Retinal haemodynamics in individuals with well-controlled type 1 diabetes.

AIMS/HYPOTHESIS: Abnormalities in retinal haemodynamics have been reported in patients with type 1 diabetes in advance of clinical retinopathy. These abnormalities could therefore be useful as early markers or surrogate endpoints for studying the microangiopathy. Since the DCCT, the increased focus on good glycaemic control is changing the natural history of diabetic retinopathy. Based on this, the aim of this study was to investigate whether patients with type 1 diabetes treated entirely or mostly in the post-DCCT era and tested in the absence of confounding factors show retinal haemodynamic abnormalities. METHODS: We measured retinal haemodynamics by laser Doppler flowmetry in 33 type 1 diabetic individuals with no or minimal retinopathy (age 30+/-7 years, duration of diabetes 8.8+/-4.6 years, 9% showing microaneurysms), and 31 age- and sex-matched non-diabetic controls. The study participants were not taking vasoactive medications, and blood glucose at the time of haemodynamic measurements was required to be between 3.8 and 11.1 mmol/l. RESULTS: HbA1c was 7.5+/-1.2% and blood glucose 7.7+/-2.8 mmol/l in these type 1 diabetic individuals, indicating relatively good glycaemic control. Retinal blood speed, arterial diameter and blood flow were not different between the diabetic individuals and the matched controls. CONCLUSIONS/INTERPRETATION: Type 1 diabetic patients with no or minimal retinopathy who maintain relatively good glycaemic control do not show abnormalities of the retinal circulation at steady state, even after several years of diabetes. In such patients it may be necessary to test the vascular response to challenges to uncover any subtle abnormalities of the retinal vessels.

Hematopoietic growth factors in clinical practice.

OBJECTIVE: To review the hematopoietic growth factors (HGFs) as they relate to hematopoiesis, dosing, administration, toxicities and clinical indications. DATA SOURCES: Research studies, abstracts, review articles, product package inserts, and book chapters pertaining to HGFs. CONCLUSIONS: HGFs are essential components for the development of blood cells. Recombinant DNA technology and the availability of HGFs have significantly altered the care of patients with cancer and bone marrow disorders. IMPLICATIONS FOR NURSING PRACTICE: Nurses can play a major role in assisting patients, families, and various consumers by providing education about HGFs as well as their indications, schedule, methods of administration, and toxicities. Familiarity with the HGFs and the literature available can assist nurses in developing management strategies for patients receiving these agents.