To Evaluate The Incidence Of Diabetic Retinopathy In Newly Diagnosed Diabetic Patients Presented At Tertiary Care Hospital

Background:Diabetes mellitus is defined as metabolic disorder of multiple etiologies characterized by chronic hyperglycemia with disturbances of carbohydrate, protein and fat metabolism resulting from defects in insulin secretion, insulin action, or both. It occurs in two forms: Insulin dependent diabetes mellitus and Non –insulin dependent diabetes mellitus1. This disease results in generalized macrovascular and microvascular complication directly affects kidneys, eyes, peripheral nerves and heart. The incidence of diabetes retinopathy in Indian population was 21.7%. Material And Methods:In this cross sectional study all the patients attending eye OPD and indoor patients at tertiary eye care were screen for eligibility. Total of 150 patients were included in the study for duration of 28 months. Detail history including hypertension and other systemic illness was asked. Best corrected visual acuity was taken after refraction. Anterior segment examination was done with slit lamp, specially looking for rubeosis iridis, pupillary reaction and type of lens opacity. Statistical analysis was done using Z test, unpaired T test and chi-square test with the help of software and methods. Result: Patients with type 2, diabetes have more incidence of developing diabetic retinopathy thanpatients with type 1. Hypertension was more commonly associated disease than other systemic illness. Diabetic retinopathy is more prevalent in patients with higher FBS and HB1Ac.Conclusion:The frequency of retinopathy is more common in patients with high blood sugar profile. Hypertension is more commonly associated with diabetes than other systemic illness.

Change in HbA1c among filipino diabetic patients who shifted from multiple daily injection to continuous subcutaneous insulin infusion: A retrospective cohort study

Introduction@#Insulin delivered by multiple daily injection (MDI), for a time, has been considered to be the most physiologic among the different insulin regimen. Among patients on MDI, there is still a significant proportion who remains uncontrolled. Continuous subcutaneous insulin infusion (CSII) or insulin pump has been shown to benefit some patients who are still uncontrolled despite intensive insulin therapy with MDI. Currently, there is little information on the use of insulin pump in the Philippines. The researchers aim to determine the change in HbA1c and the proportion of patients with HbA1c of <8% after shifting from MDI to CSII. To correlate the change in HbA1c with age and baseline HbA1c. To compare the change in HbA1c between gender, type of diabetes and type of bolus regimen.@*Methods@#This is a retrospective cohort analytical study of 33 adult patients with type 1 or type 2 diabetes mellitus (DM), switched from MDI to insulin pump. Chart review was done to obtain data on age, gender, type of bolus, baseline HbA1c and HbA1c six to twelve months after switching insulin pump initiation. The change in HbA1c was correlated with baseline HbA1c and age. Mean change in HbA1c was also compared between gender, type of bolus and type of diabetes.@*Results@#Mean HbA1c prior to switching to insulin pump was 10±1.7. The HbA1c reduction was 1.86±1.6 (p<0.001, CI 1.38-2.34), resulting to a mean final A1c of 8.1±1.2 after CSII initiation. Seventeen out of 33 patients (52%) achieved an average HBA1c of <8%. A positive correlation was observed between HBA1c reduction and baseline HbA1c (r =0.738, p<0.001) but not with age (r = -0.002, p=0.99). There was no significant difference in the HbA1c reduction between male and female (p=0.353), Type 1 DM and Type 2 DM (p=0.133), and those that used fixed bolus vs bolus calculator (p=0.559). The reduction in A1c remains significant when analyzed as individual subgroups: 2.1±2.3 (p=0.001) in males; 1.6±1.0 (p<0.001) in females; 1.5±1.6 (p=0.001) in type 1; 2.3±1.6 (p<0.001) in type 2; 2.1±1.5 (p<0.001) in bolus calculator, and 1.7±1.8 (p<0.001) in fixed bolus group.@*Conclusion@#There is significant reduction in HbA1c among this cohort of Filipino diabetic patients after switching from MDI to CSII. While majority of patients had >1% reduction, achieving an ideal goal of <7% remains to be a challenge. Greater HbA1c reduction are seen in patients with higher baseline HbA1c. There is no significant difference in the reduction in HbA1c with respect to gender, type of diabetes and type of bolus used.

Prognostic Factors of Neovascular Glaucoma in Eyes with Treated Proliferative Diabetic Retinopathy

PURPOSE: To evaluate the factors that are significant in progression to neovascular glaucoma in patients with proliferative diabetic retinopathy. METHODS: In this retrospective analysis, we reviewed the medical records of 52 patients who were first diagnosed with proliferative diabetic retinopathy from March 2014 to March 2016. We compared diabetes mellitus period, HbA1c, chronic diseases such as hypertension, hyperlipidemia, and kidney disease, insulin treatments, blood urea nitrogen, blood creatinine, glomerular filtration rate, urine albumin, dialysis, corrected visual acuity at the first visit, traction membrane sign of the retina at the first visit, vitreous hemorrhage and preretinal hemorrhage in each group and then investigated the prognostic factors of neovascular glaucoma. RESULTS: A total of 52 patients were included in the investigation, 12 patients (23.08%) were diagnosed with iris neovascularization and 4 patients (7.69%) developed neovascular glaucoma. The patients without iris neovascularization were defined as Group I, those with iris neovascularization as Group II, and those with neovascular glaucoma as Group III. The diabetes mellitus period was significantly longer in Group II (10.88 ± 7.14 years) and in Group III (11.75 ± 8.61 years) than Group I (8.30 ± 5.25 years) (p-value 0.41, 0.032, respectively). The HbA1c level was 9.59 ± 2.23 in Group II and 9.27 ± 2.54 in Group I. There was no significant difference between the two groups (p = 0.721). However, HbA1c was significantly higher in Group III (11.55 ± 0.21) than Group I (p-value 0.048). CONCLUSIONS: A long diabetes mellitus period and high HbA1c level have a significant effect on the progression to neovascular glaucoma in patients with proliferative diabetic retinopathy. This information could be useful for predicting and preventing the prognosis of patients.