Presence Of Retinopathy Research Articles

Five-Year Predictors of Insulin Initiation in People with Type 2 Diabetes under Real-Life Conditions.

We performed a real-life analysis of clinical and laboratory parameters, in orally treated T2DM patients aiming at identifying predictors of insulin treatment initiation. Overall, 366955 patients (55.8% males, age 65 ± 11 years, diabetes duration 7 ± 8 years) were followed up between 2004 and 2011. Each patient was analyzed step-by-step until either eventually starting insulin treatment or getting to the end of the follow-up period. Patients switching to insulin showed a worse global risk profile, longer disease duration (10 ± 9 years vs. 6 ± 7 years, respectively; p < 0.001), higher HbA1c (8.0 ± 1.6% vs. 7.2 ± 1.5%, respectively; p < 0.001), higher triglycerides, a greater prevalence of arterial hypertension, antihypertensive, lipid-lowering and aspirin treatment, a higher rate of nonproliferative/proliferative retinopathy, and a nearly 4 times lower prevalence of the “diet alone.” They also showed a higher prevalence of subjects with eGFR < 60 ml/min/1.73 m2 (24.0% vs. 16.2%, respectively; p < 0.001). Multivariate analysis identified diabetes duration, HbA1c, triglyceride and low HDL-C values, presence of retinopathy or renal dysfunction, and sulphonylurea utilization (the risk being approximately 3 times greater in the latter case) as independent predictors of insulin treatment initiation. LDL-C, lipid-lowering treatment, and overweight/obese seem to be protective. Results of tree analysis showed that patients on sulphonylurea, with high HbA1c, eGFR below 50 ml/min/1.73 m2, and at least 5-year disease duration, are at very high risk to start insulin treatment. We have to stick to this real-life picture, of course, until enough data are collected on patients treated with innovative medications which are expected to improve beta cell survival and further delay treatment-related insulin requirement.

Diyabetlilerde Kendi Kendine Kan Şekeri İzlemi ile HbA1c ve Diyabet Komplikasyonlarının Karşılaştırılması

Amaç: Bu çalışma diabetes mellitus nedeniyle izlenen hastalarda kan şekeri ölçüm sıklığı ile diyabet regülasyonu ve diyabetin komplikasyonları arasındaki ilişkiyi belirlemek amacıyla yapılmıştır.&#x0D; Bireyler ve Yöntem: Çalışma 951 diyabetli hastanın (tip1= 90, tip2= 861) dosyalarının retrospektif olarak incelenmesi ile gerçekleştirilmiştir. Hastaların yaşı, cinsiyeti, boyu, ağırlığı, diyabet tipi, diyabet süresi, diyabet tedavisi, hemoglobin A1c (HbA1c) değeri, nöropati varlığı, nefropati varlığı, diyabetik ayak varlığı, hipertansiyon varlığı, kan şekeri ölçüm sıklığı bilgileri not edilmiştir. Kan şekeri ölçüm sıklıklarına göre hastalar 3 gruba ayrılmıştır: haftada en az iki gün toplam 8 kez kan şekeri ölçümü yapanlar (grup 1), haftada iki günden az ve 8 ölçümden az kan şekeri ölçümü yapanlar (grup 2), düzensiz kan şekeri ölçümü yapmalarına rağmen doktor kontrolüne gelmeden önceki 2 gün içerisinde 8 kez kan şekeri ölçümü yapanlar (grup 3).&#x0D; Bulgular: Hastaların 548’i kadın, 403’ü erkek, ortalama yaş 58.12±13.17 yıldır. Gruplar arasında HbA1c (p&lt;0.001) ve diyabet süresi (p&lt;0.001) parametrelerinde anlamlı fark belirlenmiştir. Hastaların kan şekeri ölçüm sıklığı ile diyabet tipi (p&lt;0.001), diyabet tedavi şekli (p&lt;0.001), retinopati varlığı (p&lt;0.001), nefropati varlığı (p&lt;0.001), hipertansiyon varlığı (p&lt;0.001) arasında anlamlı bir fark olduğu saptanmıştır.&#x0D; Sonuç: Doğru ölçüm tekniği ve güvenilir kan şekeri ölçüm aletleri ile yapılan kan şekeri ölçümü, hastanın diyabeti tanıması ve yönetmesine imkân tanımakla birlikte diyabete bağlı gelişebilecek komplikasyonların önüne geçilmesinde yardımcı olmaktadır.

Identification of Eyes At Risk for Severe Retinopathy of Prematurity (ROP) by Third Year Ophthalmology Residents in a Tertiary Hospital

Objective: The aim of the present study is to determine the efficiency of third year ophthalmology residents from a tertiary hospital in performing preliminary retinal examination to identify eyes at risk retinopathy of prematurity on the basis of retinal fundus findings up to International Classification of Retinopathy of Prematurity (ICROP) Zone II. Methods: This is a single-center, cross-sectional, prospective comparative research conducted from June to October 2015 at a tertiary training hospital in the Philippines. All infants referred for retinopathy of prematurity screening within the study period where included. The presence of retinal vessel dilatation and tortuosity were identified by third year ophthalmology residents using indirect funduscopy. The residents’ fundus findings were then compared to that of a retina consultant who is proficient in the diagnosis and management of retinopathy of prematurity (ROP). The Kappa index was used to rate inter-observer agreement. The correlation between ROP risk factors and the presence of abnormal retinal vessels were assessed using odd ratio computations. Fisher’s exact test was used to determine the correlation between retinopathy of prematurity and the presence of retinal dilatation and tortuosity. The McNemar’s test was also applied to determine significant differences in the retinal findings of the consultant and ophthalmology residents. Results: A total of 82 eyes of 41 premature infants were evaluated to determine if retinal findings observed by ophthalmology residents were comparable to that of a retina consultant. Odds ratios show that age of gestation, birth weight, and history of blood transfusion are significantly associated with the presence of retinopathy of prematurity. Retinal vessel tortuosity and dilatation are also more common among infants diagnosed with retinopathy of prematurity. There was no significant difference between the retinal vascular findings of the retina consultant and the third year ophthalmology resident in terms of identifying retinal vessel dilatation and tortuosity (P &lt; 0.05). Conclusion: After sufficient and in-depth ophthalmology training, third year ophthalmologists, who will be general ophthalmologists in the future, can reliably identify eyes at risk for severe retinopathy of prematurity on the basis of retinal vascular dilatation and/or tortuosity.

Proliferative retinopathy and maculopathy are two independent conditions in sickle cell disease: Is there a role of blood rheology?1.

Our study investigated the prevalence of retinopathy and maculopathy in sickle cell patients and tested the association between these two conditions. In addition, we tested whether hematological and hemorheological parameters, as well as genotype, were involved in the development of these two conditions. Seventy sickle cell adult patients were recruited: 37 with sickle cell anemia (SCA) and 33 with sickle cell hemoglobin C disease (SCC). All patients underwent retinal examination and macular ocular coherence tomography. Blood was sampled for the measurements of hematological and hemorheological parameters. Twenty-six patients had maculopathy and 30 had retinopathy with no significant difference between SCA and SCC patients. No association between the presence of retinopathy and maculopathy was detected. RBC aggregation was higher and RBC deformability lower at 3 Pa in SCA patients. Blood viscosity and hematocrit were higher in SCC than in SCA patients. However, no association was found between biological parameters and the ocular complications studied. Our study showed that retinopathy and maculopathy are common in sickle cell disease. Nevertheless, we found no association with hematological parameters, blood rheology or genotype.

Risk factors for the development of micro-vascular complications of type 2 diabetes in a single-centre cohort of patients.

In type 2 diabetes, we aimed at clarifying the role of glycated haemoglobin variability and other risk factors in the development of the main micro-vascular complications: peripheral neuropathy, nephropathy and retinopathy. In a single-centre cohort of 900 patients, glycated haemoglobin variability was evaluated as intra-individual standard deviation, adjusted standard deviation and coefficient of variation of serially measured glycated haemoglobin in the 2-year period before a randomly selected index visit. We devised four models considering different aspects of glycated haemoglobin evolution. Multivariate stepwise logistic regression analysis was performed including the following covariates at the index visit: age, disease duration, body mass index, total cholesterol, high-density lipoprotein cholesterol, triglycerides, sex, smoking habit, hypertension, dyslipidemia, treatment with anti-diabetic drugs, occurrence of macro-vascular events and the presence of another micro-vascular complication. Males with high mean glycated haemoglobin, long duration of diabetes, presence of macro-vascular events and retinopathy emerged at higher risk for peripheral neuropathy. Development of nephropathy was independently associated with higher glycated haemoglobin variability, older age, male sex, current smoking status, presence of retinopathy, of peripheral neuropathy and of hypertension. Higher mean glycated haemoglobin, younger age, longer duration of diabetes, reduced estimated glomerular filtration rate and the presence of peripheral neuropathy were significantly associated with increased incidence of retinopathy. Glycated haemoglobin variability was associated with increased incidence of nephropathy, while mean glycated haemoglobin emerged as independent risk factor for the development of retinopathy and peripheral neuropathy. The presence of macro-vascular events was positively correlated with peripheral neuropathy. Finally, the occurrence of another micro-vascular complication was found to be a stronger risk factor for developing another micro-vascular complication than the mean or variability of glycated haemoglobin.

PDB12 - The Prevalence of Comorbidities and Its Association with Poor Glycemic Control in Malaysian Patients with Type 2 Diabetes Mellitus

The aim of the study was to determine the prevalence of comorbidities among Malaysian patients with Type 2 Diabetes Mellitus (T2DM) and examine the association between number and types of comorbidities and poor glycemic control. We utilized data from the Malaysian National Diabetes Registry consisting of T2DM patients followed up in public sector primary care clinics between 2013 and 2016. Descriptive analysis was used to determine the prevalence of comorbidities. Multiple logistic regression was used to examine the association between number and type of comorbidities (hypertension, dyslipidemia, retinopathy, ischemic heart disease (IHD), cerebrovascular disease (CeVD), nephropathy, diabetic foot and amputation) and poor glycemic control as measured by HbA1c. A total of 285,761 patients were included in the analysis. Mean age was 62 years and mean duration of diabetes was 7.3 years; 61.2% were female and 61.6% had waist circumference above threshold (male: >90cm, female: >80cm). Most patients (68.9%) did not achieve glycemic control (i.e. had HbA1c >6.5%). A majority (88%) of patients had at least one comorbidity, with hypertension being the most common (76.4%) followed by dyslipidemia (67.5%) and nephropathy (10.9%). Factors that were significantly associated with increased odds of an elevated HbA1c were a longer duration of diabetes (OR:3.06), waist circumference above threshold (OR:1.30), dyslipidemia (OR:1.21) and presence of IHD (OR:1.12). In contrast, age (OR:0.96), female sex (OR:0.95), presence of hypertension (OR:0.84) and CeVD (OR:0.85) reduced the odds of poor control. Total number of comorbidities and presence of retinopathy, nephropathy, diabetic foot ulcer and amputation were not associated with elevated HbA1c. In terms of the impact of comorbidities, our results were mixed. Impact depended on the type of comorbidity present. The total number of comorbidities did not affect outcome. Our analysis did not allow directionality of the association to be ascertained.

Prevalence and predictive factors for heart failure among Sudanese individuals with diabetes: Population based survey

Background: Heart failure (HF) is common problem in primary care and one of the leading causes of recurrent hospital admission across the globe. The aim of the present study was to assess the prevalence and risk factors of HF in Sudanese individuals with diabetes. Methods: This was cross sectional study with 315 participants conducted in Khartoum, Sudan. A questionnaire was used to collect demographic information. In addition to measurement of blood pressure, lipid profile and HbA1c, weight and height measurement for calculation of body mass index. Results: Among the 315 respondents, male representation in the sample was 184 (59.3%) and only 25 (13.5%) of them has heart failure (HF) while female were 131 (40.7%) and 13 (9.9%) has HF. Therefore the prevalence of HF was 12.06%. The unadjusted risk factors for HF were hypertension and cholesterol level (P value of 0.001 and 0.015 respectively). The presence of retinopathy, albuminuria, duration of diabetes and neuropathy were not associated with HF. In addition, parameters like age, sex, HbA1c, high density lipoprotein (HDL), triglyceride and low density cholesterol (LDL) are also not associated with heart failure. Importantly, hypertension was the only absolute risk factor for HF (P=0.001467). Conclusions: The prevalence of HF is estimated to be 12.06%. The risk factors are hypertension and high cholesterol. Hypertension was an absolute risk factor for HF. Therefore, further planning and strategies by health authorities in Sudan are needed to prevent, treat and manage hypertension in individuals with diabetes.

Relationship Between Diabetes Knowledge, Glycemic Control, and Associated Health Conditions.

Objective.The purpose of this study was to identify any existing relationship between diabetes knowledge and glycemic control, as well as possible associations with patient health, among patients with type 2 diabetes.Design and Methods.This qualitative study used a validated multiple-choice test (the Michigan Diabetes Knowledge Test) to assess diabetes knowledge among 17 hospital patients between the ages of 18 and 75 years with type 2 diabetes and a recent (within 3 months) A1C laboratory value. Participants also provided information about their diabetes self-care habits, previous diabetes education, and diabetes-related secondary health conditions.Results.The average diabetes knowledge score was 8.4 of 14 (60%), and the average A1C was 9.3%. Thirteen participants had previously received diabetes education, whereas four participants had never received diabetes education. The participants who had not received education scored 15.3% lower on the diabetes knowledge test and had an average A1C 0.89% higher than those who had received previous education. Although this difference was not statistically significant, it is clinically relevant. There was a significant association between diabetes knowledge and presence of retinopathy (P = 0.03).Conclusion.Diabetes self-management education and support is a crucial component of diabetes care. There is a considerable need for diabetes education strategies to improve self-management of diabetes and thereby improve outcomes and decrease the costs of diabetes-related care. There is also a need for efforts to ensure regular vision screenings for individuals with type 2 diabetes.

Risk factors for the diabetic foot infection with multidrug-resistant microorganisms in South India

Background: To analyse the risk-factors contributing to infection with multidrug-resistant organisms.Methods: 150 diabetic patients with foot ulcer were prospectively studied. Detailed clinical history and clinical examination of the ulcer were done for all patients. The microbiological profile was analyzed for each patient. Using internationally accepted criteria, the multidrug-resistant organisms were identified. Risk factors for acquiring MDRO infection were identified using appropriate statistical tools.Results: MDRO were isolated from 99 patients of 150 (66%). 54.8% (153 out of 279) of isolated organisms were multidrug-resistant organisms. By univariate analysis poor glycaemic control, previous hospitalisation, previous history of amputation, previous antibiotic usage, size of the ulcer, necrotic ulcer, recurrent ulcers, higher grade of ulcer, the presence of osteomyelitis, the presence of retinopathy, peripheral vascular disease, neuropathy and polymicrobial culture, were significantly associated with MDRO infected foot ulcers. Analysis by logistic regression indicated that only two factors significantly increased the risk of acquiring MDRO infection. They are recurrent ulcer (OR = 3.39, p &lt;0.05, 95% CI = 1.081-10.664) and higher grade of ulcer (OR = 13.44, p &lt;0.001, 95 % CI =3.595-50.278).Conclusions: The prevalence of MDRO is alarmingly high in infected diabetic foot ulcers. Recurrent ulcers and higher grade of ulcers are more prone to acquire MDROs.

Retinopathy and left ventricular hypertrophy in patients with chronic kidney disease: Interrelationship and impact on clinical outcomes

BackgroundRetinopathy and left ventricular hypertrophy (LVH) are representative markers of microvascular and cardiac dysfunction in patients with chronic kidney disease (CKD). However, their relationship and their combined effects on clinical outcomes are unknown. MethodsWe included 401 patients with nondialysis-dependent CKD stage 3–5 who had been examined with fundus photography for diabetic or hypertensive retinopathy. The presence of LVH was identified by echocardiography. The clinical significance of retinopathy and LVH was evaluated in terms of the rate of renal function decline and for any cardiovascular event (CVE)/death. ResultsCKD patients with retinopathy had a higher prevalence of LVH than those without retinopathy (38.9% vs. 27.6%, P=0.017). The presence of retinopathy was independently associated with LVH (odds ratio 1.69, 95% confidence interval [CI] 1.02, 2.80). Compared with subjects without either retinopathy or LVH, the coexistence of retinopathy and LVH was independently associated with rapid renal function decline (β=−3.28; 95% CI −6.52, −0.04), whereas retinopathy or LVH alone were not. Patients with both retinopathy and LVH had a higher risk of CVE/death (adjusted hazard ratio 2.75; 95% CI 1.44, 5.26) than patients with either factor alone. A significant synergistic interaction was observed between retinopathy and LVH to predict CVE/death (P for interaction=0.049). ConclusionsRetinopathy was independently associated with LVH. The coexistence of retinopathy and LVH was associated with higher risks of CKD progression and CVE/death than was either factor alone, and their combined effects synergized to predict the risk of CVE/death.

Retinal Vascular Imaging Markers and Incident Chronic Kidney Disease: A Prospective Cohort Study

Retinal microvascular changes indicating microvascular dysfunction have been shown to be associated with chronic kidney disease (CKD) in cross-sectional studies, but findings were mixed in prospective studies. We aimed to evaluate the relationship between retinal microvascular parameters and incident CKD in an Asian population. We examined 1256 Malay adults aged 40–80 years from the Singapore Malay Eye Study, who attended both the baseline (2004–07) and the follow-up (2011–13) examinations and were free of prevalent CKD. We measured quantitative retinal vascular parameters (arteriolar and venular calibre, tortuosity, fractal dimension and branching angle) using a computer-assisted program (Singapore I Vessel Assessment, SIVA) and retinopathy (qualitative parameter) using the modified Airlie house classification system from baseline retinal photographs. Incident CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 + 25% decrease in eGFR during follow-up. Over a median follow-up period of 6 years, 78 (6.21%) developed CKD (70.5% had diabetes). In multivariable models, smaller retinal arterioles (hazards ratio [95% confidence interval] = 1.34 [1.00–1.78]), larger retinal venules (2.35 [1.12–5.94] and presence of retinopathy (2.54 [1.48–4.36]) were associated with incident CKD. Our findings suggest that retinal microvascular abnormalities may reflect subclinical renal microvascular abnormalities involved in the development of CKD.

An assessment of the patterns and severity of diabetic neuropathy using the modified - Toronto Clinical Neuropathy Score in recently detected diabetics

Introduction: Diabetic neuropathy is among the commonest vascular complication of diabetes mellitus. Even individuals with pre-diabetes are at risk of developing diabetic neuropathy (DN). Over 50% of individuals with DN are asymptomatic, keeping them at a higher risk of developing diabetic foot. The study aimed to ascertain the patterns and severity of diabetic neuropathy among patients with recently detected diabetes mellitus, using the ‘modified -Toronto Clinical Neuropathy Score’ (m-TCNS). Materials & methods: This prospective observational study was done on 50 patients with diabetes of less than 1 year duration. Patients who fulfilled the selection criteria were recruited to the study after obtaining a written informed consent. After obtaining details of their medical history, clinical examination and investigations, patients underwent m-TCNS. Laboratory tests included sugar levels, HbA1c and urine albumin. The incidence, severity and patterns of diabetic neuropathy (DN) and its correlation to the duration, diabetes control, presence of retinopathy and albuminuria were analyzed by descriptive statistics, Chi-square test and ‘t’ test. Results: Among the 50 patients, there were 18 males and 32 females with a mean (±SD) age of 56.44 (+10. 82) years. Among them, 29 patients were new to treatment for diabetes. The average random blood sugar (RBS) and glycated hemoglobin (HbA1c) were 249.92 (±126.63) mg/dl and 10.532 (±10.64) gm% respectively. Only 46% patients had symptoms and 34% had signs of diabetic neuropathy. Pain being the commonest symptom (24%) and loss of vibration sense the most frequent sign (26%) in these patients. Features of diabetic retinopathy and albuminuria were present in 6/50 (12%) and 20/50 (40%) patients respectively. The presence or severity of neuropathic signs or symptoms had no statistically significant correlation to their glycemic control. There was a significant correlation of presence of neuropathy with albuminuria and retinopathy. Conclusion: The study establishes the use of m-TCNS as a simple and good screening tool to detect diabetic neuropathy. Pain and loss of vibration sense were the most common symptom and sign in DN. The severity of neuropathy was mild in this study, but had a significant correlation with other microvascular complications. We recommend all newly detected patients with diabetes to undergo screening tests for its microvascular complications.

The retinal microcirculation in migraine: The Rotterdam Study.

BackgroundTo explore the role of microvascular pathology in migraine, we investigated the association between migraine and retinal microvascular damage.MethodsWe included 3270 participants (age ≥ 45 years, 63% women) from the population-based Rotterdam Study (2006–2009). Participants with migraine were identified using a validated questionnaire based on ICHD-II criteria (n = 562). Retinopathy signs were graded on fundus photographs. Retinal arteriolar and venular caliber were measured by semi-automatic assessment of fundus photographs. Associations of migraine with retinopathy and retinal microvascular calibers were examined using logistic and linear regression models, respectively, adjusting for age, sex, and cardiovascular risk factors.ResultsMigraine was not associated with the presence of retinopathy (odds ratio (OR): 1.09, 95% confidence interval (CI) 0.62; 1.92). In the fully adjusted model, adjusting for the companion vessel, persons with migraine did not differ in retinal arteriolar or venular caliber compared to persons without migraine (mean difference in standardized arteriolar caliber −0.05 (95%CI −0.13; 0.03); in standardized venular caliber −0.00 (95%CI −0.09; 0.08)). Migraine subtypes, including migraine with aura, were also not associated with retinal microvascular damage.ConclusionsOur findings suggest that migraine is not associated with retinopathy or difference in retinal microvascular caliber. Further studies are needed to confirm these results.

Evaluation of kidney function and risk factors of retinopathy in Type 2 diabetes mellitus people in South Africa.

Diabetic retinopathy (DR) is a disease of the retina and an important microvascular complication of diabetes, frequently causing blindness in adults. The study aims to evaluate kidney function and risk factors for the development of retinopathy in Type 2 diabetes mellitus (DM) patients. A total of 140 participants (54 Type 2DM without retinopathy, 44 with DR and 42 normal, healthy controls) consented to participate in the study. Fasting plasma glucose (FPG), glycosylated haemoglobin (HbA1c), lipid profile and renal function tests were measured using routine laboratory methods. A significant increase in FPG, HbA1c, serum triglycerides (TG), serum urea, urine albumin, the urine albumin/creatinine ratio (UACR) and, a significant decrease in high-density lipoprotein cholesterol (HDL-C) was observed in DR patients, compared to controls. In multivariate logistic analysis, FPG, insulin treatment and UACR were the risk factors found to be significantly associated with the presence of retinopathy. According to the Receiver Operating Characteristic (ROC) curve analysis, the diagnostic performance of UACR≥1.45mg/mmol-1l-1 was the optimal cut-off point. A mild alteration in renal function was observed in DR patients and UACR is found to be an important risk factor and can be a valuable marker for predicting DR.

Relationship between retinal vessel diameters and retinopathy in the Inter99 Eye Study

PurposeTo examine the association between retinal vessel diameters and retinopathy in participants with and without type 2 diabetes in a Danish population-based cohort. MethodsThe study included 878 persons aged 30 to 60years from the Inter99 Eye Study. Retinopathy was defined as a presence of one or more retinal hemorrhages or one or more microaneurysms. Vessel diameters were expressed as central retinal artery equivalent diameter (CRAE) and central retinal vein equivalent diameter (CRVE). Multiple linear regression analyses were performed. ResultsAmong participants with diabetes, CRAE was 6.3µm (CI 95%: 1.0 to 11.6, p=0.020) wider and CRVE was 7.9µm (CI 95%: 0.7 to 15.2, p=0.030) wider in those with retinopathy compared to those without retinopathy, after adjusting for age, gender, HbA1c, blood pressure, smoking, serum total and HDL cholesterol. In all participants, CRAE increased with presence of retinopathy (p=0.005) and with smoking (p=0.001), and CRAE decreased with hypertension (p<0.001), high HDL cholesterol (p=0.016) and age (p<0.001). Central retinal vein equivalent diameter increased with presence of retinopathy (p=0.022) and with smoking (p<0.001), and decreased with higher HDL cholesterol (p<0.001) and age (p=0.015). Female gender was associated with wider CRVE (p=0.029). ConclusionsWider retinal vessel diameters were associated with the presence of retinopathy in participants with diabetes, but not in participants without diabetes. The associations between retinal vessel diameters and known retinopathy risk factors were confirmed. These results suggest that information obtained by non-invasive imaging of the interior of the eye can contribute to a better understanding of systemic disease processes.

Prevalence of diabetes mellitus and impaired fasting glucose among hypothyroid patients

Background: The association between autoimmune thyroid diseases and autoimmune diabetes is well established. However, the association between type 2 Diabetes and thyroid disease is unclear. Studies conducted on this topic worldwide have revealed varying results. The aims of this study were to assess the prevalence of diabetes and impaired fasting glucose in a group of hypothyroid patients in Sri Lanka and to assess the relationship between severity and etiology of hypothyroidism with diabetes and impaired fasting glucose. Method: This descriptive (prospective) study was conducted at the Endocrine clinic, Teaching Hospital, Ragama over a period of 12 months, where all the new and follow up patients with hypothyroidism (both overt and subclinical hypothyroid patients) attending the clinic during this study period were included until the sample size is achieved. Interviewer-administered questionnaire was used to obtain relevant data from the patient and from the clinic book. Fasting blood sugar was done for all patients. When FBS ≥ 100mg/dl, the test was repeated. For patients who had repeatedly elevated FBS ≥ 100mg/dl, Urine for micro albumin and serum creatinine were also checked. If the urine micro albumin was elevated, the test was repeated after 3 months. The presence of retinopathy was assessed by the ophthalmology team. Results: Majority of the study population consisted of females (91%). Mean age of the study population was 44.7 (SD – 12.1). 85.6% of the patients had overt hypothyroidism and 14.4% had subclinical hypothyroidism. The overall prevalence of diabetes mellitus among the study population was 15.6%. Prevalence of impaired fasting glucose was 31%. The prevalence of diabetes, impaired fasting glucose as well as dysglycaemia among patients with overt hypothyroidism and the subclinical hypothyroidism not significantly different (p-0.905, p-0.931, p-0.982). There was no significance difference between the etiology of hypothyroidism and in the prevalence of diabetes and impaired fasting glucose (p- 0.079, p- 0.182 respectively). None of the newly diagnosed patients with diabetes had microvascular complications. Conclusion: Overall prevalence of both overt and subclinical hypothyroidism was not associated with type 2 diabetes mellitus and the severity of hypothyroidism did not have an effect on the development of any form of hyperglycemia. There was no significant association between the etiology of hypothyroidism and in the prevalence of diabetes as well as impaired fasting glucose. Even though the age, the body mass index, the presence of hypertension and the family history were significantly associated with the development of diabetes mellitus, the gender and the sedentary lifestyle did not show a significant association with the development of diabetes in our study population.

English

Background and Objectives: Diabetic nephropathy is a dreaded complication of Type 2 diabetes mellitus. However in the early stages also known as incipient nephropathy it can be detected by the presence of microalbuminuria. The aim of our study was to know the occurrence of microalbuminuria in patients with Type 2 diabetes mellitus and to note its associations with the duration of diabetes since diagnosis and also the various macrovascular and microvascular complications of diabetes mellitus.Methods. A total of fifty randomly selected diabetic patients s atisfying the inclusion criteria were selected for the study. All patients were evaluated in detail along with the testing for microalbuminuria with dipsticks (Micral)Results: The overall occurrence of microalbuminuria was 38%. The occurrence of microalbuminuria showed a direct relationship with increasing age (p=0.053) and increasing duration of diabetes since diagnosis. An HbA1c value above 7% is associated with 50% or higher incidence of microalbuminuria (p=0.018). Patients with a body mass index of more than 25kg/m2 have significant increase in the incidence of microalbuminuria (p=0.027). The incidence of microalbuminuria is significantly associated with the presence of retinopathy (p=0.073), peripheral neuropathy (p=0.009), ischemic heart disease (p=0.011) and hypertension (p=0.001). Microalbuminuria is inversely associated with HDL (p= 0.089).Interpretation & Conclusion: The occurrence of microalbuminuria in Type 2 diabetic patients of chidambaram was quite high. During the evaluation of diabetic patients the possibility of microalbuminuria and its correlation with various complications of diabetes mellitus should be kept in mind

Associations between nocturnal urinary 6-sulfatoxymelatonin, obstructive sleep apnea severity and glycemic control in type 2 diabetes

ABSTRACTReduced nocturnal secretion of melatonin, a pineal hormone under circadian control, and obstructive sleep apnea have been both identified as risk factors for the development of type 2 diabetes mellitus. Whether they interact to impact glycemic control in patients with existing type 2 diabetes is not known. Therefore, this study explores the relationships between obstructive sleep apnea, melatonin and glycemic control in type 2 diabetes. As diabetic retinopathy may affect melatonin secretion, we also explore the relationship between retinopathy, melatonin and glycemic control. Fifty-six non-shift workers with type 2 diabetes, who were not using beta-blockers, participated. Most recent hemoglobin A1c (HbA1c) levels and the results of ophthalmologic examinations were obtained from medical records. Obstructive sleep apnea was diagnosed using an ambulatory device. Sleep duration and fragmentation were recorded by 7-day wrist actigraphy. The urinary 6-sulfatoxymelatonin/creatinine ratio, an indicator of nocturnal melatonin secretion, was measured in an overnight urine sample. Mediation analyses were applied to explore whether low nocturnal urinary 6-sulfatoxymelatonin/creatinine ratio could be a causal link between increasing obstructive sleep apnea severity [as measured by an Apnea Hypopnea Index (AHI)] and poorer glycemic control, and between the presence of retinopathy and glycemic control. AHI and HbA1c were log-scale (ln) transformed. Obstructive sleep apnea was found in 76.8%, and 25.5% had diabetic retinopathy. The median (interquartile range) of urinary 6-sulfatoxymelatonin/creatinine ratio was 12.3 (6.0, 20.1) ng/mg. Higher lnHbA1c significantly correlated with lower 6-sulfatoxymelatonin/creatinine ratio (p = 0.04) but was not directly associated with OSA severity. More severe obstructive sleep apnea (lnAHI, p = 0.01), longer diabetes duration (p = 0.02), retinopathy (p = 0.01) and insulin use (p = 0.03) correlated with lower urinary 6-sulfatoxymelatonin/creatinine ratio, while habitual sleep duration and fragmentation did not. A mediation analysis revealed that lnAHI negatively correlated with urinary 6-sulfatoxymelatonin/creatinine ratio (coefficient = −2.413, p = 0.03), and urinary 6-sulfatoxymelatonin/creatinine negatively associated with lnHbA1c (coefficient = −0.005, p = 0.02), after adjusting for covariates. Mediation analysis indicated that the effect of lnAHI on lnHbA1c was indirectly mediated by urinary 6-sulfatoxymelatonin/creatinine ratio (B = 0.013, 95% CI: 0.0006, 0.0505). In addition, having retinopathy was significantly associated with reduced nocturnal urinary 6-sulfatoxymelatonin/creatinine ratio, and an increase in HbA1c by 1.013% of its original value (B = −0.013, 95% CI: −0.038, −0.005). In conclusion, the presence and severity of obstructive sleep apnea as well as the presence of diabetic retinopathy were associated with lower nocturnal melatonin secretion, with an indirect adverse effect on glycemic control. Intervention studies are needed to determine whether melatonin supplementation may be beneficial in type 2 diabetes patients with obstructive sleep apnea.

Is There a Relation Between Serum Vitamin D Level and Microvascular Comlications in Type 2 Diabetes?

Objectives: The aim of this study was to further investigate the prevalence of Vitamin D deficiency in diabetes mellitus (DM) patients, as well as the association between hypovitaminosis D and the microvascular complications of type 2 (T2) DM. Methods: This was a cross-sectional, case-control study of 206 T2DM patients and 34 healthy control subjects. Participants were evaluated for the presence of diabetic retinopathy, nephropathy, and neuropathy. Results: The level of serum 25-hydroxyvitamin D (25(OH) D) was significantly lower in the T2DM patients (11.16±3.99 ng/mL vs. 15.58±3.16 ng/mL; p<0.05). Furthermore, 2.7% of the patients were found to have retinopathy (n=53), 3.6% had neuropathy (n=65), and 29.1% of the patients had microalbuminuria (n=60). Although serum 25(OH) D levels were significantly lower in the presence of retinopathy and neuropathy (p<0.05 for both), no significant association between Vitamin D level and microalbuminuria was found. Conclusion: An inverse relationship between the circulating 25(OH) D level and the prevalence of retinopathy and neuropathy in T2DM patients was determined. However, there was no significant association between microalbuminuria and the 25(OH) D level.

IMPACT OF RETINOPATHY SCREENINGS FOR PROSPECTIVE HEART TRANSPLANT CANDIDATES.

To determine the prevalence of retinopathy among patients undergoing heart transplantation screening and to determine the impact of this finding on eligibility for transplantation. A retrospective case series was collected to perform an institutional review of all inpatient consults for dilated eye examinations on potential heart transplant candidates over 5.5 years-from March 27, 2008 to October 10, 2014. Measured outcomes included the presence or absence of retinopathy and the effect of retinopathy, if present, on a patient's eligibility for cardiac transplantation. A total of 155 heart transplant candidates underwent bedside ophthalmologic examination as part of their heart transplant candidacy workup. Retinopathy was found in 16 (10%) of these patients: diabetic retinopathy in 13 (8.4%) and hypertensive retinopathy in 3 (1.9%). None of these patients were excluded from the transplant candidacy based on the presence of retinopathy. On bedside ophthalmologic examination, retinopathy is an uncommon finding among cardiac transplant candidates. Retinopathy did not preclude transplantation in these patients. We question the utility of the present system of bedside ophthalmic consultation of heart transplant candidates. This may not be an optimal allocation of provider resources. Further studies are warranted to determine an appropriate protocol for ocular evaluation of these patients.