scholarly journals The Safety of Pharmacological and Surgical Treatment of Diabetes in Patients with Diabetic Retinopathy—A Review

2021 ◽  
Vol 10 (4) ◽  
pp. 705
Author(s):  
Wojciech Matuszewski ◽  
Angelika Baranowska-Jurkun ◽  
Magdalena Maria Stefanowicz-Rutkowska ◽  
Katarzyna Gontarz-Nowak ◽  
Ewa Gątarska ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Surgical Treatment ◽  
World Literature ◽  
Vision Loss ◽  
Modern World ◽  
Diabetic Patients ◽  
Surgical Methods ◽  
Treatment Of Diabetes ◽  
Diabetic Population ◽  
Islet Transplants

Background. Diabetes mellitus (DM) is a non-infectious pandemic of the modern world; it is estimated that in 2045 it will affect 10% of the world’s population. As the prevalence of diabetes increases, the problem of its complications, including diabetic retinopathy (DR), grows. DR is a highly specific neurovascular complication of diabetes that occurs in more than one third of DM patients and accounts for 80% of complete vision loss cases in the diabetic population. We are currently witnessing many groundbreaking studies on new pharmacological and surgical methods of treating diabetes. Aim. The aim of the study is to assess the safety of pharmacological and surgical treatment of DM in patients with DR. Material and methods. An analysis of the data on diabetes treatment methods currently available in the world literature and their impact on the occurrence and progression of DR. Results. A rapid decrease in glycaemia leads to an increased occurrence and progression of DR. Its greatest risk accompanies insulin therapy and sulfonylurea therapy. The lowest risk of DR occurs with the use of SGLT2 inhibitors; the use of DPP-4 inhibitors and GLP-1 analogues is also safe. Patients undergoing pancreatic islet transplants or bariatric surgeries require intensive monitoring of the state of the eye, both in the perioperative and postoperative period. Conclusions. It is of utmost importance to individualize therapy in diabetic patients, in order to gradually achieve treatment goals with the use of safe methods and minimize the risk of development and progression of DR.

scholarly journals Plasma microRNA signature associated with retinopathy in patients with type 2 diabetes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Donato Santovito ◽  
Lisa Toto ◽  
Velia De Nardis ◽  
Pamela Marcantonio ◽  
Rossella D’Aloisio ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Retinopathy ◽  
Vision Loss ◽  
External Validation ◽  
Diabetic Patients ◽  
Disease Biomarkers ◽  
Response To Stress ◽  
Severity Of The Disease ◽  
Plasma Microrna

AbstractDiabetic retinopathy (DR) is a leading cause of vision loss and disability. Effective management of DR depends on prompt treatment and would benefit from biomarkers for screening and pre-symptomatic detection of retinopathy in diabetic patients. MicroRNAs (miRNAs) are post-transcriptional regulators of gene expression which are released in the bloodstream and may serve as biomarkers. Little is known on circulating miRNAs in patients with type 2 diabetes (T2DM) and DR. Here we show that DR is associated with higher circulating miR-25-3p (P = 0.004) and miR-320b (P = 0.011) and lower levels of miR-495-3p (P < 0.001) in a cohort of patients with T2DM with DR (n = 20), compared with diabetic subjects without DR (n = 10) and healthy individuals (n = 10). These associations persisted significant after adjustment for age, gender, and HbA1c. The circulating levels of these miRNAs correlated with severity of the disease and their concomitant evaluation showed high accuracy for identifying DR (AUROC = 0.93; P < 0.001). Gene ontology analysis of validated targets revealed enrichment in pathways such as regulation of metabolic process (P = 1.5 × 10–20), of cell response to stress (P = 1.9 × 10–14), and development of blood vessels (P = 2.7 × 10–14). Pending external validation, we anticipate that these miRNAs may serve as putative disease biomarkers and highlight novel molecular targets for improving care of patients with diabetic retinopathy.

scholarly journals Utilization of diabetic retinopathy screening among diabetic patients at a tertiary care hospital in Kerala, India

2021 ◽  
Vol 8 (10) ◽  
pp. 4938
Author(s):  
Sona Sabitha Kumar ◽  
Lathika Vasu Kamaladevi ◽  
Sruthi Mankara Valsan
Keyword(s):  
Diabetic Retinopathy ◽  
Vision Loss ◽  
Adult Population ◽  
Tertiary Care ◽  
Health Concern ◽  
Diabetic Patients ◽  
Care Hospital ◽  
Screening Programs ◽  
Diabetic Retinopathy Screening ◽  
Retinopathy Screening

Background: Diabetes is a major public health concern that affects nearly 463 million (9.3%) of global adult population. Diabetic retinopathy, which affects around 35% of all diabetic patients, is the fifth leading cause of preventable global blindness. This study was done to determine the status of diabetic retinopathy screening and the factors that influence its uptake among diabetic patients attending a tertiary care setting in Kerala, India.Methods: 200 patients with diabetes mellitus on physician care were enrolled for a questionnaire-based survey which collected information on patient demographics, education, occupation, patient’s awareness of retinopathy, screening, diabetic blindness and their source of such knowledge.Results: 83% were aware that diabetes can result in vision loss. 61% were aware that diabetic blindness is preventable. 42% patients were aware of screening options for retinopathy. The awareness of retinopathy screening was significantly associated (p=0.0001) only with duration of diabetes.Conclusions: Awareness of diabetic retinopathy among diabetic patients in Kerala was sub optimal. Better patient education and use of mass media can increase awareness on diabetes retinopathy screening programs. 

scholarly journals Reduction of Glut1 in retinal neurons but not the RPE alleviates polyol accumulation and normalizes early characteristics of diabetic retinopathy

2020 ◽  
Author(s):  
Nicholas C. Holoman ◽  
Jacob J. Aiello ◽  
Timothy D. Trobenter ◽  
Matthew J. Tarchick ◽  
Michael R. Kozlowski ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Diabetic Retinopathy ◽  
Aldose Reductase ◽  
Glucose Transporter ◽  
Vision Loss ◽  
Significant Proportion ◽  
Diabetic Patients ◽  
Retinal Neurons ◽  
Anti Vegf ◽  
Facilitative Glucose Transporter

AbstractHyperglycemia is a key determinant for development of diabetic retinopathy (DR). Inadequate glycemic control exacerbates retinopathy, while normalization of glucose levels delays its progression. In hyperglycemia, hexokinase is saturated and excess glucose is metabolized to sorbitol by aldose reductase via the polyol pathway. Therapies to reduce retinal polyol accumulation for the prevention of DR have been elusive due to low sorbitol dehydrogenase levels in the retina and inadequate inhibition of aldose reductase. Using systemic and conditional genetic inactivation, we targeted the primary facilitative glucose transporter in the retina, Glut1, as a preventative therapeutic in diabetic male and female mice. Unlike wildtype diabetics, diabetic Glut1+/− mice did not display elevated Glut1 levels in the retina. Furthermore, diabetic Glut1+/− mice exhibited ameliorated ERG defects, inflammation and oxidative stress, which was correlated with a significant reduction in retinal sorbitol accumulation. RPE-specific reduction of Glut1 did not prevent an increase in retinal sorbitol content or early hallmarks of DR. However, like diabetic Glut1+/− mice, reduction of Glut1 specifically in retinal neurons mitigated polyol accumulation and completely prevented retinal dysfunction and the elevation of markers for oxidative stress and inflammation associated with diabetes. These results suggest that modulation of retinal polyol accumulation via Glut1 in photoreceptors can circumvent the difficulties in regulating systemic glucose metabolism and be exploited to prevent DR.SignificanceDiabetic retinopathy (DR) affects one third of diabetic patients and is the primary cause of vision loss in adults aged 20-74. While anti-VEGF and photocoagulation treatments for the late-stage vision threatening complications can prevent vision loss, a significant proportion of patients do not respond to anti-VEGF therapies and mechanisms to stop progression of early-stage symptoms remain elusive. Glut1 is the primary facilitative glucose transporter for the retina. We determined that a moderate reduction in Glut1 levels, specifically in retinal neurons, but not the RPE, was sufficient to prevent retinal polyol accumulation and the earliest functional defects to be identified in the diabetic retina. Our study defines modulation of Glut1 in retinal neurons as a targetable molecule for prevention of DR.

scholarly journals Screening for Diabetic Retinopathy in Endocrinology Clinics by Using Handheld Cameras and Applying Artificial Intelligence Algorithms

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A419-A420
Author(s):  
Zack Dvey-Aharon ◽  
Petri Huhtinen
Keyword(s):  
Artificial Intelligence ◽  
Diabetic Retinopathy ◽  
Vision Loss ◽  
Ground Truth ◽  
World Health ◽  
Diabetic Patients ◽  
Early Screening ◽  
Exclusion Criteria ◽  
Fundus Camera ◽  
The World

Abstract According to estimations of the World Health Organization (WHO), there are almost 500M people in the world that suffer from diabetes. Projections suggest this number will surpass 700M by 2045 with global prevalence surpassing 7%. This huge population, alongside people with pre-diabetics, is prone to develop diabetic retinopathy, the leading cause of vision loss in the working age. While early screening can help prevent most cases of vision loss caused by diabetic retinopathy, the vast majority of patients are not being screened periodically as the guidelines instruct. The challenge is to find a reliable and convenient method to screen patients so that efficacy in detection of referral diabetic retinopathy is sufficient while integration with the flow of care is smooth, easy, simple, and cost-efficient. In this research, we described a screening process for more-than-mild retinopathy through the application of artificial intelligence (AI) algorithms on images obtained by a portable, handheld fundus camera. 156 patients were screened for mtmDR indication. Four images were taken per patient, two macula centered and two optic disc centered. The 624 images were taken using the Optomed Aurora fundus camera and were uploaded using Optomed Direct-Upload. Fully blinded and independently, a certified, experienced ophthalmologist (contracted by Optomed and based in Finland) reviewed each patient to determine ground truth. Indications that are different than mtmDR were also documented by the ophthalmologist to meet exclusion criteria. Data was obtained from anonymized images uploaded to the cloud-based AEYE-DS system and analysis results from the AI algorithm were promptly returned to the users. Of the 156 patients, a certified ophthalmologist determined 100% reached sufficient quality of images for grading, and 36 had existing retinal diseases that fall under exclusion criteria, thus, 77% of the participants met the participation criteria. Of the remaining 120 patients, the AEYE-DS system determined that 2 patients had at least one insufficient quality image. AEYE-DS provided readings for each of the 118 remaining patients (98.3% of all patients). These were statistically compared to the output of the ground truth arm. The patient ground truth was defined as the most severe diagnosis from the four patient images; the ophthalmologist diagnosed 54 patients as mtmDR+ (45% prevalence). Of the 54 patients with referable DR, 50 were diagnosed and of the 64 mtmDR- patients, 61 were correctly diagnosed by the AI. In summary, the results of the study in terms of sensitivity and specificity were 92.6% and 95.3%, respectively. The results indicated accurate classification of diabetic patients that required referral to the ophthalmologist and those who did not. The results also demonstrated the potential of efficient screening and easy workflow integration into points of care such as endocrinology clinics.

scholarly journals Accuracy Enhancement of Diabetic Retinopathy Detection Using Naive Bayes Algorithm

2021 ◽  
Vol 9 (VII) ◽  
pp. 3648-3652
Author(s):  
Mithileshkumar Yadav
Keyword(s):  
Diabetic Retinopathy ◽  
Vision Loss ◽  
Naive Bayes ◽  
Naïve Bayes ◽  
Automated System ◽  
Diabetic Patients ◽  
Detection Accuracy ◽  
Monitoring Model ◽  
Bayes Algorithm ◽  
Retinal Fundus

Diabetic retinopathy (DR) is a disease of eye which is caused by diabetes. Sometime the DR leads the diabetic patients to complete vision loss. In this scenario, early identification of DR is more essential to protect the eyesight and provide help for timely treatment. The detection of DR can be done manually by ophthalmologists and can also be done by an automated system. An ophthalmologist is required to analyze and explain retinal fundus images in the manual system, which is a time consuming and very expensive task. While, In the automated system, artificial intelligence is used to perform an significant role in the area of ophthalmology and specifically in the early detection of DR over the traditional detection approaches. Recently, numerous advanced studies related to the identification of DR have been reported, But still research for accurate detection of DR is going on. In this paper, a new diabetic retinopathy monitoring model is proposed by using the Naive Bayes method to improve the accuracy of detection of DR. The model is trained on mixture of two datasets Messidor and Kaggle, and evaluated on the Messidor dataset. By using proposed method detection accuracy is found to be higher than existing methods.

scholarly journals An Effective Method for Detecting and Classifying Diabetic Retinopathy Lesions Based on Deep Learning

2021 ◽  
Vol 2021 ◽  
pp. 1-13
Author(s):  
Abdüssamed Erciyas ◽  
Necaattin Barışçı
Keyword(s):  
Diabetic Retinopathy ◽  
Deep Learning ◽  
Transfer Learning ◽  
Vision Loss ◽  
Diabetic Patients ◽  
Disease Detection ◽  
Early Vision ◽  
Second Stage ◽  
22Nd Century ◽  
Harmful Effects

Diabetic retinopathy occurs as a result of the harmful effects of diabetes on the eyes. Diabetic retinopathy is also a disease that should be diagnosed early. If not treated early, vision loss may occur. It is estimated that one third of more than half a million diabetic patients will have diabetic retinopathy by the 22nd century. Many effective methods have been proposed for disease detection with deep learning. In this study, unlike other studies, a deep learning-based method has been proposed in which diabetic retinopathy lesions are detected automatically and independently of datasets, and the detected lesions are classified. In the first stage of the proposed method, a data pool is created by collecting diabetic retinopathy data from different datasets. With Faster RCNN, lesions are detected, and the region of interests are marked. The images obtained in the second stage are classified using the transfer learning and attention mechanism. The method tested in Kaggle and MESSIDOR datasets reached 99.1% and 100% ACC and 99.9% and 100% AUC, respectively. When the obtained results are compared with other results in the literature, it is seen that more successful results are obtained.

Closed Ankle Fractures in the Diabetic Patient

2000 ◽  
Vol 21 (4) ◽  
pp. 311-319 ◽  
Author(s):  
John M. Flynn ◽  
Felix Rodriguez-del Rio ◽  
Pedro A. Pizá
Keyword(s):  
Diabetic Patient ◽  
Medical Literature ◽  
Diabetic Group ◽  
Ankle Fractures ◽  
Diabetic Patients ◽  
Team Approach ◽  
Foot And Ankle ◽  
Risk Of Infection ◽  
Surgical Methods ◽  
Diabetic Population

Systemic and local manifestations of diabetes mellitus may complicate the treatment of ankle fractures in the diabetic population. We studied 98 patients (73 non-diabetics and 25 diabetics) who were treated for closed ankle fractures by either surgical or non-surgical methods. We found that overall, the risk of infection in the diabetic population (32%) was 4 times higher than in the non-diabetic population (8%). The infection rate in the diabetic group treated surgically more than doubled that in the non-diabetic group. Four out of six diabetic patients treated with cast became infected compared to no infections in the five non-diabetics treated with a cast. Even though the diabetic foot and ankle are well studied, the medical literature is not conclusive regarding the management of ankle fractures in the diabetic patient. Diabetic patients treated conservatively had a tendency to become infected over those treated surgically. Peripherovascular disease, peripheral neuropathy and swelling and/or echymosis increased the risk of infection in the diabetic population. Diabetic patients with poor compliance had a tendency to become infected more than those who were compliant. We concluded that the diabetic patient who is poorly compliant with evidence of neuropathic disease, peripherovascular disease and severe swelling and echymosis presents the most difficult group to manage. Although these patients are poor surgical candidates, they are also the most difficult to manage and also most prone to infection and complications if treated conservatively. When faced with this difficult scenario a multidisciplinary team approach would probably yield the best possible results by early identification and intervention in these patients.

scholarly journals Retinal Complications in Diabetes Mellitus: Importance of Screening and Management

PRILOZI ◽  
2014 ◽  
Vol 35 (3) ◽  
pp. 167-173
Author(s):  
Milena Golubovik
Keyword(s):  
Diabetic Retinopathy ◽  
Systemic Risk ◽  
Vision Loss ◽  
Developed Countries ◽  
Diabetic Patients ◽  
Common Cause ◽  
Time Expenditures ◽  
Method Analysis ◽  
Retinal Complications

AbstractIntroduction: Diabetic retinal complications are the most common cause of reduced visual acuity in persons aged 25 to 75 years. However, vision loss can be prevented or delayed if the changes are seen on time.Aim: By analyzing literature data to create an algorithm for careful follow-up of diabetic patients, which would prevent progression of the changes and development of conditions leading to blindness. At the same time, this paper presents certain changes of the eye fundus and mode of their treatment.Material and method: Analysis of studies published on diabetic retinopathy and screening conducted in developed countries, with creating an algorithm for follow-up of diabetic retinal changes and their management.Conclusion: Timely detection and treatment of diabetic retinopathy with application of protocols in developed countries as well as parallel correction of systemic risk factors for progression of diabetic retinopathy will reduce the possibility of visual impairment in diabetics due to retinal complications. At the same time expenditures related to more complicated and less effective surgical procedures will be reduced along with the societal concern.

scholarly journals Epidemiology and Risk Factors in Diabetic Retinopathy and Diabetic Macular Edema

2018 ◽  
pp. 89-93
Keyword(s):  
Risk Factors ◽  
Diabetic Retinopathy ◽  
Genetic Factors ◽  
Vision Loss ◽  
Diabetic Patients ◽  
Modifiable Risk Factors ◽  
Oral Antidiabetics ◽  
Lipid Metabolism Disorders ◽  
Prevalence Of Diabetes Mellitus ◽  
Timely Treatment

With the increased prevalence of diabetes mellitus, prolonged life-span, and the use of insulin and oral antidiabetics, diabetic retinopathy has become one of the leading causes of loss of vision in many countries. By 2013, the number of diabetic patients in the world is 382 million, but it is predicted that this number will reach 592 million in 2035 by an increase of 55%. The risk factors which are related to diabetic retinopathy are diabetes duration, hyperglycemia, hypertension, lipid metabolism disorders, genetic factors, puberty, and pregnancy. In diabetic cases, the risk of vision loss can be significantly reduced with the control of modifiable risk factors, regular eye examinations, and timely treatment.

scholarly journals Natural History of Diabetic Retinopathy Through Retrospective Analysis in Type 2 Diabetic Patients—An Exploratory Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Mehak Gupta ◽  
Amarjeet Singh ◽  
Mona Duggal ◽  
Ramandeep Singh ◽  
Sanjay Bhadada ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Natural History ◽  
Medical Records ◽  
Vision Loss ◽  
Adult Population ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
History Of ◽  
Type 2 Diabetic

Background and Aims: Diabetic retinopathy is the most common diabetes-associated microvascular complication and is among the leading causes of vision loss or blindness in the adult population. The present study is a retrospective study that reported the natural history of diabetic retinopathy.Methods: Retrospective medical records of 170 patients aged &gt; 20 years with a confirmed complication of diabetic retinopathy were recruited into the present study. A questionnaire was also sent to each subject for gathering their experiences, and verification was done by the attending medical physicians. The questionnaire was answered by all recruited patients.Results: The results showed that 23 (13.5%) subjects have a family history of diabetic retinopathy with 10 (5.9%) having mild NPDR, 63 (37.1%) with moderate NPDR, 60 (25.3%) have severe NPDR while 37 (21.8%) have PDR complications. The presence of co-morbidities was found in 139 (81.8%) subjects. Patients with PDR reported a significantly longer duration of diabetes mellitus with worse glycemic control.Conclusions: The study revealed and concluded that adherence to the prescribed management regimen is important, for which patient education was the key which was lacking.

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