Two dilemmas of diabetes

Article Abstract:

Results are discussed from two articles in the July 1991 issue of the Archives of Internal Medicine that present data concerning the high rate of premature death among the seven million diabetics in the US. One study found high mortality (139 deaths) among a group of 759 primarily middle-aged insulin-dependent diabetics who were followed-up for between four and five years. The patients did not have signs of major kidney abnormalities and were judged at risk for coronary artery disease, the major cause of death among this patient population. A strong association was found between drug treatment for high blood pressure (hypertension) with diuretics and mortality (both overall and due to coronary causes alone). Although additional information beyond this study, which was retrospective in nature, is needed to understand these drug effects, the results are important and disturbing. The use of diuretics to control hypertension in diabetes is critically evaluated. The second study focused on nephropathy (kidney disease), the second major killer among diabetics. Significant protein loss in the urine, a predictor of future complications and mortality, was observed in 14 percent of the 966 early-onset diabetics studied. This is somewhat less alarming than the results concerning diuretics because treatments exist that can slow the development of nephropathy, which is hastened by hypertension. Unfortunately, one major treatment involves the reduction of blood pressure using drugs that inhibit angiotensin-converting enzyme (a protein essential for producing angiotensin II, which raises blood pressure); when the blood pressure of diabetics falls below certain levels, patients' vulnerability to coronary artery disease seems to increase. Attention must be paid to the ways diuretics are used in diabetes to control hypertension and to the potential effects of antihypertensives on coronary artery disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Antihypertensive drugs, Antihypertensive agents, Diuretics, editorial

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Prevalence of undiagnosed eye disease in high-risk diabetic individuals

Article Abstract:

The prevalence of eye disease was assessed among 533 patients with diabetes; 172 of these diabetic patients had never undergone an ophthalmological eye examination and were considered to be at high risk for diabetes-related eye disease. Ophthalmic examination was performed on 145 of the high-risk patients. Abnormalities of the eye were detected in 61 percent (88) of the patients. Eye disorders included: diabetic retinopathy, a disease of the retina, or inner lining of the eye; glaucoma, or increased pressure within the eye that can lead to damage of the optic nerve and blindness; and cataract, which is characterized by abnormal changes in the lens of the eye. Immediate management such as treatment, referral or follow-up was necessary in 25 of the cases of eye disorders. Thirty-five percent of the 533 diabetic patients indicated that they had seen an ophthalmologist two or more years ago, or could not recall their last visit. These clinical findings demonstrate that there is a high incidence of eye disease among diabetic patients who do not undergo routine eye examinations. Improvements must be made in the compliance or adherence of both patients and professionals to guidelines recommended for eye care in diabetic patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medical examination, Demographic aspects, Eye, Eye diseases, Eye examination

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