Discussion of Diabetes and the Eye and other Systemic Complications

Diabetic retinopathy is the leading cause of new cases of blindness between the ages of 20 and 74. Diabetes affects aproximately 26 million Americans with up to one-third of the cases still undiagnosed. Another 80 million Americans are pre-diabetic at risk to progress to Type II diabetes. With obesity epidemic in this country, this presages the onset of diabetes and it's sequelae.

Good diabetes care is critical for preventing or minimizing diabetic eye disease. Patients with diabetes have 50 to 80 times the elevated risk for legal blindness compare to those without it. It is estimated that between 12,000 to 24,000 Americans become legally blind as a result of diabetic retinopathy annually..

The two most serious forms of diabetic retinopathy (DR) are diabetic macular edema (100,000 cases/year) and proliferative diabetic retinopathy (40,000 new case/year). Anatomically the macula is the central part of the back of the eye where we have our most discriminating vision. Diabetic retinopathy occurs as a result of chronic hyperglycemia (elevated Blood glucose/sugar).

The hallmark sign of diabetic retinopathy is a microaneurysm formation as a result of weakened capillary integrity. Dot and Blot intraretinal hemorrhages, with lipid and protein hard exudates occur as capillary permeability increase within the retina of the eye.

New blood vessel formation (neovascularization) of the optic nerve head (the entrance of the nerve to the back of the eye) or elsewhere is an essential sign of proliferative diabetic retinopathy. These new blood vessels are fragile and can migrate into the vitreous gel of the eye where the break and bleed.

Diabetic macular edema occurs when blood vessels within the center of the back of the eye (the macula) leak serum and exudates which lead to a swelling of the macula and photoreceptor disruption.

Studies have shown that intensive diabetes management reduce the risk and progression of DR in patients. The goal is to have blood sugar levels as near normal as possible.

Cardiovascular

Cardiovascular disease is the most important complication of diabetes. Diabetes is a major risk factor for the development of cardiovascular disease. Coronary artery disease (vessels of the Heart) and cerebral vascular disease (brain) are most common. Heart failure and peripheral artery disease are also common. Adults with diabetes have heart disease mortality (death rates) that are 2 to 4 times higher than those without diabetes. The risk of stroke is 2-4 times higher with people with diabetes.

Kidney Disease

Chronic elevated blood sugar causes inflammation that can damage the kidney. Control of blood pressure, Blood lipids, and blood sugar will decrease the incidence and progression of kidney disease.

Neurologic

Studies show neuropathy is a very common complication of diabetics with 60 to 70% of American diabetics experiencing some degree of neuropathy. The most severe neuropathy occurs in patients who have been diabetic for at least 25 years.

Podiatric Complications (feet)

The root of foot problems are twofold - poor circulation and neuropathy. Neuropathy decreases sensation while poor circulation decreases the ability to heal and resist infection. Ulceration can lead to gangrene and amputation. More than 60% of lower leg amputations are related to diabetes.

Dermatological Effects

A number of changes are seen with diabetic patients. These include dry or cracked skin. Blisters that allow infections (bacterial and fungal) secondary to elevated blood sugar and compromised immune response. Early intervention will minimize complications and prevent amputation.

Oral Health

Diabetes can adversely affect small blood vessels that serve the soft tissue and bone that support the teeth. Roughly one third of the diabetics experience severe gum disease. Improvement in periodontal disease is linked to tight blood sugar control.

Gastrointestinal Disease

75% of diabetic patients report significant GI problems including difficulty swallowing, acid reflux, constipation, abdominal pain, nausea, vomiting and diarrhea. Obesity and type 2 diabetes are strongly associated with digestive tract cancers.

Mental Health

It is not surprising that those with diabetes suffer a higher incidence of depression, anxiety, schizophrenia, and dementia. Depression is two to three times more common in people with diabetes. Many studies have shown that their is increased risk of dementia with the presence of obesity. Other studies reveal a strong association of diabetes and Alzheimer's disease.

In Summary we can see the implications of uncontrolled or poorly controlled diabetes can be devastating on one's vision and overall health. I cannot overemphasize the importance of diet, exercise, and taking one's medications as directed. There is a team approach to maintaining good health and minimizing the adverse consequences of diabetes. My hope is to motivate you to exercise and watch what you eat.