Prevalence of Diabetic Retinopathy [ role of BP & glycemic control ] In Diabetic patients cared for at the Family Care Center at RCRMC Kam Chan, DO

Background Estimated 18.2 million Americans and one in 20 world-wide lives with diabetes Type II Diabetes account for 90% of total cases in the US Diabetic Retinopathy is the most frequent cause of new cases of blindness in diabetic patients aged 20-74 years in the US

Diabetic Retinopathy Background Retinopathy - microaneurysm formation, capillary leakage causing dot blot hemorrhage & hard exudates Pre-proliferative retinopathy - cotton-wool spots due to infarction of retinal nerve fiber layers and venous beading Proliferative retinopathy { PDR } growth of new blood vessels from the optic nerve head OR posterior surface of vitreous

Diabetic Retinopathy

NON PROLIFERATIVE RETINOPATHY

PROLIFERATIVE RETINOPATHY

ASSOCIATED RISK FACTORS Duration / Onset age Glycemic control Renal disease Systemic HTN Hyperlipidemia Pregnancy

RETINOPATHY vs DURATION TYPE I diabetes < 5 years - 17%  5 - 10 years - 74%  > 15 years - 98% TYPE II diabetes 0 - 10% 0 - 5 years - 29% > 15 years - 78%

Data TOTAL # of SUBJECTS = 133 Approx. 70% of patients were Hispanic Age range - 31-85 years Mean age = 57 +/- 8 years 68% females

50% patients had some type of eye disorder 26% with diabetic retinopathy 9% with PDR 17% with NPDR   9% cases – cataract alone 2% glaucoma alone 2% both 4 cases NPDR + cataract

Impact of uncontrolled HTN No of patients Percent of Total N = 133 subjects

No of patients PDR NPDR No Retinopathy

A1c N=12 N=23 N= 98

Prevalence of retinopathy in patients with different presenting BP Diabetes and Diabetic Retinopathy in a Mexican-American Population Proyecto VER Sheila K. West, PHD1, Ronald Klein, MD2, Jorge Rodriguez, MD, MPH3, Beatriz Muñoz, MS1, Aimee T. Broman, MS1, Rosario Sanchez, MD, MPH1 and Robert Snyder, MD, PHD 3  <140 159 15.1  140–160 28 14.3  >160 9 33.3 Prevalence of retinopathy in patients with different presenting BP

CONCLUSION The prevalence of diabetic patients with retinopathy in our clinic is 26% Tighter control of BP will have immense impact on the progression of retinopathy More effort should be placed in making sure all diabetics obtain eye exams This study will help provide a reference point for implementing changes toward improved therapy

Bibliography 1. Fong, DS et. al. Diabetic retinopathy. Diabetes Care. 2003 Jan; 26(1): 226-9. Review 2. Tooke, JE. Possible pathophysiological mechanisms for diabetic angiopathy in type 2 diabetes.J Diabetes Complications. 2000 Jul-Aug; 14(4): 197-200. Review 3. Klein R, et al: The Wisconsin Epidemiologic Study of Diabetic Retinopathy. II.Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol 102:520–526, 1984 4. UK Prospective Diabetes Study Group: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 317:708–713, 1998 5. Estacio RO et al: Effect of blood pressure control on diabetic microvascular complications in patients with hypertension and type 2 diabetes. Diabetes Care 23 (Suppl. 2):B54–B64, 2000 Sheila K. West, et al. Diabetes and Diabetic Retinopathy in a Mexican-American Population: Proyecto VER Diabetes Care 2001 24: 1204-1209 9. Harris MI, et al: Is the risk of diabetic retinopathy greater in non-Hispanic blacks and Mexican Americans than in non-Hispanic whites with type 2 diabetes? A U.S. population study. Diabetes Care 21:1230–1235, 1998