Degree Of Diabetic Retinopathy Research Articles

Exploración de la Relación de la Calidad del Sueño en Pacientes con Retinopatía Diabética, Villahermosa Tabasco

Introduction: In recent decades, there has been growing evidence suggesting that too little or too much sleep is associated with adverse health outcomes, including type 2 diabetes. There is a close association between diabetes and diabetic retinopathy (DR), so it is reasonable to assume that sleep may also have associations with DR. Objective: To explore the relationship between the perception of sleep quality and the degree of diabetic retinopathy in patients with type 2 Diabetes Mellitus treated at a 3rd level dophthalmological care service. Results: Significant correlations were found in: diastolic and systolic blood pressure (0.429), triglycerides and total cholesterol (0.707), glycosylated hemoglobin (HbA1c) and glycemia (0.561), Epworth sleepiness scale (ESS Score) and age (0.394) , ESS Score and weight (0.365), extended STOP questionnaire (Stop Bang) and age (0.317), Stop Bang and weight (0.579), Stop Bang and ESS Score (0.452), insomnia severity index (ISI Score) and Stop Bang (0.460). Although the reduced sample size limited the results in the associations by subgroups in the study, a trend towards an elevation of the ESS score can be seen in the subgroup of patients who reported sleeping 8 hours or more. Conclusions: Although the trends are not statistically significant, the authors consider that this finding is congruent with the state of the art on the subject of sleep and metabolic condition of retinopathic diabetic patients (increased trend of ESS score reported in the subgroup of 8 or more hours sleep), it will be necessary to explore this phenomenon in more detail and in a larger number of patients.

Correlation Between Retinal Microvascular Abnormalities and Total Magnetic Resonance Imaging Burden of Cerebral Small Vessel Disease in Patients With Type 2 Diabetes.

Background and Purpose: Diabetic retinopathy (DR) is one of the common microvascular complications in diabetes. The total magnetic resonance imaging (MRI) burden of cerebral small vessel disease (CSVD) tends to be increased in diabetic patients and is a marker of microvascular disease; however, the relationship between DR and CSVD is unclear. This study aimed to explore the relationship between retinal microvascular abnormalities and the total MRI burden of CSVD in patients with type 2 diabetes.Methods: Data were collected from patients with type 2 diabetes who were hospitalized between December 2019 and November 2020 in Changzhou Second People’s Hospital affiliated to Nanjing Medical University. All patients underwent retinal photography and cerebral MRI. The central retinal artery equivalent (CRAE), the central retinal venous equivalent (CRVE), and arteriole-to-venule ratio (AVR) were calculated using Image J software to determine the retinal vascular calibers for each patient. The total MRI burden score for CSVD was determined, and the relationship between retinal microvascular abnormalities and the total MRI burden of CSVD was analyzed.Results: Of the 151 diabetic patients included in the study, 84 (55.6%) had no diabetic retinopathy (NDR), 27 (17.9%) had mild DR, and 40 (26.5%) had moderate, or severe non-proliferative DR (grouped together for this study as “more than mild DR”). In patients with more than mild DR, the proportion of moderate to severe burden of CSVD was 75%, which was higher than in patients with mild DR (48.1%) or NDR (26.2%). Patients with moderate to severe burden of CSVD were more likely than those with mild burden of CSVD to have narrowed retinal arterioles (105.24 ± 8.42 μm vs. 109.45 ± 7.93 μm), widened retinal venules (201.67 ± 16.25 μm vs. 193.95 ± 13.54 μm), and lower arteriole-to-venule ratio (0.52 ± 0.05 vs. 0.57 ± 0.04) (P < 0.05 for all). The degree of DR (r = 0.465, P < 0.001) and CRVE (r = 0.366, P < 0.001) were positively correlated with the total MRI burden of CSVD. Multivariate logistic regression analysis indicated that, after adjustments were made for age, smoking, alcohol consumption, hypertension, and other factors, more than mild DR (OR, 4.383; P = 0.028), CRAE (OR, 0.490; P = 0.031), and CRVE (OR, 1.475; P = 0.041) were independently associated with moderate to severe burden of CSVD.Conclusion: Retinal microvascular abnormalities in patients with type 2 diabetes are associated with the presence of cerebral small vessel lesions. The degree of DR and retinal vessel changes can be used as predictors of intracranial microcirculation lesions.

Prevalence and Associated Factors of Diabetic Retinopathy in a Russian Population. The Ural Eye and Medical Study.

AimTo assess prevalence and associated factors of diabetic retinopathy (DR) in a Russian population.MethodsOut of 7328 eligible individuals, the population-based cross-sectional Ural Eye and Medical Study included 5899 (80.5%) individuals aged 40+ years, who underwent a detailed medical and ophthalmological examination. Using ocular fundus photographs and optical coherence tomographic images, we assessed prevalence and degree of DR in 5105 participants.ResultsDR was present in 99/5105 individuals (1.9%; 95% confidence interval [CI]: 1.6, 2.3). Its prevalence increased from 6/657 (1.0%; 95% CI: 0.2, 1.6) in the age group of 45–50 years to 24/680 (3.5%; 95% CI: 2.1, 4.9) in the age group of 65–70 years, and decreased to 3/153 (2.0%; 95% CI: 0.00, 4.2) in the age group of 80+ years. DR prevalence within the 577 (11.4%; 95% CI: 10.5, 12.2) individuals with diabetes was 99/577 (17.2%; 95% CI: 14.1, 20.2). DR was the cause for moderate-to-severe vision impairment (best corrected visual acuity <6/18 but ≥3/60) in four individuals (4/5105; 0.07%). In multivariable analysis, higher DR prevalence was associated with higher serum glucose concentration (odds ratio [OR]: 1.30; 95% CI: 1.20, 141), longer diabetes duration (OR: 1.06; 95% CI: 1.02, 1.09), type of diabetes therapy (nil/diet/oral/insulin) (OR:4.19;95% CI:3.08, 5.70), lower educational level (OR:0.81;95% CI:0.67, 0.98), lower manual dynamometric force (OR: 0.96; 95% CI: 0.94, 0.99), shorter ocular axial length (OR: 0.73; 95% CI: 0.56, 0.96), and higher diastolic blood pressure (OR: 1.04; 95% CI: 1.01, 1.06), or alternatively, higher estimated cerebrospinal fluid pressure (OR: 1.09; 95% CI: 1.01, 1.18).ConclusionIn this urban and rural Russian population aged 40+ years, DR prevalence was relatively low (1.9%; 95% CI: 1.6, 2.3), showed an inverted U-shaped association with age, and in a cross-sectional study design it was associated with shorter axial length and higher estimated cerebrospinal fluid pressure.

Особливості способу життя як фактор ризику розвитку і прогресування діабетичної ретинопатії у хворих на цукровий діабет 2-го типу

Актуальність. На сьогодні активно вивчається роль загальної дієти, окремих харчових продуктів і поживних речовин, способу життя (CЖ), фізичної активності тощо у розвитку цукрового діабету 2-го типу (ЦД2). Мета — провести аналіз особливостей способу життя як фактора ризику розвитку і прогресування діабетичної ретинопатії (ДР) у хворих на цукровий діабет 2-го типу. Матеріали та методи. Дослідження включало 76 хворих із ЦД2, у яких за результатами офтальмологічного обстеження виявлено різний ступень ДР. Контрольну групу (n = 43) становили особи без ЦД, співставні із пацієнтами за статтю, віком, індексом маси тіла. Для вивчення СЖ була розроблена анкета, на питання якої пропонували відповісти всім досліджуваним особам. Результати. Для інтегральної оцінки показників СЖ в групах порівнянь доцільно проводити аналіз відповідей анкети через визначення індексів. Найбільш вдалим виявився індекс раціональності рекомендації через відношення «рекомендовано — не рекомендовано». 90 % хворих із ЦД2 дотримуються спеціальної дієти, але наявність погрішностей при дієтичному харчуванні не корелює прямо із тяжкістю стану і розвитком ДР. Додаткове фізичне навантаження, як і вживання додаткової кількості води в раціоні є звичками, які суттєво відрізняють хворих із ЦД2 від їх ровесників без діабету. Але відсутність додаткових фізичних вправ і невелика кількість рідини при щоденному вживанні не виявили кореляції із погіршенням стану і посиленням ускладнення у вигляді ДР. Аналіз харчових звичок показав, що недостатність вживання фруктів і овочів знаходиться в прямій залежності із захворюванням на ЦД і його ускладненням у вигляді прогресування ДР. Висновки. Отримані дані надають підставу сформувати рекомендацію для пацієнтів з ЦД2 у вигляді збагачення раціону харчування фруктами й овочами і розглядати цю пораду як профілактичний засіб розвитку захворювання й ускладнення у вигляді прогресування ДР.

Влияние экспрессии L-FABP и жирнокислотного состава пищи на состояние липидного метаболизма больных с разной степенью диабетической ретинопатии и сахарным диабетом 2-го типа

Актуальность. Чрезмерный уровень жирных кислот (ЖК) является токсичным для клеток, поэтому экс­прессию протеина FABP рассматривают как защитный механизм, связывающий ЖК и направляющий их в соответствующие сайты внутриклеточной утилизации и окисления или накопления. Повышение в плазме содержания свободных ЖК играет ключевую роль в развитии сахарного диабета и его осложнений, а также инсулинорезистентности. Цель работы: изучение влияния экспрессии L-FABP и жирнокислотного состава пищи на состояние липидного метаболизма у пациентов с разной степенью диабетической ретинопатии (ДР) и сахарного диабета 2-го типа (СД2). Материалы и методы. Исследование включало 76 больных (76 глаз) с СД2, у которых по результатам офтальмологического обследования выявлена разная степень ДР. Контрольную группу (КГ) составили 23 лица без СД, сопоставимые с пациентами по полу, возрасту, индексу массы тела. Прогрессирование ДР определяли по шкале ETDRS, выделили 3 группы: ДР-1 группа (18 больных, 18 глаз) — пациенты с легкой, умеренной и тяжелой непролиферативной ДР; ДР-2 группа (27 больных, 27 глаз) — пациенты с легкой, умеренной и высокого риска пролиферативной ДР; ДР-3 группа (31 больной, 31 глаз) — пациенты с прогрессирующей пролиферативной ДР. Изучение спектра ЖК в мембранах эритроцитов проводили методом газожидкостной хроматографии. Содержание L-FABP определяли в сыворотке крови методом ELISA. Для изучения особенностей питания была разработана анкета, на вопросы которой предлагалось ответить всем исследуемым. Результаты. Состояние липидного метаболизма у пациентов с ДР и СД2 характеризовалось существенной разницей содержания ЖК в мембранах эритроцитов по сравнению с группой здоровых лиц с достоверным повышением степени «насыщенности». В группах ДР-1 и ДР-3 наблюдалось повышение в 1,5–2 раза (Р &lt; 0,05) содержания насыщенных жирных кислот (НЖК) и снижение ненасыщенных жирных кислот (ННЖК) за счет полиненасыщенных жирных кислот, а в группе ДР-2 — практически равное содержание НЖК и ННЖК. С прогрессированием ДР выявлена тенденция к снижению содержания миристиновой и арахидоновой ЖК и повышение стеариновой и олеиновой ЖК. Употребление в пищу продуктов-источников различных типов ЖК по рассчитанному показателю «рациональность потребления продуктов», полученному на основании анализа анкет питания, не отличалось в группах здоровых лиц и у пациентов с разной степенью ДР. У пациентов с ДР и длительным СД2 мы обнаружили достоверное повышение сывороточного уровня L-FABP. В группе ДР-1 L-FABP был в 1,5 раза (Р &lt; 0,05) выше, чем в КГ. В группе ДР-2 наблюдали незначительное уменьшение показателя, но он оставался в 1,3 раза больше КГ, а в группе ДР-3 снова обнаружили повышение относительно КГ в 1,7 раза. Можно предположить, что уменьшение экспрессии L-FABP в группе ДР-2 отображает адаптацию организма к высокому уровню ЖК плазмы и имеет сдерживающее влияние на развитие и прогрессирование ДР. Выводы. Проведенное исследование отображает регуляторную роль L-FABP как важного фактора эндогенной регуляции липидного гомеостаза на фоне отсутствия существенных экзогенных воздействий пищевой нагрузки на метаболизм липидов организма у больных с ДР и СД2.

Relationship between soluble protein ST2 (sST2) levels and microvascular complications in a cohort of patients with type 1 diabetes

AimTo determine the association and the prognostic value of soluble ST2 (sST2) levels in the development of diabetic retinopathy (DR), diabetic macular oedema (DMO) or diabetic nephropathy (DN), in a cohort of patients with type 1 diabetes (T1D). MethodsA total of 269 individuals with T1D (154 males and 115 females) were recruited. The overall mean age was 43.2±14.9 years, and the diabetes duration was 17.1±12.1 years. Levels of sST2 in serum were evaluated, and the presence as well as the degree of DR, DMO and DN was recorded. Additionally, other clinical and analytical parameters including demographic variables were recovered from patients’ electronic health record. Ten years later, the presence and stage of DR, DMO and DN were again recorded under the same criteria.The association between previously mentioned parameters with DR and DN was analysed by univariate and multivariate logistic regression. The variables in the final multivariate models were adjusted from complete models via backward elimination and maintained only when significant. ResultsAn increase of 10ng/ml in the levels of sST2 was associated with a 1.50 (1.02–2.19) and 1.48 (1.05–2.08) prevalence odds ratio (OR) in DMO and DR, respectively. There was no association between sST2 levels and DN. Meanwhile, sST2 levels did not display a prognostic effect in any of the microangiopathic diabetic complications studied. ConclusionsLevels of sST2 are associated with the presence of DR and DMO, they do not seem to be predictive for the development or deterioration of DR, DMO or DN.

Association of Bone Metabolism Indices and Bone Mineral Density with Diabetic Retinopathy in Elderly Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Inpatient Study in China.

Objective This study is aimed at analyzing the association between bone metabolism indices and diabetic retinopathy (DR) in elderly patients with type 2 diabetes mellitus. Methods Data of 352 men and 284 postmenopausal women, aged more than 50 years, with type 2 diabetes mellitus were retrospectively analyzed. Patients were divided into three groups based on the degree of DR: nondiabetic retinopathy (NDR) group, background diabetic retinopathy (BDR) group, and proliferative diabetic retinopathy (PDR) group. Results (1) The diabetic duration and urinary albumin to creatinine ratio (UACR) were significantly higher in the PDR and BDR groups than in the NDR group (P < 0.05). The level of beta-C-terminal telopeptide (β-CTX) in male patients was lower in the PDR and BDR groups than in the NDR group (P < 0.05). In addition, the level of procollagen 1 intact N-terminal (P1NP) in female patients was higher in the PDR and BDR groups than in the NDR group (P < 0.05). (2) For men and postmenopausal women, the proportion of vitamin deficiency was higher in the PDR and BDR groups than in the NDR group (P < 0.05). (3) The logistic regression analysis in men and postmenopausal women showed that the diabetic duration and lower levels of UACR and 25(OH)D were independent risk factors for DR (P < 0.05). (4) The diabetic duration was also an independent risk factor for PDR (P < 0.05); however, no independent correlation was found between the level of 25(OH)D and PDR (P > 0.05). Conclusions A close association was observed between 25(OH)D level and DR in the elderly male patients and postmenopausal women with type 2 diabetes mellitus. P1NP and β-CTX levels might be closely related to DR in elderly male patients and postmenopausal women with type 2 diabetes mellitus.

Comparison between the Foveal Avascular Zone and Macular Capillary Network Density in Diabetic Retinopathy and Normal Retina

Background: Diabetic retinopathy (DR) is mostly a vascular disease where the development of macular oedema and proliferative retinopathy are major causes of visual impairment. Enlargement of the foveal avascular zone (FAZ) is associated with visual deterioration in patients with diabetic retinopathy. Objective: To evaluate the foveal avascular zone (FAZ) and perifoveal capillary network density in the superficial retinal layer (SRL) and deep retinal layer (DRL) in patients with varying severities of diabetic retinopathy (DR). Patients and methods: This is a prospective comparative randomized case-control study consisting of 77 eyes divided into two groups, each group underwent imaging using OCT-A device. Group one: 37 healthy control eyes, and group two: 40 eyes with DM of different degrees of diabetic retinopathy. Subjects were imaged between September 2019 and February 2020 at Kasr El-Ainy Teaching Hospital. Results: The FAZ area at the levels of the superficial and deep vascular networks of eyes with DR were found to be larger compared with those of age-matched healthy controls, and as would be expected, control eyes had higher vascular density in both networks compared with the diabetic eyes. Furthermore, eyes with worse DR stage showed larger FAZ area and lower vascular density values. This study also showed that angiographic parameters, namely FAZ area and vessel density (VD) correlated with best corrected visual acuity. Conclusion: Our study revealed that vascular density and FAZ area can be quantified in DR eyes in a rapid, automated, and noninvasive manner with OCTA. Also foveal avascular zone area and vascular density as measures of DMI correlate with visual acuity in patients with DR.

Comparison between the Foveal Avascular Zone and Macular Capillary Network Density in Diabetic Retinopathy and Normal Retina

Background: Diabetic retinopathy (DR) is mostly a vascular disease where the development of macular oedema and proliferative retinopathy are major causes of visual impairment. Enlargement of the foveal avascular zone (FAZ) is associated with visual deterioration in patients with diabetic retinopathy. Objective: To evaluate the foveal avascular zone (FAZ) and perifoveal capillary network density in the superficial retinal layer (SRL) and deep retinal layer (DRL) in patients with varying severities of diabetic retinopathy (DR). Patients and methods: This is a prospective comparative randomized case-control study consisting of 77 eyes divided into two groups, each group underwent imaging using OCT-A device. Group one: 37 healthy control eyes, and group two: 40 eyes with DM of different degrees of diabetic retinopathy. Subjects were imaged between September 2019 and February 2020 at Kasr El-Ainy Teaching Hospital. Results: The FAZ area at the levels of the superficial and deep vascular networks of eyes with DR were found to be larger compared with those of age-matched healthy controls, and as would be expected, control eyes had higher vascular density in both networks compared with the diabetic eyes. Furthermore, eyes with worse DR stage showed larger FAZ area and lower vascular density values. This study also showed that angiographic parameters, namely FAZ area and vessel density (VD) correlated with best corrected visual acuity. Conclusion: Our study revealed that vascular density and FAZ area can be quantified in DR eyes in a rapid, automated, and noninvasive manner with OCTA. Also foveal avascular zone area and vascular density as measures of DMI correlate with visual acuity in patients with DR.

Study of dry eye in diabetes mellitus type II and it’s association with diabetic retinopathy

Dry eye disease and diabetic retinopathy are complications in diabetes mellitus. However association between diabetes mellitus type II and dry eye disease are still unclear. Objectives of this study objective is was to analyse association between dry eye disease and diabetic retinopathy in patients with type 2 diabetes mellitus.A prospective study on seventy patients of diabetis mellitus type II/patients undergone indirect ophthalmoscopy and retinal photography, and the dry eye syndrome analysis using tear break up time and Schirmer tests. Diabetic retinopathy was graded.: In this study, there was no association identified among the age, sex &amp; duration of diabetes mellitus type II disease and diabetic retinopathy. 52.8% (n=37) patients were observed to be suffering from dry eye syndrome and it was common in older and female patients. Diabetic retniopathy observed in 67.1%(n=47) patients. Upon classification, 34.2% (n=24) belongs to non-proliferative diabetic retinopathy, 27.1% (n=19)belong to severe NPDR and 5.7% (n=4) belongs to proliferative DR. TBUP was observed as ≤10 seconds. Moderate NPDR was significantly high in diabetes mellitus type II patients with dry eye disease. Statistically significant association observed between diabetic retinopathy and dry eye disease. The dry eye disease prevalence observed as 52.8% patients. Statistically significant association observed between severity of dry eye disease with duration of diabetes mellitus disease and the degree of diabetic retinopathy. There was significant association identified between diabetic retinopathy and dry eye disease.

6 voces en 10 minutos: Retinopatía

6 voces en 10 minutos: Actualización en complicaciones crónicasRetinopatíaLa retinopatía diabética (RD) es la causa más frecuente de nuevos casos de ceguera evitable en adultos entre 20 y 74 años; se estima que más de un tercio de los pacientes con diabetes mellitus (DM) tiene algún grado de RD y la misma correlaciona con el tiempo de duración de la diabetes y el control glucémico. La complicación ocular relacionada con diabetes representa a nivel mundial el 35,6% en alguna de sus manifestaciones, siendo 7,24% formas proliferativas (PDR), 7,48% edema macular diabético (EMD) y 11,72% compromiso grave de pérdida de agudeza visual.

The degree of retinopathy correlates with the presence of silent myocardial ischemia in diabetic patients

Abstract Background Silent myocardial is a major component of the total ischemic burden for patients with ischemic heart disease. The disease is more prevalent in diabetic patients than their peers, and early detection of the high-risk group would play an integral role in the prevention of sudden cardiovascular accidents that are common in these patients. Methods A prospective cohort study including asymptomatic 53 diabetic patients with diabetic retinopathy who suffer no ischemic cardiac symptoms was conducted. The presence and degree of diabetic retinopathy were evidenced using fundus examination and optical coherence tomography. All the enrolled patients underwent stress-resting 99mTc SestaMIBI myocardial perfusion scintigraphy to detect the ischemic burden. The relation between diabetic retinopathy and silent myocardial ischemia was stratified using statistical analysis. Results A total of 13 diabetic patients (24.5%) have silent myocardial ischemia in the form of regional myocardial perfusion abnormalities. The strongest predictors of abnormal tests were the presence of moderate to severe retinopathy, comorbid hypertension and diabetic duration for more than 10 years. Conclusion Silent myocardial ischemia affects one in four asymptomatic diabetic patients suffering from diabetic retinopathy. The presence of comorbid risk factors such as high-grade retinopathy, hypertension and/or long diabetic duration surge the incidence and considered additional predictors of the disease. Funding Acknowledgement Type of funding source: None

Efficacy of Intravitreal Dexamethasone implants in Diabetic Macular Edema Unresponsive to Anti-VEGF Therapy

Background: Diabetic retinopathy is a common microvascular complication of diabetes leading to DiabeticMacular Edema (DME)and visual impairment in the working age population1About one third of diabeticindividuals had some degree of Diabetic retinopathy and less than 10% develop DME.Intravitreal dexamethasone implant in cases unresponsive to anti VEGF therapy has a beneficial role inimproving visual acuity and macular morphology. The possible mechanism of action could be resolution ofedema that was resistant to anti VEGF agentsAims and Objectives: To determine the efficacy of intravitreal dexamethasone implant for DMEunresponsive to anti Vascular Endothelial Growth factor(VEGF)treatmentMethodology: A retrospective analysis of refractory 21 cases, 30 eyes of DME to primary anti VEGFtreatment was performed to analyze the profile of presentation and treatment outcome to Intravitrealdexamethsone implants. Ranibizumab (0.5 mg) administered monthly and if, were unresponsive after 5-6injection were switched to Intravitreal Dexamethasone implants (0.7 mg).Failure to therapeutic response was characterized by increase in central macular thickness from baselinefinding or no response to treatment. Intravitreal dexamethasone implant was administered every two monthsBest corrected visual acuity,Intraocular pressure and central macular thickness was evaluated at baselinesand following intravitreal dexamethasone impant.Result: The mean age was 56.3± 5.9 years. The mean Intra ocular pressure was 17.3±2.7 mmHg.The mean anti VEGF treatment sessions was 5.8±1.2. The mean BCVA improved significantly from LogMar0.76 ±0.16 to 0.67 ±0.19 (p value=0.029) and CMT improved significantly from 431.6 ±100.9µm to 379.1±80.72µm (p value =0.0005).Conclusion: Intravitreal dexamethasone is effective in refractory cases of DME unresponsive to anti VEGFtherapy. Optimal evaluation and tailoring therapy with the therapeutic response will be beneficial.

Predictive Factors of the Adherence to Real-Time Continuous Glucose Monitoring Sensors: A Prospective Observational Study (PARCS STUDY).

Information about factors related to better adherence to continuous glucose monitoring (CGM) sensor adherence is quite limited. Forty-six participants with type 1 diabetes using continuous subcutaneous insulin infusion (CSII) without CGM were recruited. The participants' characteristics and diabetes-related quality of life (QOL) were evaluated at baseline and one year after starting to use CGM. Participants wearing the sensor for ≥60% of the time were considered as adherent. The mean age of the 46 participants was 44.1 ± 15.0 years old and the mean glycohemoglobin (HbA1c) was 7.7 ± 1.0%; 60.9% of the participants were classified as adherent. The duration of using CSII was longer in the adherent group, and the degree of diabetic retinopathy was significantly different. There were no significant differences in age, frequency of self-monitoring of blood glucose, or Hypoglycemia Fear Survey (HFS-B for behavior, HFS-W for worry) score at baseline between the adherent and nonadherent groups. The Problem Areas in Diabetes (PAID) score at baseline was significantly higher and the total CSII-QOL score at baseline was significantly lower in the adherent group. The usage of dual-wave bolus was significantly increased in the adherent group (34.6%-61.5%, P = .016), but not in the nonadherent group (33.3%-33.3%, P > .999). The HbA1c level showed a significant improvement in the adherent group (7.8%-7.3%, P < .001), but not in the nonadherent group (7.5%-7.2%, P = .102). Higher adherence to CGM sensors may be associated with a heavier emotional burden of diabetes and a worse QOL in relation to CSII at baseline.

Why Miss the Chance? Incidental Findings while Telescreening for Diabetic Retinopathy

ABSTRACT Purpose To report on incidental pathological findings met while screening for Diabetic Retinopathy (DR) in Diabetes Clinics (DC) by ophthalmologist-graded digital fundus imaging. Methods At the DC of Pescara (central Italy), for 3,859 eyes of 1,930 consecutive patients having not undergone fundus examination in the last year, two mydriatic fundus digital images, taken with a CenterVue DRS Digital Retinal Camera, were sent along with Best Corrected Visual Acuity, on a “store-and-forward” basis, to an ophthalmologist trained in DR screening, and graded according to the UK Diabetic Eye Screening Programme. Incidental fundus abnormalities other than DR were reported. Results No adverse event to mydriasis was reported. One hundred and eighty eyes (4.66%) were ungradable. Among the 3,679 gradable ones, 1,105 (30.04%) showed different degrees of DR (R1 to R3), and 126 (3.42%) maculopathy (M1). Any Age-Related Macular Degeneration was present in 387 eyes (10.52%), any optic disc and parapapillary area features suspect for glaucoma in 562 eyes (15.27%), any hypertensive retinopathy in 1,263 eyes (34.33%), vitreoretinal interface disease in 252 eyes (6.84%), myopic choroidopathy in 92 eyes (2.50%), disc pallor in 31 eyes (0.84%). Mean time was 5 min for screening, 2 min for grading. Conclusion Teleretinography is a well-established, cost-effective procedure in DR screening. Along with increased attendance, locating a digital camera in a DC with a retina-specialist grader results in finding fundus pathologies also beyond DR, very similarly to fundus examination in an outpatient ophthalmic setting.

The Degree of Retinopathy Correlates with the Presence of Silent Myocardial Ischemia in Diabetic Patients

Background: Silent myocardial ischemia is a major component of the total ischemic burden for patients with ischemic heart disease. The disease is more prevalent in diabetic patients than their peers, and early detection of the high-risk group would play an integral role in the prevention of sudden cardiovascular accidents that are common in these patients. Methods: A prospective cohort study including asymptomatic 53 diabetic patients with diabetic retinopathy who suffer no ischemic cardiac symptoms was conducted. The presence and degree of diabetic retinopathy were evidenced using fundus examination and optical coherence tomography. All the enrolled patients underwent stress-resting 99mTc SestaMIBI myocardial perfusion scintigraphy to detect the ischemic burden. The relation between diabetic retinopathy and silent myocardial ischemia was stratified using statistical analysis. Results: A total of 13 diabetic patients (24.5%) have silent myocardial ischemia in the form of regional myocardial perfusion abnormalities. The strongest predictors of abnormal tests were the presence of moderate to severe retinopathy, comorbid hypertension and diabetic duration for more than 10 years. Conclusion: Silent myocardial ischemia affects one in four asymptomatic diabetic patients suffering from diabetic retinopathy. The presence of comorbid risk factors such as high-grade retinopathy, hypertension and/or long diabetic duration surge the incidence and considered additional predictors of the disease.

Diabetic retinopathy as an independent predictor of subclinical cardiovascular disease: baseline results of the PRECISED study

ObjectiveDetection of subclinical cardiovascular disease (CVD) has significant impact on the management of type 2 diabetes. We examined whether the assessment of diabetic retinopathy (DR) is useful for identifying patients...

Oxidative Stress and Microvascular Alterations in Diabetic Retinopathy: Future Therapies.

Diabetes is a disease that can be treated with oral antidiabetic agents and/or insulin. However, patients' metabolic control is inadequate in a high percentage of them and a major cause of chronic diseases like diabetic retinopathy. Approximately 15% of patients have some degree of diabetic retinopathy when diabetes is first diagnosed, and most will have developed this microvascular complication after 20 years. Early diagnosis of the disease is the best tool to prevent or delay vision loss and reduce the involved costs. However, diabetic retinopathy is an asymptomatic disease and its development to advanced stages reduces the effectiveness of treatments. Today, the recommended treatment for severe nonproliferative and proliferative diabetic retinopathy is photocoagulation with an argon laser and intravitreal injections of anti-VEGF associated with, or not, focal laser for diabetic macular oedema. The use of these therapeutic approaches is severely limited, such as uncomfortable administration for patients, long-term side effects, the costs they incur, and the therapeutic effectiveness of the employed management protocols. Hence, diabetic retinopathy is the widespread diabetic eye disease and a leading cause of blindness in adults in developed countries. The growing interest in using polyphenols, e.g., resveratrol, in treatments related to oxidative stress diseases has spread to diabetic retinopathy. This review focuses on analysing the sources and effects of oxidative stress and inflammation on vascular alterations and diabetic retinopathy development. Furthermore, current and antioxidant therapies, together with new molecular targets, are postulated for diabetic retinopathy treatment.

Repositioning of Itraconazole for the Management of Ocular Neovascularization Through Surface-Modified Nanostructured Lipid Carriers

Retinopathy is one of the most common complications of diabetes. Approximately 80% of patients with diabetes history for over 10 years suffer from some degree of diabetic retinopathy (DR). Currently available treatments include use of antivascular endothelial growth factor-165 (VEGF165) agents or steroids. However, they are very expensive, involve an invasive procedure that is painful, and show ocular and systemic complications. Currently, the focus for treatment of such disorders has shifted from new drug discovery to repositioning of available drugs because of the cost and time consumption involved in the former. Working on this strategy, itraconazole (ITR) was selected for treatment of DR due to its potent unutilized antiangiogenic activity for the management of DR. An attempt was made to develop a topical, noninvasive nanostructured lipid carrier (NLC) owing to the potential to carry entrapped drug across the membranes. ITR-NLCs were prepared using high-pressure homogenization by applying Box-Behnken design for optimization. Surface of NLCs was modified by chitosan (CS) coating. ITR-NLCs were examined for antiangiogenic potential and their VEGF165 targeting efficiency. Drug-loaded NLC showed desired particle size, zeta potential, and polydispersity index. In VEGF-induced DR rats, ITR and CS-ITR-NLCs were found to exhibit an antineovascularization effect by targeting VEGF165. The developed CS-ITR-NLC proved to be an effective topical therapy for management of DR, offering the advantages of cost-effectiveness, higher patient compliance, and better tolerance.

Association of Diabetic Retinopathy and Lipid Profile in Diabetic Patients in Mathura District

Background: It is estimated that diabetes mellitus affects 4 percent of the world’s population, almost half of whom have some degree of diabetic retinopathy at any given time. Elevated serum lipid levels are associated with an increased risk of retinal hard exudate in persons with diabetic retinopathy. Therefore the current study was undertaken to determine the association of serum lipid profile with diabetic retinopathy and its severity. Subjects and Methods: One hundred fifty diabetic patients, out of these, 75 diabetic patients with retinopathy served as the study group I and 75 diabetic patients with no retinopathy formed group II (control group). Simultaneously, 75 age and sex matched healthy subjects were also studied as controls (group III). Serum total cholesterol, serum triglyceride, serum low density lipoprotein and serum high density lipoprotein were measured by using enzymatic method and autoanylyser. Fasting blood sugar and post prandial blood sugar were estimated by using GOD POD method. Results: Most of the patients in Group I had some degree of visual impairment. However there was no statistical significance with p >0.05. The mean value of total cholesterol was higher in both group I and group II with value being higher in group1 (229.09mg/dl) as compared to group II (215.32mg/dl). Triglyceride levels also followed the similar trend with group I having mean value of 238.95mg/dl and group II having 179.93 mg/dl. But only total cholesterol value had statistical significance p < 0.05. Conclusion: The present study demonstrated statistically significant correlation between diabetic retinopathy and hypercholesterolemia. Increased cholesterol level was significantly associated with the occurrence of all grades of retinopathy especially severe NPDR, very severe NPDR and PDR. No correlation was found between lipid profile and visual acuity. These data suggest that hyperlipidaemia should be promptly treated in diabetic patients.