ABSTRACT
A District Screening and Treatment Service for diabetic retinopathy using diabetic clinic staff is described. From 1978 to 1984 a total of 1195 diabetics entered the screening programme in a district with a population of 136 700. From 1982, when laser treatment became available locally, the average number of patients from the district requiring treatment for the first time per year was 14.0 for proliferative retinopathy and 11.3 for maculopathy. The laser was also used to treat patients from two other districts and the results of treatment from all three districts are reported. Regression of new vessels was achieved in 86% of 72 patients with proliferative retinopathy but 12 of these were also seen at the regional eye centre. Visual acuity was the same or better in 79% of the 104 eyes in 76 patients treated for maculopathy. Effective treatment can be given by a trained hospital practitioner at district level. This reduces demands on the regional centre but good liaison is necessary for difficult cases.
Subject(s)
Diabetic Retinopathy/prevention & control , Laser Therapy , Adolescent , Adult , Aged , Diabetic Retinopathy/diagnosis , Diabetic Retinopathy/surgery , England , Hospitals, District , Humans , Macula Lutea , Mass Screening , Middle Aged , Outpatient Clinics, HospitalABSTRACT
Control of diabetes in a group of 82 insulin-treated diabetics was assessed by in-patient 24-hour plasma glucose profiles and haemoglobin A1 (HbA1) estimation. Thirty-two of these patients (39 per cent) had hypoglycaemia (plasma glucose less than or equal to 2 mmol/l) which was rarely associated with symptoms. Twenty-seven (61 per cent) of 44 patients who took a series of out-patient pre-prandial capillary blood samples over a three-day period had hypoglycaemia. Conventional measurements of diabetic control including fasting plasma glucose and HbA1, were lower in patients with hypoglycaemia than in those without. Rebound hyperglycaemia following hypoglycaemia was not seen and its absence was not due to diabetic autonomic neuropathy. Cortisol/creatinine ratios in early morning urine samples were similar in patients with and without nocturnal hypoglycaemia, consistent with the absence or rebound hyperglycaemia. Diabetic retinopathy was less prevalent in patients with hypoglycaemia, possibly reflecting better long-term diabetic control in this group. HbA1 concentration reflects overall blood glucose control in diabetes but near-normal levels must be interpreted with caution since they may be associated with recurrent hypoglycaemia.
