SA JOURNAL OF DIABETES & VASCULAR DISEASE
ABSTRACTS
VOLUME 7 NUMBER 3 • SEPTEMBER 2010
127
Journal update: Retinopathy focus
Not a great deal of contact time was spent
on building rapport, but rather focused on
patient education about the need for eye
care and the importance of screening and
early treatment of such problems. The inter-
vention was not overly intensive (seven calls
over a six-month period) but did include
problem solving, such as where to have the
eye examination, costs and insurance costs
coverage.
Source: Jones HL, Walker EA, Schechter CB, Blanco E.
A successful behavioural intervention to increase the
rate of screening for diabetic retinopathy for inner-
city adults.
Diabetes Ed
2010;
201036
(1): 118–126.
Doi:10.1177/0145721709356116
Early retinal alterations may be use-
ful markers of diabetic microvascu-
lar complications in young type 1
diabetics
Variations in retinal microvascular geomet-
ric characteristics in young type 1 diabetics
are associated with factors such as longer
duration of diabetes, higher blood pressure,
HbA
1c
and cholesterol levels. This Austral-
ian study is the first to show specific retinal
microvascular changes in diabetic patients
without retinopathy as a predictor of future
microvascular complications.
The longer duration of diabetes was
associated with a larger arteriolar branching
angle and increasing deviation from normal
patterns. This is interesting, as an optimal
branching angle is associated with greater
efficiency in blood flow, with lower energy
demand. This efficiency is reduced when the
branching angle becomes too large.
Of interest is that female diabet-
ics have a larger arteriolar branching
angle than men, perhaps a reason for the
observation that females have a greater
risk for diabetic microvascular compli-
cations than their male counterparts.
Arterial tortuosity was associated with
raised HbA
1c
levels of above 8.5%, indica-
tive of a threshold effect with regard to this
microvascular injury. Increasing width of the
arteriole was associated with raised systo-
lic blood pressure and this may have been
due to impaired autoregulation of the small
blood vessels.
Higher cholesterol levels were associated
with changes in length-to-diameter ratio
and deviation in venular optimality suggests
that lipid levels may also have an influence
on the microvasculature in young type 1 dia-
betic patients.
The strength of this study is that it
included a large cohort (944 patients) with
a high participation rate of more than 80%.
Also all measurements were quantified
measurements of retinal microvasculature
using computer programs as opposed to
observational studies.
This study of early vascular changes
before retinopathy developed in young dia-
betics, highlights the importance of manag-
ing blood pressure, lipids and glucose levels
in younger type 1 diabetics.
Source: Sasongko MB, Wang JJ, Donaghue KC, Cheung
N, Benitez-Agurre P, Jenkins A, et al. Alterations in
retinal microvascular geometry in young type 1 diabetes.
Diabetes Care
2010;
33
(6): 1331–1336.
Long-term risk of retinopathy –
highest in younger age at onset
(5–14 years) in type 1 diabetes
While type 1 diabetic patients diagnosed
at the youngest age (0–4 years) enjoy the
longest mean duration of retinopathy-free
diabetes, this earlier advantage is lost and
after 30 years, this group has a similar risk to
the older age-of-onset group of 5–15 years.
This study from the Finnish Diabetic
Nephropathy study included more than 1
000 consecutively recruited patients with
diabetes, defined as insulin treatment within
one year, age of onset before 40 years and
C-peptide levels less than 0.3 mmol/l. Retin-
opathy was defined based on ophthalmic
records and/or fundus photographs.
The lower incidence of proliferative retin-
opathy in the age-at-onset group of 15–40
years compared to the younger group could
be explained by higher
β
-cell function, as
indicated by higher C-peptide concentra-
tions.
It is important for clinicians to note the
loss of the initial advantage of the younger
patients with regard to proliferative retin-
opathy and to ensure that these patients
undergo regular eye examinations using
fundus photography as the preferred
screening method.
Source: Hietala K, Harjutsalo V, Forsblom C, Summanen
P, Groop PH on behalf of the FinnDiane study group. Age
at onset and the risk of proliferative retinopathy in type 1
diabetes.
Diabetes Care
2010;
33
(6): 1315–1319.
Sustained reductions in retinopathy
are determined by early optimal glu-
cose control – the DCCT/EDIC study
at 10 years (adolescents and adults)
Further analyses of the EDIC retinopathy
data at 10 years have shown that prior early
glycaemic control without hypoglycaemia
is critical for reducing progression of retin-
opathy in type 1 diabetic patients. This
study compared the 10-year progression of
retinopathy in the DCCT/EDIC study in 156
adolescents and 1 211 adults for whom
retinopathy data was available.
While the number of adolescents in the
trial was small and their HbA
1c
levels were
generally higher than that of the adults over
the period of the study, the legacy effect of
intensive glucose control was not retained in
this group of patients at 10 years, compared
to the adults.
This was seen in the three-step progres-
sion of retinopathy from the DCCT close
at year four of 7.9% prevalence, to the
10-year EDIC prevalence of 40% in both
the conventionally treated and intensively
treated adolescents. This was in contrast
to the intensively treated adults who at
10 years still had lower levels of retinopa-
thy (22%) than the conventionally treated
adults (40%).
Source: White NH, Sun W, Cleary PA, Tamboriane WV,
Danis RP, Hainsworth DP, Davis MD, for the DCCT-EDIC
Research Group. Effect of prior intensive therapy in type
1 diabetes on 10-year progression of retinopathy in
the DCCT/EDIC: comparison of adults and adolescents.
Diabetes
2010;
20
: 1244–1253.
Saving vision – a successful behav-
ioural intervention for inner-city
adult diabetics
A telephonic contact programme to edu-
cate patients about diabetes and related
eye health helped motivate participants to
have a dilated fundus examination, achiev-
ing a 74% increased rate of screening in this
ethnically diverse urban population in New
York.
This programme was driven by certified
diabetes nurse educators in New York and
was conducted in both English and Span-
ish. Interestingly, the ethnic match between
nurse and patient was not a significant
factor in achieving a successful outcome,
namely a fundus examination.
