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Bouazza M, Razzak A, Amri G, Zadnass M, Rayad R, Oubaaz A. [Medico-surgical management of intravitreal hemorrhage in diabetic patients]. J Fr Ophtalmol 2023; 46:851-856. [PMID: 37598102 DOI: 10.1016/j.jfo.2023.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/04/2023] [Accepted: 02/09/2023] [Indexed: 08/21/2023]
Abstract
Vitreous hemorrhage (VH) is the main complication of proliferative diabetic retinopathy and remains the primary indication for vitrectomy in diabetic patients. The objective of our study is to compare our medical and surgical management of VH with data from the literature and to report the functional results of our series. We studied a series of 284 cases collected over 2 years in two tertiary care centers. In our series, 90.1% of patients had type 2 diabetes, and 70% had glycosylated hemoglobin greater than 7.5%. On fundus examination, 35.2% presented with stage 1 VH, 42.6% with stage 2, 3.6% with stage 3 and 5.2% with stage 4. Ocular ultrasound performed when fundus exam was difficult diagnosed an associated tractional retinal detachment in 8.8% of patients. Medical treatment was sufficient in 77.8% of patients, while 22.2% of our patients underwent vitrectomy, argon laser endophotocoagulation and postoperative anti-VEGF injection. Peeling of tractional fibrovascular membranes and or associated epiretinal membranes was performed in 69.8% of cases. Iatrogenic tears were noted in 11.8% of patients. In this study, 31.5% of patients underwent intraocular gas tamponade, while 23.8% of cases underwent silicone oil tamponade. Postoperative visual acuity improved by at least 2 lines in 60% of our patients, and the VH recurred in 24.2% of cases after surgery.
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Affiliation(s)
- M Bouazza
- Service d'ophtalmologie, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Cheikh-Khalifa International University Hospital, Casablanca, Maroc.
| | - A Razzak
- Service d'ophtalmologie, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Cheikh-Khalifa International University Hospital, Casablanca, Maroc
| | - G Amri
- Service d'ophtalmologie, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Cheikh-Khalifa International University Hospital, Casablanca, Maroc
| | - M Zadnass
- Service d'ophtalmologie, Hassan II University, hôpital 20 Août 1953, Casablanca, Maroc
| | - R Rayad
- Service d'ophtalmologie, Hassan II University, hôpital 20 Août 1953, Casablanca, Maroc
| | - A Oubaaz
- Service d'ophtalmologie, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Cheikh-Khalifa International University Hospital, Casablanca, Maroc
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2
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Li H, Zhang L, Wang X, Wang W, Zhang J, Pan Q, Guo L. Direct medical cost and medications for patient of diabetes retinopathy in Beijing, China, 2016 to 2018. Diabetes Res Clin Pract 2023:110796. [PMID: 37355099 DOI: 10.1016/j.diabres.2023.110796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 06/26/2023]
Abstract
AIMS Medications and costs of drug for diabetic retinopathy in outpatient in China have not been evaluated. The purpose of this study was to evaluate the hypoglycemic drugs and medical costs of diabetic retinopathy patients in the Beijing medical insurance system, analyze the characteristics of outpatient treatment, and investigate the changes in the quantity and cost of hypoglycemic drugs from 2016 to 2018 METHODS: This is a retrospective observational study, including diabetic patients with outpatient records in Beijing medical insurance from 2016 to 2018. Data on oral hypoglycemic drugs , insulin and non-hypoglycemic drugs, complications, treatment strategies, and annual medical costs were recorded Results: A total of 2,853,036 diabetic patients in Beijing medical insurance were enrolled in this study. 4.19%-4.67% of patients were diagnosed with retinopathy. Patients with retinopathy have more diabetic complications (1.65±0.71 vs 0.18±0.44. pp<.0001),and use more drugs (5.11±2.60 vs 3.85±2.34, pp <.0001), the annual total drug cost is also higher (¥ 13836±11244 vs ¥ 10030±9375, pp <.0001). The numbers of medication in retinopathy patients increased(5.11±2.60 vs 4.95±2.57, pp <.0001), and the annual total drug cost (¥13836±11244 vs ¥15642±13344, pp <.0001)decreased in 2018 compared with 2016. CONCLUSIONS Patients with retinopathy were associated with more complications. Compared with patients without retinopathy, the number of medications and total medical costs were significantly increased. From 2016 to 2018, there was an increase in the number of medication treatments for patients with retinopathy, but a decrease in cost.
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Affiliation(s)
- Hui Li
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Lina Zhang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Xiaoxia Wang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Weihao Wang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Jie Zhang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Qi Pan
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China.
| | - Lixin Guo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China.
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3
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Grauslund J, Pedersen FN, Andersen N, Andresen J, Bek T, Dinesen S, Hajari J, Heegaard S, Højlund K, Laugesen CS, Kawasaki R, Möller S, Schielke KC, Thykjaer AS, Stokholm L. Presence and development of diabetic retinopathy in 153 238 patients with type 2 diabetes in the Danish Registry of Diabetic Retinopathy. Acta Ophthalmol 2023; 101:207-214. [PMID: 36189965 DOI: 10.1111/aos.15264] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/25/2022] [Accepted: 09/19/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of the study was to evaluate the prevalence and incidence of diabetic retinopathy (DR) along with associated markers in patients with type 2 diabetes in the Danish DR-screening programme. METHODS We included all persons with type 2 diabetes in the Danish Registry of Diabetic Retinopathy, who had attended at least one episode of DR screening in 2013-2018. DR was classified as levels 0-4 indicating increasing severity. Data were linked with various national health registries to retrieve information on diabetes duration, marital status, comorbidity and systemic medication. RESULTS Among 153 238 persons with type 2 diabetes, median age and duration of diabetes were 66.9 and 5.3 years and 56.4% were males. Prevalence and 5-year incidences of DR, 2-step-or-more progression of DR and progression to proliferative DR (PDR) were 8.8%, 3.8%, 0.7% and 0.2%, respectively. In multivariable models, leading markers of incident DR and progression to PDR were duration of diabetes (HR 1.98, 95% CI 1.87-2.09; HR 2.89, 95% CI 2.34-3.58 per 10 years of duration) and use of insulin (HR 1.88, 95% CI 1.76-2.01; HR 2.40, 95% CI 1.84-3.13), while the use of cholesterol-lowering medicine was a protecting marker (HR 0.87, 95% CI 0.81-0.93; HR 0.70, 95% CI 0.52-0.93). From 2013 to 2015, 3-year incidence rates of PDR decreased from 1.22 to 0.45 events per 1000 person-years. CONCLUSION Nationally, among Danish individuals with type 2 diabetes attending DR screening, we identified duration of diabetes and use of insulin as the most important predictor for the development of DR, while cholesterol-lowering medicine was a protective factor.
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Affiliation(s)
- Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Frederik Nørregaard Pedersen
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Nis Andersen
- Organization of Danish Practicing Ophthalmologists, Copenhagen, Denmark
| | - Jens Andresen
- Organization of Danish Practicing Ophthalmologists, Copenhagen, Denmark
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Sebastian Dinesen
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Javad Hajari
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - Kurt Højlund
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | | | - Ryo Kawasaki
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Vision Informatics, University of Osaka, Osaka, Japan
| | - Sören Möller
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Anne Suhr Thykjaer
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Lonny Stokholm
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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4
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Nag S, Majumder S. Starch, gallic acid, their inclusion complex and their effects in diabetes and other
diseases—A
review. Food Sci Nutr 2022; 11:1612-1621. [PMID: 37051339 PMCID: PMC10084954 DOI: 10.1002/fsn3.3208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/09/2022] [Accepted: 12/13/2022] [Indexed: 12/29/2022] Open
Abstract
Starch is the most important energy-providing component of food. It is useful for maintaining the structural and rheological consistency of food, ad thus, in turn, is responsible for maintaining the freshness of food. Polyphenols are present in plant products in huge amounts as secondary metabolites. Gallic acid, one of the potent plant polyphenols, has been reported to have excellent anti-inflammatory, antioxidative, anticarcinogenic, microbicidal, and antidiabetic properties. Till date, very few articles on the starch-polyphenol inclusion complex are present. Quite a few hypotheses have been proposed as to how the formation of an inclusion complex of starch with polyphenol can slower the digestion or the hydrolysis of starch. The efficient qualities of starch-polyphenol systems, such as reduced starch digestion, lower blood glucose and preserving food freshness, have formed a necessity for investigation in this area. The focus of this review centers on the recent research on starch-polyphenol interactions and starch-gallic acid inclusion complexes in native and extruded food systems, as well as how the production of these complexes can aid in the treatment of diseases, particularly diabetes mellitus.
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Affiliation(s)
- Sayoni Nag
- Department of Biotechnology Brainware University Barasat India
| | - Suman Majumder
- Department of Biotechnology Brainware University Barasat India
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5
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Sahiledengle B, Assefa T, Negash W, Tahir A, Regasa T, Tekalegn Y, Mamo A, Teferu Z, Solomon D, Gezahegn H, Bekele K, Zenbaba D, Tasew A, Desta F, Regassa Z, Feleke Z, Kene C, Tolcha F, Gomora D, Dibaba D, Atlaw D. Prevalence and Factors Associated with Diabetic Retinopathy among Adult Diabetes Patients in Southeast Ethiopia: A Hospital-Based Cross-Sectional Study. Clin Ophthalmol 2022; 16:3527-3545. [PMID: 36274673 PMCID: PMC9581466 DOI: 10.2147/opth.s385806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/11/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is the most prevalent microvascular consequence of diabetes mellitus, and it can result in blindness that is irreversible. Due to delayed diagnosis and limited access to diabetic care, the situation is even worse in developing countries. Scientific evidence on the prevalence of DR and its associated factors among diabetes patients in low-income countries, such as Ethiopia, is limited. This study aimed to determine the prevalence of DR and associated factors among adult diabetes patients in southeast Ethiopia. METHODS A hospital-based cross-sectional study was conducted among diabetes patients who visited Madda Walabu University Goba Referral Hospital. Fundus and slit-lamp examination were performed for screening of DR. Multivariate binary logistic regression was computed to identify factors associated with DR. RESULTS A total of 256 patients (144 men, 56.2%) aged 50.15±15.71 years were included in the study. The prevalence of any DR was 19.9% (95% CI 15.4%-25.3%), mild nonproliferative diabetic retinopathy (NPDR) 10.9% (95% CI 7.6%-15.4%), moderate NPDR 5.9% (95% CI 3.5%-9.5%), severe NPDR 0.9% (95% CI 0.2%-3.9%), and proliferative DR 2.3% (95% CI 1.0%-5.1%). Duration of diabetes ≥10 years (AOR 10.22, 95% CI 1.70-61.44), central obesity (AOR 5.42, 95% CI 1.38-21.19), overweight/obese (AOR 2.65, 95% CI 1.02-6.92), lower high-density lipoprotein (HDL) cholesterol (AOR 5.82, 95% CI 1.86-18.24), moderate triglyceride:HDL cholesterol ratio (AOR 4.13, 95% CI 1.13-15.15), and urban dwelling (AOR 2.84, 95% CI 1.04-7.78) were significantly associated with DR. CONCLUSION One in every five DM patients had DR. Sociodemographic, anthropometric, and blood lipids were independently associated with DR. To reduce the burden of diabetes, strategies that focus on lifestyle modifications targeted at identified modifiable risk factors are essential.
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Affiliation(s)
- Biniyam Sahiledengle
- Public Health Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia,Correspondence: Biniyam Sahiledengle, Public Health Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia, Email
| | - Tesfaye Assefa
- Nursing Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Wogene Negash
- Nursing Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Anwar Tahir
- Nursing Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Tadele Regasa
- Biomedical Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Yohannes Tekalegn
- Public Health Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Ayele Mamo
- Pharmacy Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Zinash Teferu
- Public Health Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Damtew Solomon
- Biomedical Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Habtamu Gezahegn
- Biomedical Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Kebebe Bekele
- Surgery Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Demisu Zenbaba
- Public Health Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Alelign Tasew
- Public Health Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Fikreab Desta
- Public Health Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Zegeye Regassa
- Nursing Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Zegeye Feleke
- Nursing Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Chala Kene
- Midwifery of Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Fekata Tolcha
- Pediatrics and Child Health Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Degefa Gomora
- Midwifery of Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Diriba Dibaba
- Public Health Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
| | - Daniel Atlaw
- Biomedical Department, Madda Walabu University, Goba Referral Hospital, Bale Goba, Ethiopia
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The Prevalence of Anemia and Its Associated Factors among Older Persons: Findings from the National Health and Morbidity Survey (NHMS) 2015. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19094983. [PMID: 35564378 PMCID: PMC9101117 DOI: 10.3390/ijerph19094983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/05/2022] [Accepted: 04/15/2022] [Indexed: 12/21/2022]
Abstract
Background: There is limited evidence on the association of anemia with chronic diseases and disabilities among older persons in Malaysia. We assessed the prevalence of anemia and its associated factors among community-dwelling older persons. Methods: This was a cross-sectional study using data from the nationwide National Health and Morbidity Survey 2015 (NHMS 2015) on the health of older adults conducted by the Institute for Public Health, National Institutes of Health, Malaysia. A two-stage stratified random-cluster sampling design was utilized. Data were collected on the sociodemographic profiles, non-communicable disease (NCD) comorbidities (hypertension, diabetes and hypercholesterolemia status) and disabilities among the older persons. Anemia was defined based on the World Health Organization’s standards. A multivariable logistic regression analysis was used to assess the association of anemia with chronic diseases and disabilities. Results: The prevalence of anemia was 35.3% (95% CI: 33.1, 37.4) in the older persons. Chronic disease profiling showed that the prevalence rates of anemia among the older persons with diabetes, hypertension and hypercholesterolemia were 38.6%, 35.3% and 34.1%, respectively. In the multivariable analysis, persons aged 80 years and above (adjusted OR (aOR): 2.64; 95% CI: 2.00, 3.47), 70–79 years (aOR: 1.42; 95% CI: 1.21, 1.66), with diabetes (aOR: 1.30; 95% CI: 1.13, 1.51) and with disabilities in walking (aOR: 1.31; 95% CI: 1.11, 1.54) and self-care (aOR: 1.58; 95% CI: 1.22, 2.05) had higher odds of anemia compared to their respective reference categories. Among the persons with diabetes, the respondents aged 80 years and above (aOR: 2.48; 95% CI: 1.56, 3.94), 70–79 years old (aOR: 1.38; 95% CI: 1.08, 1.76) and with disabilities in vision (aOR: 1.29; 95% CI: 1.02, 1.63) and walking (aOR: 1.50; 95% CI: 1.18, 1.91) were more likely to be anemic. Furthermore, among the older persons without diabetes, persons aged 80 years and above (aOR: 2.89; 95% CI: 2.05, 4.07), 70–79 years old (aOR: 1.46; 95% CI: 1.19, 1.80) and with difficulty in self-care (aOR: 1.87; 95% CI: 1.30, 2.69) were more likely to be anemic. Conclusions: The resilient predictors of developing anemia were advancing age and diabetes, based on our study. Anemia is significantly associated with walking and vision disabilities among older persons with diabetes and with self-care difficulties in those without diabetes. There is a need for future studies to evaluate strategies to prevent anemia among older adults in order to promote healthy aging.
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7
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Alsbirk KE, Seland JH, Assmus J. Diabetic retinopathy and visual impairment in a Norwegian diabetic coast population with a high dietary intake of fish oils. An observational study. Acta Ophthalmol 2022; 100:e532-e538. [PMID: 34472215 DOI: 10.1111/aos.14977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/19/2021] [Accepted: 07/01/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE To present retinal and visual findings in a Norwegian west coast diabetic population and to elucidate the effect of dietary intake of marine polyunsaturated fatty acids (PUFAs) on the development of diabetic retinopathy (DR). METHODS In an eye practice in an archipelago of 314 km², serving a population of about 40 000, we recorded the prevalence of visual impairment and DR in a referred diabetic population. 510 consecutive patients were included, 238 females and 272 males. 50 patients had type I and 460 had type II diabetes mellitus (DM). Self-reported medication, diet supplements, HbA1c and fish consumption were registered. RESULTS In the type I group, the median age was 44.5 and median DM duration 11.5 years [1-44]. 48% had photographic evidence of DR, 8 patients (16%) had proliferative retinopathy (PDR), and 6 patients (12%) had diabetic macular oedema (DME). All had best-corrected visual acuity (BCVA) of 0.5 (log MAR 0.3) or better in the best eye. In the type II group, the median DM duration was 8 years [1-53], and median age was 66. 98% had best eye BCVA at or better than 0.5 (log MAR 0.3) in the best eye. CONCLUSION None of the 510 patients had BCVA worse than 0.3 (log MAR 0.48) due to diabetic retinopathy. Compared to similar studies, we found a very low visual impairment rate. A possible protective effect of PUFA on the prevalence and progression of diabetic microangiopathy including retinopathy is discussed.
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Affiliation(s)
| | | | - Jörg Assmus
- Centre for Clinical Research Haukeland University Hospital Bergen Norway
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8
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Bek T, Nielsen MS, Klug SE, Eriksen JE. Increasing metabolic variability increases the risk for vitrectomy in proliferative diabetic retinopathy. Int Ophthalmol 2021; 42:757-763. [PMID: 34625890 DOI: 10.1007/s10792-021-02041-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 09/22/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Proliferative diabetic retinopathy (PDR) can be treated by retinal photocoagulation, but in some cases, the treatment is initiated too late or is insufficient so that the disease advances to a stage requiring vitrectomy. There is a need to identify risk factors that can predict if patients with PDR will develop complications in need for vitrectomy. METHODS Survival analysis with death as competing risk was used to study systemic risk factors for PDR progression to a complication in need for vitrectomy in right eyes of all 1288 diabetic patients from the Aarhus area, Denmark, who had developed proliferative retinopathy in the right eye during the 25 years period from 1 July 1994 until 1 July 2019. RESULTS The overall cumulative incidence of reaching a vitrectomy end point in the right eye was 24.1% (n = 311). In 9.3% (n = 120) of the patients where vitrectomy had been performed together with the first photocoagulation, the age of onset of diabetes was significantly higher (p < 0.0001), the diabetes duration longer (p < 0.035) and BMI higher (p < 0.01) than in the patients who had been vitrectomized later than the first photocoagulation. The risk for vitrectomy was significantly increased by high variability of HbA1c before the development of PDR (p < 0.0001), but not by other parameters known to increase the risk for developing PDR. CONCLUSION Increasing variability of HbA1c before the development of PDR increases the risk for progression to a complication in need of vitrectomy. The need for vitrectomy is unaffected by other risk factors known to increase the risk for developing PDR.
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Affiliation(s)
- Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, 8200, Aarhus N, Denmark.
| | - Mette Slot Nielsen
- Department of Ophthalmology, Aarhus University Hospital, 8200, Aarhus N, Denmark
| | - Sidsel Ehlers Klug
- Department of Ophthalmology, Aarhus University Hospital, 8200, Aarhus N, Denmark
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9
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Hashemi H, Rezvan F, Pakzad R, Ansaripour A, Heydarian S, Yekta A, Ostadimoghaddam H, Pakbin M, Khabazkhoob M. Global and Regional Prevalence of Diabetic Retinopathy; A Comprehensive Systematic Review and Meta-analysis. Semin Ophthalmol 2021; 37:291-306. [PMID: 34402390 DOI: 10.1080/08820538.2021.1962920] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE We conducted a systematic search to estimate DR prevalence in different age and gender groups, and to evaluate the determinants of heterogeneity in its prevalence. METHODS A systematic and comprehensive search from inception to August 10, 2020, was done in international databases, including Scopus, PubMed, Web of Science, Embase, and other data sources without any restriction to find cross-sectional studies related to the prevalence of DR. RESULTS Of 6399 studies, 90 articles with a sample size of 563460 individuals and 204189 diabetic patients were analyzed. The estimated pooled prevalence of DR in the diabetic population in general; in female and in male was 28.41% (95% CI: 25.98 to 30.84); 25.93% (95% CI: 23.54 to 28.31) and 28.95% (95% CI: 26.57 to 31.32); respectively and the prevalence of DR showed no inter-gender difference. The heterogeneity of the pooled prevalence according to I2 was 99% (p < .001). According to the meta-regression results, the variables of WHO region (Coefficient of AMRO vs SEARO: 15.56; p: 0.002), age (Coefficient of above 60 years vs below 40 year: 18.67; p: 0.001), type of DR (Coefficient: 19.01; p < .001), and publication year (Coefficient: -0.60; p: 0.001) had a significant correlation with heterogeneity. CONCLUSION One third of diabetic patients suffered from DR, mostly NPDR. DR increased markedly after the age of 60 years, which could be due to the longer duration of diabetes. Age, WHO region, type of DR, and publication year affected the heterogeneity in the prevalence of DR.
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Affiliation(s)
- Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Farhad Rezvan
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Reza Pakzad
- Department of Epidemiology, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | | | | | - Abbasali Yekta
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Rehabilitation Science, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hadi Ostadimoghaddam
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mojgan Pakbin
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Mehdi Khabazkhoob
- Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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10
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Teo ZL, Tham YC, Yu M, Chee ML, Rim TH, Cheung N, Bikbov MM, Wang YX, Tang Y, Lu Y, Wong IY, Ting DSW, Tan GSW, Jonas JB, Sabanayagam C, Wong TY, Cheng CY. Global Prevalence of Diabetic Retinopathy and Projection of Burden through 2045: Systematic Review and Meta-analysis. Ophthalmology 2021; 128:1580-1591. [PMID: 33940045 DOI: 10.1016/j.ophtha.2021.04.027] [Citation(s) in RCA: 598] [Impact Index Per Article: 199.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 04/20/2021] [Accepted: 04/23/2021] [Indexed: 12/11/2022] Open
Abstract
TOPIC To provide updated estimates on the global prevalence and number of people with diabetic retinopathy (DR) through 2045. CLINICAL RELEVANCE The International Diabetes Federation (IDF) estimated the global population with diabetes mellitus (DM) to be 463 million in 2019 and 700 million in 2045. Diabetic retinopathy remains a common complication of DM and a leading cause of preventable blindness in the adult working population. METHODS We conducted a systematic review using PubMed, Medline, Web of Science, and Scopus for population-based studies published up to March 2020. Random effect meta-analysis with logit transformation was performed to estimate global and regional prevalence of DR, vision-threatening DR (VTDR), and clinically significant macular edema (CSME). Projections of DR, VTDR, and CSME burden were based on population data from the IDF Atlas 2019. RESULTS We included 59 population-based studies. Among individuals with diabetes, global prevalence was 22.27% (95% confidence interval [CI], 19.73%-25.03%) for DR, 6.17% (95% CI, 5.43%-6.98%) for VTDR, and 4.07% (95% CI, 3.42%-4.82%) for CSME. In 2020, the number of adults worldwide with DR, VTDR, and CSME was estimated to be 103.12 million, 28.54 million, and 18.83 million, respectively; by 2045, the numbers are projected to increase to 160.50 million, 44.82 million, and 28.61 million, respectively. Diabetic retinopathy prevalence was highest in Africa (35.90%) and North American and the Caribbean (33.30%) and was lowest in South and Central America (13.37%). In meta-regression models adjusting for habitation type, response rate, study year, and DR diagnostic method, Hispanics (odds ratio [OR], 2.92; 95% CI, 1.22-6.98) and Middle Easterners (OR, 2.44; 95% CI, 1.51-3.94) with diabetes were more likely to have DR compared with Asians. DISCUSSION The global DR burden is expected to remain high through 2045, disproportionately affecting countries in the Middle East and North Africa and the Western Pacific. These updated estimates may guide DR screening, treatment, and public health care strategies.
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Affiliation(s)
- Zhen Ling Teo
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore
| | - Yih-Chung Tham
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore; Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Marco Yu
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore; Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Miao Li Chee
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore
| | - Tyler Hyungtaek Rim
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore; Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Ning Cheung
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore; Duke-NUS Medical School, Singapore, Republic of Singapore
| | | | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yating Tang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Yi Lu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Ian Y Wong
- Department of Ophthalmology, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, China; Department of Ophthalmology, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China
| | - Daniel Shu Wei Ting
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore; Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Gavin Siew Wei Tan
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore; Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Charumathi Sabanayagam
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore; Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Tien Yin Wong
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore; Duke-NUS Medical School, Singapore, Republic of Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Ching-Yu Cheng
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore; Duke-NUS Medical School, Singapore, Republic of Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore.
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11
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Euswas N, Phonnopparat N, Morasert K, Thakhampaeng P, Kaewsanit A, Mungthin M, Rangsin R, Sakboonyarat B. National trends in the prevalence of diabetic retinopathy among Thai patients with type 2 diabetes and its associated factors from 2014 to 2018. PLoS One 2021; 16:e0245801. [PMID: 33481907 PMCID: PMC7822250 DOI: 10.1371/journal.pone.0245801] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 01/07/2021] [Indexed: 12/18/2022] Open
Abstract
Introduction Diabetic retinopathy (DR) is one of the most common and serious ocular complications in both developed and developing countries. To date, epidemiological data of DR and their associated factors in Southeast Asian countries especially in Thailand are scarce. We aimed to use the information from the Thailand Diabetes Mellitus/Hypertension (DM/HT) study to determine trends in DR prevalence and also risk factors among Thai patients with type 2 diabetes (T2D). Methods A series of cross-sectional surveys of clinical outcomes was conducted annually in 2014, 2015 and 2018 among patients with T2D aged >18 years receiving medical care for at least 12 months. A stratified single stage cluster sampling method that was proportional to the size sampling technique was used to select a nationally and provincially representative sample of patients with T2D in Thailand. A standardized case report form was used to obtain the required information from medical records. Results A total of 104,472 Thai patients with T2D were included in the study from 2014 to 2018. The dominant proportion of participants, 70,756 (67.7%), were females. The overall prevalence of DR declined from 6.9% in 2014 to 6.3% in 2015 and 5.0% in 2018 (p for trend <0.001). The independent associated factors with DR included survey year, greater duration of DM, geographic region, hospital level, social security scheme, dyslipidemia, insulin therapy, high HbA1c level and elevated pulse pressure. Conclusion We reported a decreasing in trend in the prevalence of DR among Thai patients with T2D over one half decade. Patients with T2D should be encouraged to control their underlying diseases and engage in other effective interventions. When these modifiable risk factors can be inhibited, DR and other cardiovascular complications will be alleviated.
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Affiliation(s)
| | | | | | - Pongpisut Thakhampaeng
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Apisit Kaewsanit
- Department of Anatomy, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Mathirut Mungthin
- Department of Pharmacology, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Ram Rangsin
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Boonsub Sakboonyarat
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
- * E-mail:
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12
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Bek T. Systemic risk factors contribute differently to the development of proliferative diabetic retinopathy and clinically significant macular oedema. Diabetologia 2020; 63:2462-2470. [PMID: 32696115 DOI: 10.1007/s00125-020-05234-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023]
Abstract
AIMS/HYPOTHESIS The purpose of screening for diabetic retinopathy is to detect either of the two sight-threatening complications: proliferative diabetic retinopathy (PDR) or clinically significant diabetic macular oedema (DME). The aim of the study was to evaluate whether systemic risk factors affect the risk of developing these two complications differently. METHODS Survival analysis with death as a competing risk was used to describe the effect of sex, age and time of onset of diabetes, systolic (SBP) and diastolic (DBP) BPs, and the weighted exposure and CV of HbA1c for the development of PDR and DME from all 2773 patients treated for diabetic retinopathy in a defined population from the Aarhus area, Denmark, between 1 July 1994 and 1 July 2019. RESULTS Increasing HbA1c above normal increased the risk of developing both PDR and DME (p < 0.04), and values below normal increased the risk of developing PDR (p < 0.013). Increasing DBP increased the risk of developing both PDR and DME (p < 0.0001), whereas increasing SBP increased the risk of developing DME (p < 0.0001), but not PDR (p > 0.08). The risk of developing PDR increased with decreasing age of onset of diabetes (p < 0.0001), whereas the risk of developing DME was maximal for a known onset of diabetes at about 30 years of age and decreased significantly for both lower and higher ages of onset (p < 0.0001). The risk of developing both PDR and DME was lower in women than in men (p < 0.004) and was reduced with lower variability of repeated HbA1c measurements (p < 0.0001). CONCLUSIONS/INTERPRETATION Systemic risk factors such as metabolic regulation, arterial BP and the age of onset of diabetes contribute differently to the development of PDR and DME. The overall risk of developing treatment-requiring diabetic retinopathy should be calculated from the risks of reaching each of the two complications separately.
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Affiliation(s)
- Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, DK-8200, Aarhus N, Denmark.
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13
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Pidro A, Ahmedbegovic-Pjano M, Grisevic S, Sofic-Drino V, Gabric K, Biscevic A. Epidemiology of Diabetic Retinopathy at Eye Clinic Svjetlost Sarajevo: Two Years Retrospective Single Center Study. Mater Sociomed 2020; 31:290-293. [PMID: 32082096 PMCID: PMC7007630 DOI: 10.5455/msm.2019.31.290-293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Introduction: Diabetic retinopathy (DR) is an important cause of blindness, and occurs as a result of long-term accumulated damage to the small blood vessels in the retina. 2.6% of global blindness can be attributed to diabetes. Disease severity was most often classified by the Early Treatment Diabetic Retinopathy Study (ETDRS) classification for DR severity. Patients are usually categorized based on the severity of DR as having mild nonproliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR, or proliferative diabetic retinopathy (PDR). Aim: To evaluate DR status among patients at Eye Clinic Svjetlost Sarajevo , both, type 1 and type 2 DM patients who presented in our clinic at 2 years period – from June 2016 to June 2018. This is single center study. Methods: Retrospective analysis of 753 diabetic patients that came for the first check up in our institution during those two years, 363 patients were male and 390 were female. Patients were divided in 3 groups (based on DR changes): a) No changes, b) Nonproliferative DR (with and without Diabetic macular edema–DME), c) Prolipherative DR (with and without DME + Advanced PDR). Results: There were 35% of patients with no ocular changes, 41.2% had NPDR and 24% had PDR. Prevalence of DR in our study was 65.32%. Distribution of NPDR was 66.27%, and PDR was 33.73%. DME was present in 33.70% cases. In NPDR, DME was presented in 51% of the cases, while in PDR was presented in 49% of the cases. In state of advanced PDR, PDR was presented in 30.52% cases, tractional detachment and haemophtalmus in 50.20% of cases and neovascular glaucoma in 19.28%. Sixty-three patients ended up with vitroretinal surgery (8.4%) while in other studies that number is up to 3%. Out of that number 9 patients were patient with virgin eyes (14.28%). Neovascular glaucoma occurred in 19.28% of diabetics with proliferative retinopathy and 4.60% in all of diabetics. Conclusion: Diabetic retinopathy status of patients presenting at Eye clinic Svjetlost Sarajevo, Bosnia and Herzegovina is quite poor. There is a big need for early DR screening measures, good prevention and management of DR risk factors. Adequate and ON TIME management of DM and its vision threatening complications is of major importance.
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Affiliation(s)
- Ajla Pidro
- Eye Clinic Svjetlost Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Senad Grisevic
- Eye Clinic Svjetlost Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | | | - Alma Biscevic
- Eye Clinic Svjetlost Sarajevo, Sarajevo, Bosnia and Herzegovina.,University Eye Clinic Svjetlost Zagreb, Zagreb, Croatia
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14
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Bek T. Incidence and Risk for Developing Proliferative Diabetic Retinopathy after Photocoagulation for Diabetic Maculopathy. Curr Eye Res 2020; 45:986-991. [DOI: 10.1080/02713683.2020.1712729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
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15
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Sheikhrezaee M, Alizadeh MR, Abediankenari S. The tear VEGF and IGFBP3 in healthy and diabetic retinopathy. Int J Diabetes Dev Ctries 2019. [DOI: 10.1007/s13410-019-00761-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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16
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Jin G, Xiao W, Ding X, Xu X, An L, Congdon N, Zhao J, He M. Prevalence of and Risk Factors for Diabetic Retinopathy in a Rural Chinese Population: The Yangxi Eye Study. Invest Ophthalmol Vis Sci 2019; 59:5067-5073. [PMID: 30357401 DOI: 10.1167/iovs.18-24280] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the prevalence and determinants of diabetic retinopathy (DR) among older adults in rural Southern China. Methods Using random cluster sampling, persons aged 50 years or older were randomly selected in rural Yangxi County, Guangdong Province, China. All participants underwent a standardized interview, fundus photography, and point of service glycosylated hemoglobin A1c (HbA1c) testing. Diabetes mellitus (DM) was diagnosed based on confirmed medical history or HbA1c ≥6.5%. Fundus photographs were graded for DR and diabetic macular edema (DME) based on the United Kingdom National Diabetic Eye Screening Program guidelines. Prevalence of and risk factors for DR and vision-threatening diabetic retinopathy (VTDR) were evaluated. Results Among 5825 subjects who participated (90.7% response rate) in the Yangxi Eye Study, 562 (9.6%) were diagnosed with DM, including 79 (14.1%) known and 483 new (85.9%) cases. Among DM cases, 476 (84.7%) had gradable fundus photos. The prevalence of any DR and VTDR were 8.19% (95% confidence interval [CI] 5.9-11.0) and 5.25% (95% CI 3.43-7.66), respectively. These figures were 23.9% and 12.7% for known and 5.43% and 3.95% for new DM cases. Risk factors for any DR were higher HbA1c level (OR [odds ratio] per unit 1.34, P < 0.001), longer duration of DM (OR per year = 2.29, P < 0.001) and having previously undergone cataract surgery (OR 4.11, P < 0.030). Conclusions Our study found a lower prevalence of DR among adults 50 years and older than in previously reports. Perhaps this difference can be explained by the short duration of most cases.
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Affiliation(s)
- Guangming Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Wei Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaohu Ding
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiao Xu
- Rehabilitation Administration Department, National Institute of Hospital Administration, Chinese National Health and Family Planning Commission, Beijing, China
| | - Lei An
- Rehabilitation Administration Department, National Institute of Hospital Administration, Chinese National Health and Family Planning Commission, Beijing, China
| | - Nathan Congdon
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Translational Research for Equitable Eye Care, Centre for Public Health, Royal Victoria Hospital, Queen's University Belfast, Belfast, United Kingdom.,Orbis International, New York, New York, United States
| | - Jialiang Zhao
- Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Centre for Eye Research Australia, Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
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17
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Bek T, Stefánsson E, Hardarson SH. Retinal oxygen saturation is an independent risk factor for the severity of diabetic retinopathy. Br J Ophthalmol 2018; 103:1167-1172. [PMID: 30337331 DOI: 10.1136/bjophthalmol-2018-312764] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/11/2018] [Accepted: 09/17/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND The oxygen saturation in larger retinal vessels has been shown to increase with increasing diabetic retinopathy (DR) grade and to help predict the effect of antivascular endothelial growth factor treatment in patients with diabetic maculopathy. However, it is unknown to what extent the increased oxygen saturation co-varies with other risk factors and whether it is an independent risk factor for the severity of DR. METHODS Seven hundred and twenty-two successive patients referred for specialist evaluation of diabetic retinopathy including retinal oximetry were studied. Multiple regression analysis was used to investigate whether oxygen saturation in the larger retinal arterioles and venules contributed to the severity of diabetic retinopathy, independently of gender, age, diabetes duration, diabetes type, body mass index, blood pressure, haemoglobin A1c, visual acuity and central retinal thickness. RESULTS The included parameters could explain less than 15% of the variation in retinopathy grade. Approximately, one-third of the explained variation was related to the retinal oxygen saturation. CONCLUSIONS Prospective studies are needed to evaluate whether retinal oxygen saturation is predictive for the development of diabetic retinopathy and how it interacts with other biomarkers and risk factors over time.
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Affiliation(s)
- Toke Bek
- Departments of Ophthalmology, University of Iceland, Reykjavik, Iceland
| | - Einar Stefánsson
- Departments of Physiology, University of Iceland, Reykjavik, Iceland.,Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Sveinn Hákon Hardarson
- Departments of Physiology, University of Iceland, Reykjavik, Iceland.,Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
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18
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Ibitoye OB, Olofinsan KA, Teralı K, Ghali UM, Ajiboye TO. Bioactivity-guided isolation of antidiabetic principles from the methanolic leaf extract ofBryophyllum pinnatum. J Food Biochem 2018. [DOI: 10.1111/jfbc.12627] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- O. B. Ibitoye
- Department of Biological Sciences; Al-Hikmah University; Ilorin Nigeria
| | - K. A. Olofinsan
- Faculty of Natural and Applied Sciences, Department of Biological Sciences; Nile University of Nigeria; Abuja Nigeria
| | - K. Teralı
- Faculty of Medicine, Department of Medical Biochemistry; Near East University; Nicosia Cyprus
| | - U. M. Ghali
- Faculty of Medicine, Department of Medical Biochemistry; Near East University; Nicosia Cyprus
| | - T. O. Ajiboye
- Antioxidants, Redox Biology and Toxicology Research Group, Department of Medical Biochemistry; College of Health Sciences, Nile University of Nigeria; Abuja Nigeria
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19
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'Statins in retinal disease'. Eye (Lond) 2018; 32:981-991. [PMID: 29556012 DOI: 10.1038/s41433-018-0066-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/05/2018] [Accepted: 02/12/2018] [Indexed: 01/14/2023] Open
Abstract
Statins are known for their blood cholesterol-lowering effect and are widely used in patients with cardiovascular and metabolic diseases. Research over the past three decades shows that statins have diverse effects on different pathophysiological pathways involved in angiogenesis, inflammation, apoptosis, and anti-oxidation, leading to new therapeutic options. Recently, statins have attracted considerable attention for their immunomodulatory effect. Since immune reactivity has been implicated in a number of retinal diseases, such as uveitis, age-related macular degeneration (AMD) and diabetic retinopathy, there is now a growing body of evidence supporting the beneficial effects of statins in these retinopathies. This review evaluates the relationship between statins and the pathophysiological basis of these diseases, focusing on their potential role in treatment. A PubMed database search and literature review was conducted. Among AMD patients, there is inconsistent evidence regarding protection against development of early AMD or delaying disease progression; though they have been found to reduce the risk of developing choroidal neovascular membranes (CNV). In patients with retinal vein occlusion, there was no evidence to support a therapeutic benefit or a protective role with statins. In patients with diabetic retinopathy, statins demonstrate a reduction in disease progression and improved resolution of diabetic macular oedema (DMO). Among patients with uveitis, statins have a protective effect by reducing the likelihood of uveitis development.
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20
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Bandurska-Stankiewicz E, Wiatr D. Diabetic Blindness Significantly Reduced in the Warmia and Mazury Region of Poland: Saint Vincent Declaration Targets Achieved. Eur J Ophthalmol 2018; 16:722-7. [PMID: 17061224 DOI: 10.1177/112067210601600510] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The authors’ aim was to verify if the targets of the Saint Vincent Declaration concerning the reduction of diabetes-related blindness in the Warmia and Mazury Region, Poland, had been achieved. Methods A register of World Health Organization-defined blindness due to diabetes was conducted in the Warmia and Mazury Region between 1989 and 2004. The incidence rate of blindness as the number of new cases/100,000 diabetic population/year and 100,000 total population/year was estimated for three subperiods differing in political-economic system and diabetologic care delivery: 1989–1994, 1995–1999, and 2000–2004. Results The major cause of blindness among diabetic patients was diabetic eye disease (97%). Out of 70 patients with Type 1 diabetes, 53% lost vision due to proliferative diabetologic vitreoretinopathy 20% due to neovascularization with glaucoma, while clinically significant macula edema and cataract associated with proliferative diabetologic vitreoretinopathy or clinically significant macula edema predominated in 210 patients with Type 2 diabetes. The incidence rate of blindness due to diabetes in the diabetic population ranged from 102.4/100,000 (confidence interval [CI]: 65.7–139.0) to 13.3/100,000 (3.8–24.9). The incidence rate of blindness due to Type 1 diabetes ranged from 1.3/100,000 (CI: 0.5–2.2) to 0.1/100,000 (CI: −0.1–0.4). The incidence rate of blindness due to Type 2 diabetes was variable in the first subperiod, and it next decreased by 19% each year from 3.9/100,000 (CI: 2.5–5.3) to 0.7/100,000 (CI: 0.1–1.2); p<0.001. Conclusions The Saint Vincent Declaration target of reducing diabetes-related blindness by one third appears to have been achieved in the Warmia and Mazury Region.
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21
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Ibitoye OB, Uwazie JN, Ajiboye TO. Bioactivity-guided isolation of kaempferol as the antidiabetic principle from Cucumis sativus
L. fruits. J Food Biochem 2017. [DOI: 10.1111/jfbc.12479] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Oluwayemisi B. Ibitoye
- Antioxidants, Redox Biology and Toxicology Research Laboratory, Department of Biological Sciences; Al-Hikmah University; Ilorin Nigeria
| | - Judith N. Uwazie
- Department of Biochemistry; University of Ilorin; Ilorin Nigeria
| | - Taofeek O. Ajiboye
- Antioxidants, Redox Biology and Toxicology Research Group, Department of Medical Biochemistry, College of Health Sciences; Nile University of Nigeria; Abuja Nigeria
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22
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Mukona D, Munjanja SP, Zvinavashe M, Stray-Pederson B. Barriers of Adherence and Possible Solutions to Nonadherence to Antidiabetic Therapy in Women with Diabetes in Pregnancy: Patients' Perspective. J Diabetes Res 2017; 2017:3578075. [PMID: 28828389 PMCID: PMC5554546 DOI: 10.1155/2017/3578075] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/07/2017] [Accepted: 07/12/2017] [Indexed: 11/18/2022] Open
Abstract
Diabetes in pregnancy contributes to maternal mortality and morbidity though it receives little attention in developing countries. The purpose of the study was to explore the barriers to adherence and possible solutions to nonadherence to antidiabetic therapy in women with diabetes in pregnancy. Antidiabetic therapy referred to diet, physical activity, and medications. Four focus group discussions (FGDs), each with 7 participants, were held at a central hospital in Zimbabwe. Included were women with a diagnosis of diabetes in pregnancy, aged 18 to 49 years, and able to speak Shona or English. Approval was obtained from respective ethical review boards. FGDs followed a semistructured questionnaire. Detailed notes were taken during the interviews which were also being audiotaped. Data were analysed thematically and manually. Themes identified were barriers and possible solutions to nonadherence to therapy. Barriers were poor socioeconomic status, lack of family, peer and community support, effects of pregnancy, complicated therapeutic regimen, pathophysiology of diabetes, cultural and religious beliefs, and poor health care system. Possible solutions were fostering social support, financial support, and improvement of hospital services. Individualised care of women with diabetes is essential, and barriers and possible solutions identified can be utilised to improve care.
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Affiliation(s)
- Doreen Mukona
- Department of Nursing Science, University of Zimbabwe College of Health Sciences, Box A178, Avondale, Harare, Zimbabwe
| | - Stephen Peter Munjanja
- Department of Obstetrics and Gynecology, University of Zimbabwe College of Health Sciences, Box A178, Avondale, Harare, Zimbabwe
| | - Mathilda Zvinavashe
- Department of Nursing Science, University of Zimbabwe College of Health Sciences, Box A178, Avondale, Harare, Zimbabwe
| | - Babil Stray-Pederson
- Institute of Clinical Medicine, Oslo University and Division of Women and Children, Oslo University Hospital, Rikshospitalet, 00 27 Oslo, Norway
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Sunita M, Singh AK, Rogye A, Sonawane M, Gaonkar R, Srinivasan R, Natarajan S, Stevens FCJ, Scherpbier AJJA, Kumaramanickavel G, McCarty C. Prevalence of Diabetic Retinopathy in Urban Slums: The Aditya Jyot Diabetic Retinopathy in Urban Mumbai Slums Study—Report 2. Ophthalmic Epidemiol 2017; 24:303-310. [DOI: 10.1080/09286586.2017.1290258] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mohan Sunita
- Aditya Jyot Foundation for Twinkling Little Eyes, Mumbai, Maharashtra, India
| | - Arvind Kumar Singh
- Aditya Jyot Foundation for Twinkling Little Eyes, Mumbai, Maharashtra, India
| | - Ashwini Rogye
- Aditya Jyot Foundation for Twinkling Little Eyes, Mumbai, Maharashtra, India
| | - Manish Sonawane
- Aditya Jyot Foundation for Twinkling Little Eyes, Mumbai, Maharashtra, India
| | - Ravina Gaonkar
- Aditya Jyot Foundation for Twinkling Little Eyes, Mumbai, Maharashtra, India
| | - Radhika Srinivasan
- Aditya Jyot Foundation for Twinkling Little Eyes, Mumbai, Maharashtra, India
| | | | - Fred C. J. Stevens
- Department of Educational Development & Research, Maastricht University, Maastricht, the Netherlands
| | - A. J. J. A. Scherpbier
- Department of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Ponto KA, Koenig J, Peto T, Lamparter J, Raum P, Wild PS, Lackner KJ, Pfeiffer N, Mirshahi A. Prevalence of diabetic retinopathy in screening-detected diabetes mellitus: results from the Gutenberg Health Study (GHS). Diabetologia 2016; 59:1913-9. [PMID: 27314413 DOI: 10.1007/s00125-016-4013-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 05/18/2016] [Indexed: 01/06/2023]
Abstract
AIMS/HYPOTHESIS Individuals with type 2 diabetes mellitus may experience an asymptomatic period of hyperglycaemia, and complications may already be present at the time of diagnosis. We aimed to determine the prevalence of diabetic retinopathy in patients with newly diagnosed (screening-detected) type 2 diabetes. METHODS The Gutenberg Health Study is a population-based study with 15,010 participants aged between 35 and 74 years. We determined the weighted prevalence of diabetic retinopathy by assessing fundus photographs. Screening-detected type 2 diabetes was defined as an HbA1c concentration of 6.5% (47.5 mmol/mol) or more, no medical diagnosis of diabetes and no intake of insulin or oral glucose-lowering agents. RESULTS Of 14,948 participants, 1377 (9.2%) had diabetes mellitus. Of these, 347 (25.2%) had newly diagnosed type 2 diabetes detected by the screening. Overall, the weighted prevalence of screening-detected type 2 diabetes was 2.1%. Fundus photos were evaluable for 285 (82.1%) participants with newly diagnosed diabetes. The weighted prevalence of diabetic retinopathy in screening-detected type 2 diabetes was 13.0%; 12% of participants had a mild non-proliferative diabetic retinopathy and 0.6% had a moderate non-proliferative diabetic retinopathy. Diabetic retinopathy was proliferative in 0.3%. No cases of severe non-proliferative diabetic retinopathy or diabetic maculopathy were found. Thirty (14.9%) of 202 and six (7.2%) of 83 individuals with and without concomitant arterial hypertension, respectively, had diabetic retinopathy (OR 2.54, 95% CI 1.06, 7.14). Visual acuity did not differ between individuals with and without diabetic retinopathy . CONCLUSIONS/INTERPRETATION In this large European study, the prevalence of diabetic retinopathy in screening-detected type 2 diabetes was 13%. Only a very small proportion of participants with detected diabetic retinopathy needed treatment.
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Affiliation(s)
- Katharina A Ponto
- Department of Ophthalmology, University Medical Center Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
- Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany.
| | - Jochem Koenig
- Institute of Medical Biostatistics, Epidemiology and Informatics, Division of Biostatistics and Bioinformatics, University Medical Center, Mainz, Germany
| | - Tunde Peto
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Julia Lamparter
- Department of Ophthalmology, University Medical Center Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Philipp Raum
- Department of Ophthalmology, University Medical Center Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Philipp S Wild
- Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany
- Preventive Cardiology and Preventive Medicine, Department of Medicine II, University Medical Center, Mainz, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Rhine Main, Mainz, Germany
| | - Karl J Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Alireza Mirshahi
- Department of Ophthalmology, University Medical Center Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
- Dardenne Eye Hospital, Bonn-Bad Godesberg, Germany
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Influence of gallic acid on α-amylase and α-glucosidase inhibitory properties of acarbose. J Food Drug Anal 2016; 24:627-634. [PMID: 28911570 PMCID: PMC9336674 DOI: 10.1016/j.jfda.2016.03.003] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 03/08/2016] [Accepted: 03/15/2016] [Indexed: 12/26/2022] Open
Abstract
Acarbose is an antidiabetic drug which acts by inhibiting α-amylase and α-glucosidase activities but with deleterious side effects. Gallic acid (GA) is a phenolic acid that is widespread in plant foods. We therefore investigated the influence of GA on α-amylase and α-glucosidase inhibitory properties of acarbose (in vitro). Aqueous solutions of acarbose and GA were prepared to a final concentration of 25μM each. Thereafter, mixtures of the samples (50% acarbose + 50% GA; 75% acarbose+25% GA; and 25% acarbose+75% GA) were prepared. The results revealed that the combination of 50% acarbose and 50% GA showed the highest α-glucosidase inhibitory effect, while 75% acarbose+25% GA showed the highest α-amylase inhibitory effect. Furthermore, all the samples caused the inhibition of Fe2+-induced lipid peroxidation (in vitro) in rat pancreatic tissue homogenate, with the combination of 50% acarbose and 50% GA causing the highest inhibition. All the samples also showed antioxidant properties (reducing property, 2,2'-azino-bis (-3-ethylbenzthiazoline-6-sulphonate [ABTS*] and 1,1-diphenyl-2-picrylhydrazyl [DPPH] free radicals scavenging abilities, and Fe2+ chelating ability). Therefore, combinations of GA with acarbose could be employed as antidiabetic therapy, with a possible reduction of side effects of acarbose; nevertheless, the combination of 50% acarbose and 50% GA seems the best.
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Prakash G, Agrawal R, Natung T. Role of Lipids in Retinal Vascular and Macular Disorders. Indian J Clin Biochem 2016; 32:3-8. [PMID: 28149006 DOI: 10.1007/s12291-016-0560-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 02/25/2016] [Indexed: 12/20/2022]
Abstract
Retinal diseases are significant by increasing problem in every part of the world. While excellent treatment has emerged for various retinal diseases, treatment for early disease is lacking due to an incomplete understanding of all molecular events. With aging, there is a striking accumulation of neutral lipids in Bruch's membrane. These neutral lipids leads to the creation of a lipid wall at the same locations where drusen and basal linear deposit, pathognomonic lesions of Age-related macular degeneration, subsequently form. High lipid levels are also known to cause endothelial dysfunction, an important factor in the pathogenesis of Diabetic Retinopathy. Various studies suggest that 20 % of Retinal Vascular Occlusion is connected to hyperlipidemia. Biochemical studies have implicated mutation in gene encoding ABCA4, a lipid transporter in pathogenesis of Stargardt disease. This article reviews how systemic and local production of lipids might contribute to the pathogenesis of above retinal disorders.
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Affiliation(s)
- Gunjan Prakash
- Upgraded Department of Ophthalmology, S.N Medical College, Room No. 186, SBH, Agra, 282002 India
| | - Rachit Agrawal
- Upgraded Department of Ophthalmology, S.N Medical College, Room No. 186, SBH, Agra, 282002 India
| | - Tanie Natung
- North Eastern Indira Gandhi Regional Institute Of Health and Medical Sciences, Shillong, India
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Ting DSW, Cheung GCM, Wong TY. Diabetic retinopathy: global prevalence, major risk factors, screening practices and public health challenges: a review. Clin Exp Ophthalmol 2016; 44:260-77. [DOI: 10.1111/ceo.12696] [Citation(s) in RCA: 444] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 12/07/2015] [Accepted: 12/21/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Daniel Shu Wei Ting
- Singapore National Eye Center, Singapore Health Service (SingHealth); Singapore Singapore
- Singapore Eye Research Institute; Singapore Singapore
| | - Gemmy Chui Ming Cheung
- Singapore National Eye Center, Singapore Health Service (SingHealth); Singapore Singapore
- Singapore Eye Research Institute; Singapore Singapore
- Duke-NUS Graduate Medical School; Singapore Singapore
| | - Tien Yin Wong
- Singapore National Eye Center, Singapore Health Service (SingHealth); Singapore Singapore
- Singapore Eye Research Institute; Singapore Singapore
- Duke-NUS Graduate Medical School; Singapore Singapore
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Enhanced Oxidative Stress and Other Potential Biomarkers for Retinopathy in Type 2 Diabetics: Beneficial Effects of the Nutraceutic Supplements. BIOMED RESEARCH INTERNATIONAL 2015; 2015:408180. [PMID: 26618168 PMCID: PMC4649073 DOI: 10.1155/2015/408180] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 08/28/2015] [Accepted: 08/31/2015] [Indexed: 12/28/2022]
Abstract
We have studied the global risk of retinopathy in a Mediterranean population of type 2 diabetes mellitus (T2DM) patients, according to clinical, biochemical, and lifestyle biomarkers. The effects of the oral supplementation containing antioxidants/omega 3 fatty acids (A/ω3) were also evaluated. Suitable participants were distributed into two main groups: (1) T2DMG (with retinopathy (+DR) or without retinopathy (-DR)) and (2) controls (CG). Participants were randomly assigned (+A/ω3) or not (-A/ω3) to the oral supplementation with a daily pill of Nutrof Omega (R) for 18 months. Data collected including demographics, anthropometrics, characteristics/lifestyle, ophthalmic examination (best corrected visual acuity, ocular fundus photographs, and retinal thickness as assessed by optical coherence tomography), and blood parameters (glucose, glycosylated hemoglobin, triglycerides, malondialdehyde, and total antioxidant capacity) were registered, integrated, and statistically processed by the SPSS 15.0 program. Finally, 208 participants (130 diabetics (68 +DR/62 -DR) and 78 controls) completed the follow-up. Blood analyses confirmed that the T2DMG+DR patients had significantly higher oxidative stress (p < 0.05), inflammatory (p < 0.05), and vascular (p < 0.001) risk markers than the T2DMG-DR and the CG. Furthermore, the A/ω3 oral supplementation positively changed the baseline parameters, presumptively by inducing metabolic activation and ameliorating the ocular health after 18 months of supplementation.
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Jang H, Min DH. Highly precise plasmonic and colorimetric sensor based on enzymatic etching of nanospheres for the detection of blood and urinary glucose. RSC Adv 2015. [DOI: 10.1039/c4ra15485a] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A highly precise glucose sensor was developed based on plasmon peak shift induced by the glucose oxidase mediated etching of Au–Ag nanoparticles. The platform enabled quantitative glucose detection in human blood and urine samples.
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Affiliation(s)
- Hongje Jang
- Department of Chemistry
- Seoul National University
- Seoul
- Korea
- Center for RNA Research
| | - Dal-Hee Min
- Department of Chemistry
- Seoul National University
- Seoul
- Korea
- Center for RNA Research
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30
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Associations between hearing handicap, metabolic control and other otoneurological disturbances in individuals with type 1 diabetes mellitus. Int J Diabetes Dev Ctries 2014. [DOI: 10.1007/s13410-014-0221-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Insulin and risk of diabetic retinopathy in patients with type 2 diabetes mellitus: data from a meta-analysis of seven cohort studies. Diagn Pathol 2014; 9:130. [PMID: 24972631 PMCID: PMC4227060 DOI: 10.1186/1746-1596-9-130] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 06/22/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a chronic incurable disease associated with multi-systemic complications. The chronic complications related to T2DM induce growing burden to the national health system. Diabetic retinopathy (DR) is the most serious ocular complication associated with T2DM and one of the leading causes of secondary blindness. The association between insulin use and DR risk has also been reported in different studies. METHODS In order to obtain more informative results on the relationship between insulin intake and risk of DR and to take into account more recent evidence, we conducted this meta-analysis by including all available relevant cohort studies. A systemic literature search was performed via electronic databases inclu-apding Pubmed and EMBASE to identify all available relevant studies until February 2014. A total of seven cohort studies were included in this meta-analysis. In this meta-analysis, we conducted a rigorous search of all available published cohort studies to quantify the possible association between insulin use and incidental DR in individuals with type 2 diabetes. RESULTS Although major heterogeneity existed in this study, the significant association between insulin use and risk of DR was detected. The subgroup analyses by study design, region, data source and adjustment of HbA1c generated similar results. Also, when the DM duration was adjusted, no result was reported with significant difference. CONCLUSION The results of this meta-analysis helps to better explore the role of insulin use in DR risk development. Meanwhile, our results are statistically robust and yield important conclusions. The underlying mechanism by which insulin use increases DR risk should be explored in future in vitro and in vivo studies. Additional large-scale, well-designed studies with sufficient data are needed to confirm our findings. VIRTUAL SLIDES The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2003724731291657.
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Olafsdottir E, Andersson DKG, Dedorsson I, Stefánsson E. The prevalence of retinopathy in subjects with and without type 2 diabetes mellitus. Acta Ophthalmol 2014; 92:133-7. [PMID: 23452444 DOI: 10.1111/aos.12095] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the prevalence of and risk factors for, retinopathy in a geographically defined population with type 2 diabetes mellitus compared with a control group of subjects without diabetes, matched by age, sex and residence in order to find the retinopathy attributable to type 2 diabetes. METHODS The study populations are, on one hand, a prevalence cohort of subjects with type 2 diabetes resident in the community of Laxå, Sweden, and on the other a control group, matched by age, gender and residence with those with a diagnosis of type 2 diabetes mellitus. Retinopathy was graded from fundus photographs using a modification of the Early Treatment Retinopathy Study (ETDRS) adaptation of the modified Airlie House classification of diabetic retinopathy (DR). RESULTS Any retinopathy was found in 34.6% in the type 2 diabetes cohort and in 8.8% in the control group without diabetes. Among the diabetic patients, any retinopathy was significantly associated with duration of diabetes (p = 0.0001), HbA1c (p = 0.0056), systolic blood pressure (p = 0.0091) and lower serum cholesterol (p = 0.0197) in multivariate logistic regression analyses. Having retinopathy in the control group was associated only with systolic blood pressure (p = 0.0014) in logistic regression analysis. CONCLUSIONS The prevalence of retinopathy among patients with type 2 diabetes in Laxå, Sweden, was similar or somewhat lower compared with other studies in the Nordic countries. The prevalence of retinopathy in a control group without diabetes equalled numbers from population studies worldwide. Our study indicates that the retinopathy that can be attributed to hyperglycaemia in the diabetic state is less common than is usually accounted for. A considerable fraction of retinopathy in subjects with diabetes may instead be due to other factors such as hypertension and should thus be treated correspondingly.
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Affiliation(s)
- Eydis Olafsdottir
- Department of Ophthalmology, The National University Hospital, Reykjavik, IcelandUniversity of Iceland, Reykjavik, IcelandDepartment of Ophthalmology, Örebro University Hospital, Örebro, SwedenDepartment of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology Section, Uppsala University, Uppsala, Sweden
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TNF-alpha levels in tears: a novel biomarker to assess the degree of diabetic retinopathy. Mediators Inflamm 2013; 2013:629529. [PMID: 24259948 PMCID: PMC3821908 DOI: 10.1155/2013/629529] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Accepted: 09/09/2013] [Indexed: 02/08/2023] Open
Abstract
We assess the level of tumour necrosis factor alpha (TNF-alpha) in tear fluids and other serum parameters associated with diabetes in different degrees of diabetic retinopathy. We have performed a prospective, nonrandomized, observational study. Study population consisted of 16 healthy subjects (controls) and 32 type 2 diabetic patients: 16 affected by proliferative diabetic retinopathy (PDR) and 16 with nonproliferative retinopathy (NDPR, background/preproliferative). Body mass index, urinary albumin, blood glucose, HbA1c, and tear levels of TNF-alpha were measured in all subjects. The value of glycaemia, microalbuminurea, and Body mass index in diabetic retinopathy groups were higher than those in control group (P < 0.05). Glycemia in NPDR: 6.6 mmol/L (range: 5.8-6.3); in PDR: 6.7 mmol/L (range: 6.1-7.2); in control: 5.7 mmol/L (range: 4.9-6.1); microalbuminurea in NPDR: 10.6 mg/L (range: 5.6-20); in PDR: 25.2 mg/L (range: 17-40); in control: 5.3 mg/L (range: 2.6-10); Body mass index in NPDR: 26 Kg/m(2) (range: 20.3-40); in PDR: 28 Kg/m(2) (range 20.3-52); in control: 21 Kg/m(2) (range 19-26). The TNF-alpha concentrations in tears increase with the severity of pathology and were lower in control group than in diabetic subjects. In the end, the level of TNF-alpha is highly correlated with severity of diabetic retinopathy and with nephropathy. Tear fluid collection may be a useful noninvasive method for the detection of proliferative diabetic retinopathy.
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Cetin EN, Bulgu Y, Ozdemir S, Topsakal S, Akın F, Aybek H, Yıldırım C. Association of serum lipid levels with diabetic retinopathy. Int J Ophthalmol 2013; 6:346-9. [PMID: 23826531 DOI: 10.3980/j.issn.2222-3959.2013.03.17] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 05/27/2013] [Indexed: 11/02/2022] Open
Abstract
AIM To assess the association between serum lipids and diabetic retinopathy (DR). METHODS Sixty-one diabetic patients without retinopathy(NDR), 55 diabetic patients with non-proliferative retinopathy(NPDR) and 75 diabetic patients with proliferative retinopathy (PDR) according to ETDRS grading scale were enrolled in this study. Total cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL) and triglyceride values were compared between the groups. RESULTS The groups were well-balanced in terms of age and gender (P=0.071, P=0.265 respectively). The mean HbA1c values were significantly lower in NDR group than the NPDR and PDR groups (P=0.004, P=0.009 respectively). Mean total cholesterol, triglyceride, LDL, HDL and VLDL levels were not significantly different between the groups (P=0.693, P=0.774, P=0.644, P=0.910 and P=0.967 respectively, one way ANOVA). Mean total cholesterol, triglyceride, LDL, HDL and VLDL levels were not significantly different between the patients with ME and patients without ME (P=0.622, P=0.113, P=0.955, P=0.735 and P=0.490 respectively, t-test). The mean blood glucose significantly correlated with total cholesterol (r=0.173, P=0.017) and LDL (r=0.190, P=0.008). The mean HbA1c significantly correlated with total cholesterol (r=0.158, P=0.030) and triglyceride (r=0.148, P=0.042). CONCLUSION Serum lipid levels were not significantly associated with the severity of DR or existence of ME despite the significant correlation between the mean blood glucose, HbA1c and total cholesterol.
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Affiliation(s)
- Ebru Nevin Cetin
- Department of Ophthalmology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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Ruta LM, Magliano DJ, Lemesurier R, Taylor HR, Zimmet PZ, Shaw JE. Prevalence of diabetic retinopathy in Type 2 diabetes in developing and developed countries. Diabet Med 2013; 30:387-98. [PMID: 23331210 DOI: 10.1111/dme.12119] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND As the global prevalence of diabetes increases, so will the numbers of people with diabetic retinopathy. Our review aimed to provide a comprehensive picture of available studies of diabetic retinopathy and how prevalence varies around the developed and developing world. METHODS A detailed literature search using PubMed was undertaken. The following search term was used: 'diabetic retinopathy AND prevalence'. The titles and abstracts of all publications identified by the search were reviewed and 492 studies were retrieved. Inclusion and exclusion criteria were applied. RESULTS A total of 72 articles from 33 countries were included. There were only 26 population-based studies using fundus photography (12 in developing countries), of which only 16 (eight in developing countries) were published since 2000. Prevalence estimates varied from as low as 10% to as high as 61% in persons with known diabetes and from 1.5 to 31% in newly diagnosed diabetes. Across all the studies, the median (interquartile range) prevalence of any diabetic retinopathy in known diabetes was 27.9% (22-37%) and 10.5% (6-16%) in newly diagnosed diabetes. Prevalence of diabetic retinopathy was higher in developing countries. CONCLUSION Significant gaps exist in that reliable population-based data from developing nations and indigenous populations in particular are lacking. Major differences in study characteristics and methodologies make comparisons very difficult. More research is required and study methodologies must be better standardized. This will provide important information for prevention and treatment strategies.
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Affiliation(s)
- L M Ruta
- Baker IDI Heart and Diabetes Institute, The University of Melbourne, Melbourne, Vic., Australia
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Sundling V, Gulbrandsen P, Straand J. Sensitivity and specificity of Norwegian optometrists' evaluation of diabetic retinopathy in single-field retinal images - a cross-sectional experimental study. BMC Health Serv Res 2013; 13:17. [PMID: 23305337 PMCID: PMC3562149 DOI: 10.1186/1472-6963-13-17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 11/17/2012] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND In the working age group, diabetic retinopathy is a leading cause of visual impairment. Regular eye examinations and early treatment of retinopathy can prevent visual loss, so screening for diabetic retinopathy is cost-effective. Dilated retinal digital photography with the additional use of ophthalmoscopy is the most effective and robust method of diabetic retinopathy screening. The aim of this study was to estimate the sensitivity and specificity of diabetic retinopathy screening when performed by Norwegian optometrists. METHODS This study employed a cross-sectional experimental design. Seventy-four optometrists working in private optometric practice were asked to screen 14 single-field retinal images for possible diabetic retinopathy. The screening was undertaken using a web-based visual identification and management of ophthalmological conditions (VIMOC) examination. The images used in the VIMOC examination were selected from a population survey and had been previously examined by two independent ophthalmologists. In order to establish a "gold standard", images were only chosen for use in the VIMOC examination if they had elicited diagnostic agreement between the two independent ophthalmologists. To reduce the possibility of falsely high specificity occurring by chance, half the presented images were of retinas that were not affected by diabetic retinopathy. Sensitivity and specificity for diabetic retinopathy was calculated with 95% confidence intervals (CIs). RESULTS The mean (95%CI) sensitivity for identifying eyes with any diabetic retinopathy was 67% (62% to 72%). The mean (95%CI) specificity for identifying eyes without diabetic retinopathy was 84% (80% to 89%). The mean (95%CI) sensitivity for identifying eyes with mild non-proliferative diabetic retinopathy or moderate non-proliferative diabetes was 54% (47% to 61%) and 100%, respectively. Only four optometrists (5%) met the required standard of at least 80% sensitivity and 95% specificity that has been previously set for diabetic retinopathy screening programmes. CONCLUSIONS The evaluation of retinal images for diabetic retinopathy by Norwegian optometrists does not meet the required screening standard of at least 80% sensitivity and 95% specificity. The introduction of measures to improve this situation could have implications for both formal optometric training and continuing optometric professional education.
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Affiliation(s)
- Vibeke Sundling
- Institute of Optometry and Visual Science, Faculty of Health Sciences, Buskerud University College, Kongsberg, Norway
| | - Pål Gulbrandsen
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
- HØKH, Research Centre, Akershus University Hospital, Oslo, Norway
| | - Jørund Straand
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
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Kilstad HN, Sjølie AK, Gøransson L, Hapnes R, Henschien HJ, Alsbirk KE, Fossen K, Bertelsen G, Holstad G, Bergrem H. Prevalence of diabetic retinopathy in Norway: report from a screening study. Acta Ophthalmol 2012; 90:609-12. [PMID: 21955522 DOI: 10.1111/j.1755-3768.2011.02160.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE The purpose of the present study was to investigate the prevalence of diabetic retinopathy (DR) in Norway and adherence to the Norwegian Guidelines for screening for diabetic eye disease. METHODS Two hundred and ninety-nine people with diabetes were randomly recruited from the patient lists of randomly selected general practitioners from three different regions in Norway. Retinopathy was evaluated from retinal photographs after dilation of the pupils using a red-free digital camera and visual acuity was measured using the Snellen chart. The patients were interviewed about their ophthalmological and general diabetes control, duration and type of diabetes and medical treatment. RESULTS The prevalence of any DR was 28%, 66% for type 1 and 24% for type 2 diabetes. The prevalence of proliferative retinopathy was 38% in type 1 and 1.5% in type 2 diabetes. Two patients (one type 1 and one insulin-treated type 2) were visually impaired (visual acuity 0.3 or worse in the better eye) because of proliferative DR. Twenty-six per cent of the patients had never been to an eye examination, and only 69% attended routine eye examinations. Patients who did not attend regular eye screenings were mostly people with type 2 diabetes. CONCLUSION The prevalence of DR was higher than previously reported in Norway. Screening for DR did not follow guidelines in a considerable proportion of the patients with type 2 diabetes. There is place for improvement in the implementation of guidelines for screening for DR for people with type 2 diabetes in Norway.
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Ozawa GY, Bearse MA, Bronson-Castain KW, Harrison WW, Schneck ME, Barez S, Adams AJ. Neurodegenerative differences in the retinas of male and female patients with type 2 diabetes. Invest Ophthalmol Vis Sci 2012; 53:3040-6. [PMID: 22491405 DOI: 10.1167/iovs.11-8226] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The purpose of our study is to determine whether neuroretinal function, measured by the multifocal electroretinogram, differs between males and females with type 2 diabetes and no retinopathy. METHODS This study included 70 eyes from 70 adult subjects (14 control males, 22 control females, 16 males with type 2 diabetes, and 18 females with type 2 diabetes). A template-scaling technique was used to obtain first-order P1 implicit times and N1-P1 amplitudes from photopic multifocal electroretinograms within the central 45 degrees. RESULTS The males with type 2 diabetes were significantly more abnormal than their female counterparts in two separate analyses of local neuroretinal function. First, the total number of retinal locations with an abnormally delayed implicit time (z score ≥ 2) was higher (P < 0.001) in the diabetic males (482 locations = 29.2%) compared to the diabetic females (298 locations = 16.1%). Second, in the response topographies that consisted of 103 means of local implicit times for each group, the diabetic males were significantly delayed (P < 0.025) at 23 corresponding positions (22.3%) compared to the diabetic females. At the same time, no corresponding stimulus locations were significantly delayed in the diabetic females compared to the diabetic males. CONCLUSIONS Neuroretinal function is more abnormal in males than in females for adults with type 2 diabetes and no retinopathy. These results suggest that, relative to males, females may have some protection from, or resistance to, neurodegenerative changes that precede the development of background retinopathy in type 2 diabetes.
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Affiliation(s)
- Glen Y Ozawa
- Berkeley School of Optometry, University of California, Berkeley, California 94720, USA.
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Sundling V, Platou CGP, Jansson RW, Bertelsen G, Wøllo E, Gulbrandsen P. Retinopathy and visual impairment in diabetes, impaired glucose tolerance and normal glucose tolerance: the Nord-Trøndelag Health Study (the HUNT study). Acta Ophthalmol 2012; 90:237-43. [PMID: 20809910 DOI: 10.1111/j.1755-3768.2010.01998.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE The aim of the study was to describe the prevalence of visual impairment and retinopathy and to investigate risk factors for retinopathy in persons with diabetes, screen-detected diabetes, impaired glucose tolerance and normal glucose tolerance in a subpopulation of the HUNT study. METHODS We used a sample (n = 163) from a population-based screening survey of hyperglycaemia, undertaken in 2004-2005 in Verdal, Norway. Baseline information was accessible through the second Nord-Trøndelag Health Study (HUNT2), 1995-97. Data collection was made in 2005 and included patient history, refraction, visual acuity, cataract assessment and single-field, nonmydriatic retinal photography. Retinal photographs were graded independently by two graders blinded to patient information. Data were analysed with standard statistical methods, and p < 0.05 was considered significant. RESULTS In all, 126 (77%) persons participated, 55% were women. The mean (SD) age was 59 (± 14) years. Four (3%) had correctable visual impairment, and none were visually impaired. Retinal photographs were gradable for both eyes in 109 (87%) participants. The prevalence of retinopathy was 11% in persons with known diabetes, 4% in persons with screen-detected diabetes, 3% in persons with impaired glucose tolerance and 10% in persons with normal glucose tolerance. Retinopathy was not associated with known history of diabetes or current glycaemic status. Nonfasting plasma glucose (in 1995-97) was an independent risk factor for retinopathy (in 2005), OR (95% CI) 1.5 (1.01, 2.13), p = 0.046. CONCLUSION The prevalence of diabetic retinopathy in persons with diabetes in this study was low. Appropriate optical correction and regular eye examination can prevent unnecessary visual impairment in both persons with and without diabetes.
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Affiliation(s)
- Vibeke Sundling
- Department of Optometry and Visual Science, Buskerud University College, Kongsberg, Norway.
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Sivaprasad S, Gupta B, Crosby-Nwaobi R, Evans J. Prevalence of diabetic retinopathy in various ethnic groups: a worldwide perspective. Surv Ophthalmol 2012; 57:347-70. [PMID: 22542913 DOI: 10.1016/j.survophthal.2012.01.004] [Citation(s) in RCA: 225] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 01/17/2012] [Accepted: 01/18/2012] [Indexed: 01/10/2023]
Abstract
The alarming rise in diabetes prevalence is a global public health and economic problem. Diabetic retinopathy is the most common complication of diabetes and the leading cause of blindness among working-age populations in the Western world. Screening and prompt treatment of diabetic retinopathy are not top priorities in many regions of the world, because the impacts of other causes of preventable blindness remain an issue. Ethnicity is a complex, independent risk factor for diabetic retinopathy. Observations from white populations cannot be extrapolated fully to other ethnic groups. The prevalence of diabetic retinopathy, sight-threatening diabetic retinopathy, and clinically significant macular edema are higher in people of South Asian, African, Latin American, and indigenous tribal descent compared to the white population. Although all ethnic groups are susceptible to the established risk factors of diabetic retinopathy-such as length of exposure and severity of hyperglycemia, hypertension, and hyperlipidemia-ethnic-specific risk factors also may influence these rates. Such risk factors may include differential susceptibility to conventional risk factors, insulin resistance, differences in anthropometric measurements, truncal obesity, urbanization, variations in access to healthcare systems, genetic susceptibility, and epigenetics. The rates of nonproliferative diabetic retinopathy appear to be declining in the United States, supporting the observation that better medical management of diabetes and prompt treatment of sight-threatening diabetic retinopathy substantially improve the long-term diabetic retinopathy incidence; studies from other parts of the world are limited and do not mirror this finding, however. We examine the ethnicity and region-based prevalence of diabetic retinopathy around the world and highlight the need to reinforce ethnicity-based screening and treatment thresholds in diabetic retinopathy.
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Affiliation(s)
- Sobha Sivaprasad
- King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK.
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Mehlsen J, Erlandsen M, Poulsen PL, Bek T. Individualized optimization of the screening interval for diabetic retinopathy: a new model. Acta Ophthalmol 2012; 90:109-14. [PMID: 20384605 DOI: 10.1111/j.1755-3768.2010.01882.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Screening programmes for diabetic retinopathy follow guidelines that ensure that vision-threatening complications are detected even when the disease progression is fast. This implies that patients with slow disease progression will be recommended examinations more often than needed. METHOD On the basis of previously defined individual risk factors, multiple logistic regression was used to develop a model for individualized determination of the screening interval in diabetic retinopathy, while adjusting for the fact that in the data set used to construct the model, the screening interval acted as a time-dependent confounder. The model was tested on 1372 patients screened during year 2000. RESULTS It was possible to construct a model for calculating the optimal screening interval in low-risk patients in whom the recommended screening interval was longer than 12 months. When the probability of reaching a treatment requiring event was set to 0.5%, none of the patients reached a treatment end-point in a validation of the model, and the screening interval was prolonged on average 2.9 times in patients with type 1 diabetes and 1.2 times in those with type 2 diabetes. The predictive strength of the model depended on the number of variables included. CONCLUSIONS It is possible to construct a model for optimizing the examination interval during screening for diabetic retinopathy in low-risk patients. The model can potentially be improved by identifying unknown or unmeasured confounders and by including knowledge of risk factors before and after the examination on the basis of which the prediction is made.
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Affiliation(s)
- Jesper Mehlsen
- Department of Ophthalmology, Aarhus University Hospital, DK- 8000 Aarhus C, Denmark.
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Mehlsen J, Erlandsen M, Poulsen PL, Bek T. Identification of independent risk factors for the development of diabetic retinopathy requiring treatment. Acta Ophthalmol 2011; 89:515-21. [PMID: 19912134 DOI: 10.1111/j.1755-3768.2009.01742.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Diabetic retinopathy is screened by fundus photography and screening intervals are defined according to general rules to ensure that vision threatening complications are detected even if the progression of the disease is fast. The resulting superfluous examinations of patients with slow disease progression can be reduced by a more exact decision model that allows an adjustment of the screening interval to each patient's individual risk profile. This requires an identification of independent risk factors for reaching treatment end points for diabetic retinopathy. METHODS Clinical data from 5365 patients who had undergone 23 324 examinations at the Department of Ophthalmology, Århus University Hospital between Jan 1st 1994 and Dec 31st 2007 were used to identify independent risk factors for progression of treatment requiring retinopathy. RESULTS The risk of reaching a treatment end point was in both diabetes types independently affected by retinopathy grade and HbA1c. Furthermore, in type 1 diabetic patients the risk of reaching a treatment end point was independently affected by disease duration and by a recommended control interval of less than 3 months, in spite of correction for retinopathy grade and other studied confounders, whereas in type 2 diabetes this risk was affected by increasing age of diagnosis of the disease. CONCLUSIONS Only a subset of known risk factors for development and progression of diabetic retinopathy should be used to construct a decision model for optimizing screening intervals for diabetic retinopathy.
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Affiliation(s)
- Jesper Mehlsen
- Department of Ophthalmology, Aarhus University Hospital, Denmark.
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Kärvestedt L, Mårtensson E, Grill V, Elofsson S, von Wendt G, Hamsten A, Brismar K. The prevalence of peripheral neuropathy in a population-based study of patients with type 2 diabetes in Sweden. J Diabetes Complications 2011; 25:97-106. [PMID: 20488731 DOI: 10.1016/j.jdiacomp.2010.04.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 03/31/2010] [Accepted: 04/14/2010] [Indexed: 11/22/2022]
Abstract
AIMS To assess peripheral neuropathy following a standardized foot examination protocol in a representative population-based cohort of subjects with type 2 diabetes. METHODS In a geographically defined population, aged 40-70 years with diabetes prevalence of 3.5% according to medical records, we investigated 156 type 2 diabetic subjects, 95% Caucasian, mean age 61.7±7.2 years, duration of diabetes 7.0±5.7 years, and HbA(1c) 7.3±2.4% (6.4% Mono-S), by questionnaires, clinical examinations, blood sampling, and review of medical records. Foot examination included clinical signs of peripheral neuropathy and tests of sensibility with monofilament, tuning fork, and assessments of the vibration perception thresholds (VPT). RESULTS Peripheral autonomic neuropathy (PAN) as judged by two or more signs of dysfunction was the most common and affected 43%. The prevalence of peripheral sensory neuropathy (PSN) was 15% by monofilament, 24% by tuning fork, and 28% by VPT expressed as ZscoreVPT ≥2.0 S.D. Twenty-nine percent had a VPT ≥25 V. Signs of peripheral motor neuropathy (PMN) affected 15%. Peripheral neuropathy, at least one variable, affected 67%, whereas 25% were affected by more than one variable of neuropathy, i.e., polyneuropathy. Exclusion of other identified causes for neuropathy than diabetes reduced the prevalence of diabetic polyneuropathy to 23%. Concurrent diabetic complications were 29% for retinopathy, 14% for incipient nephropathy, and 8% for overt nephropathy. The prevalence of macrovascular complications was 62% for CVD, 26% for PVD, and 11% for cerebrovascular lesion (CVL). CONCLUSION Peripheral neuropathy was common in this representative type 2 diabetes population. Clinical signs of PAN were the most frequent followed by diminished perception of vibration and touch.
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Affiliation(s)
- Lars Kärvestedt
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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Affiliation(s)
- Francesco Boscia
- Department of Ophthalmology and Otolaryngology, University of Bari, Bari, Italy.
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Delcourt C, Massin P, Rosilio M. Epidemiology of diabetic retinopathy: Expected vs reported prevalence of cases in the French population. DIABETES & METABOLISM 2009; 35:431-8. [DOI: 10.1016/j.diabet.2009.06.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 05/27/2009] [Accepted: 06/02/2009] [Indexed: 11/25/2022]
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Klein R, Lee KE, Knudtson MD, Gangnon RE, Klein BEK. Changes in visual impairment prevalence by period of diagnosis of diabetes: the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Ophthalmology 2009; 116:1937-42. [PMID: 19616855 DOI: 10.1016/j.ophtha.2009.03.012] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 03/07/2009] [Accepted: 03/09/2009] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To examine relationships of period of diagnosis of type 1 diabetes mellitus (T1DM) to the prevalence of visual impairment (VI). DESIGN Population-based longitudinal study. PARTICIPANTS Nine hundred fifty-five persons (3719 participant visits) 4 to 80 years of age at baseline who lived in an 11-county area in southern Wisconsin who were diagnosed with T1DM before 30 years of age contributed to the prevalence of VI. METHODS Five eye examination visits occurred in the following periods: 1980 through 1982, 1984 through 1986, 1990 through 1992, 1995 through 1996, and 2005 through 2007. Age of diagnosis of T1DM was grouped as before 1960, 1960 through 1969, 1970 through 1974, and 1975 through 1979. Best-corrected visual acuity (VA) using a modification of the Early Treatment Diabetic Retinopathy protocol was measured. MAIN OUTCOME MEASURES Visual impairment was defined as best-corrected VA in the better eye of 20/40 or worse. RESULTS While controlling for duration of T1DM, there was a lower prevalence of VI for more recent periods of diagnosis of diabetes (odds ratio per category, 0.91; 95% confidence interval, 0.88-0.93; P<0.001). This remained while controlling for glycosylated hemoglobin, blood pressure, and other related factors. CONCLUSIONS More recently diagnosed T1DM was associated with a lower prevalence of VI. This is likely because of the diminishing incidence of proliferative diabetic retinopathy (PDR) and clinically significant macular edema (CSME) resulting from better glycemic control and more timely interventions with photocoagulation for CSME and PDR in those with more recently diagnosed T1DM.
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Affiliation(s)
- Ronald Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726-2336, USA.
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Bek T, Lund-Andersen H, Hansen AB, Johnsen KB, Sandbaek A, Lauritzen T. The prevalence of diabetic retinopathy in patients with screen-detected type 2 diabetes in Denmark: the ADDITION study. Acta Ophthalmol 2009; 87:270-4. [PMID: 18823287 DOI: 10.1111/j.1755-3768.2008.01207.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The prevalence of type 2 diabetes is increasing, but the exact prevalence of the disease and its accompanying late complications are unknown. In the Anglo-Danish-Dutch study of Intensive Treatment in People with Screen-detected Diabetes in Primary Care (ADDITION study), patients with hitherto undiagnosed type 2 diabetes are identified using a stepwise screening strategy in selected general practices. This article reports the occurrence of diabetic retinopathy in this population. METHODS In Arhus and Copenhagen counties, a total of 12,708 of the persons invited by mail were screened for diabetes mellitus. Consequently, 763 persons with type 2 diabetes were identified; 670 of these (335 from each of the two centres) underwent a general physical examination (including measurement of blood pressure and HbA1c) and an ophthalmological examination (including measurement of visual acuity and fundus photography). Retinopathy was graded from the photographs by counting all retinopathy lesions. RESULTS Forty-five (6.8%) of the examined patients had any retinopathy, of which the majority was minimal. No patients had severe non-proliferative or proliferative diabetic retinopathy. There was no significant difference between age, sex and visual acuity among patients with and without retinopathy. However, the patients with retinopathy had significantly higher HbA1c and systolic and diastolic blood pressure than the patients without retinopathy. CONCLUSION Patients with screen-detected diabetes have a low prevalence of diabetic retinopathy and no vision-threatening lesions. Screening for diabetic retinopathy should be focused on those patients who have already been diagnosed with type 2 diabetes during routine clinical practice.
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Zimering MB, Anderson RJ, Moritz TE, Ge L. Low plasma basic fibroblast growth factor is associated with laser photocoagulation treatment in adult type 2 diabetes mellitus from the Veterans Affairs Diabetes Trial. Metabolism 2009; 58:393-400. [PMID: 19217457 DOI: 10.1016/j.metabol.2008.10.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Accepted: 10/20/2008] [Indexed: 10/21/2022]
Abstract
Basic fibroblast growth factor (bFGF) is a potent endothelial cell mitogen that does not normally circulate. Yet plasma bFGF-like bioactivity was increased in association with persistent microalbuminuria and retinopathy in adult type 2 diabetes mellitus. In the present study, we tested whether plasma bFGF immunoreactivity (IR) could predict the need for laser treatment of diabetic retinopathy in a baseline subset of advanced type 2 diabetes mellitus from the Veterans Affairs Diabetes Trial (mean: age, 59 years; diabetes duration, 11 years; baseline glycosylated hemoglobin, 9.5%). Plasma bFGF-IR was determined with a sensitive and specific 2-site enzyme-linked immunoassay in 172 patients at the baseline visit. Results were dichotomized at 4.5 pg/mL, the upper limit in healthy men. There was an unexpected significant association between low baseline plasma bFGF-IR level and the interim (4 years) need for laser treatment. First laser treatment was significantly more likely to be required in patients with low compared with high baseline bFGF (19% vs 6%, P = .03 for the difference). After adjusting for clinical risk factors, low vs high bFGF (hazard ratio [HR], 5.01; P = .012), duration of diabetes (HR, 1.05; P = .050), and low-density lipoprotein cholesterol concentration (HR, 0.98; P = .027) were all significantly associated with time to first laser occurrence. These and our prior results suggest that low plasma bFGF-IR may be a marker for the presence of anti-endothelial cell autoantibodies that may contribute to the need for laser photocoagulation treatment in adult men with advanced type 2 diabetes mellitus.
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Affiliation(s)
- Mark B Zimering
- Medical Service, Department of Veterans Affairs New Jersey Health Care System, Lyons, NJ 07939, USA.
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Tucker D, Rousculp M, Girach A, Palmer A, Valentine W. Investigating the links between retinopathy, macular edema and visual acuity in patients with diabetes. EXPERT REVIEW OF OPHTHALMOLOGY 2008. [DOI: 10.1586/17469899.3.6.673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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