5.01%), the mild form in 70 patients (2.14%). Diabetic macular oedema was observed in 41 patients (1.25%). In 119 patients (3.63%) the retinography could not be interpreted and were referred to the hospital; 113 patients also were referred due to other pathologies; the largest group of these patients had age-related macular disease or age-related macular degeneration (42 patients). Finally, 458 patients (13.99%) required mydriatic eye-drops.

CONCLUSIONS

The non-mydriatic fundus camera is a useful technique for assessing the presence of diabetic retinopathy, particularly in patients with poor ophthalmic control. This technique may enable us to diagnose these patients who need laser treatment.

[Glucose metabolism alterations and follow-up study of a non-diabetic adult population]

OBJECTIVE

To determine the appearance of type 2 diabetes mellitus (DM2) and impaired fasting glucose (IFG) at five years of follow-up in a known non-diabetic population.

PATIENTS AND METHODS

DESIGN

nested case control studies (case s-control into a cohort) developed in two stages: 1) identification and characterization of the cohort and 2) follow-up.

STUDY POPULATION

representative sample of a non-diabetic population between 40 and 75 years old attended in a Primary Health Center.

RESULTS

IDENTIFICATION

326 persons, 2.1% of whom were diagnosed of previously unknown DM2 and 7.3% of IFG. Insulin resistance (IR) was higher in patients with IFG and pancreatic function of beta cells (PFBC) was higher in the population without glucose metabolism alteration.

FOLLOW-UP

121 persons, 9.7 % of whom evolved to DM2 (all with IFG). IFG proportion at the end of the follow-up was 23.96%.

CONCLUSIONS

At 5 years of follow-up, more than 1/3 of the population studied developed DM2 or IFG. These diagnoses were related with IR and PFBC.

Diabetic retinopathy at high altitude

The objective of this study was to determine whether altitude hypoxia favors the development of diabetic retinopathy (DR) in healthy type 1 diabetic climbers with tight glycemia control. The retinas of 7 type 1 diabetic climbers with a history of stays at high altitude were studied through nonmydriatic chamber retinography (Ffo-CNM). The retinographies were performed before and after a 7,143 m peak expedition. One of the subjects presented evidence of DR prior to the ascent, in addition to a microhemorrhage afterward; the rest of the retinographies were normal. Fine glycemia management and adequate acclimatization are not the only cautions for diabetics going to altitude; an ophthalmologic exam beforehand is also recommended.