Ocular Disease, Knowledge and Technology Applications in Patients With Diabetes

doi:10.1097/MAJ.0b013e31828aa6fb

The American Journal of the Medical Sciences

Volume 345, Issue 4, April 2013, Pages 266-270

https://doi.org/10.1097/MAJ.0b013e31828aa6fb Get rights and content

Abstract

An estimated 25.8 million children and adults in the United States, approximately 8.3% of the population, have diabetes. Diabetes prevalence varies by race and ethnicity. African Americans have the highest prevalence (12.6%), followed closely by Hispanics (11.8%), Asian Americans (8.4%) and whites (7.1%). The purpose of this article was to discuss the ocular complications of diabetes, the cultural and racial differences in diabetes knowledge and the role of telemedicine as a means to reach the undeserved who are at risk of complications. Information on the pathophysiology of ocular disease in patients with diabetes and the role of telemedicine in diabetes care was derived from a literature review. National Institutes of Health online resources were queried to present data on the racial and cultural understandings of diabetes and diabetes-related complications. The microvascular ocular complications of diabetes are discussed for retinopathy, cataracts, glaucoma and ocular surface disease. Racial and cultural differences in knowledge of recommended self-care practices are presented. These differences, in part, may explain health disparities and the increased risk of diabetes and its complications in rural minority communities. Finally, advances in telemedicine technology are discussed that show improvements in metabolic control and cardiovascular risk in adults with type 2 diabetes. Improving provider and patient understanding of diabetes complications may improve management and self-care practices that are important for diabetes control. Telemedicine may improve access to diabetes specialists and may improve self-management education and diabetes control particularly in rural and underserved communities.

Section snippets

THE DIABETES EPIDEMIC

An estimated 25.8 million children and adults in the United States, approximately 8.3% of the population, have diabetes. Of the 25.8 million, 7 million people are suspected to be undiagnosed with an additional 79 million people living with prediabetes.¹ Diabetes prevalence varies across ethnicities and communities. African Americans have the highest prevalence (12.6%), followed closely by Hispanics (11.8%), Asian Americans (8.4%), and whites (7.1%).¹ This article discusses 3 related areas of

Retinopathy

Diabetic retinopathy is the leading cause of blindness among adults aged 20 to 74 in the United States. The prevalence of diabetic retinopathy is especially high, with more than 90% of patients with type 1 diabetes and at least 60% of patients with type 2 diabetes having some degree of retinopathy 20 years after diagnosis.⁶ Both type 1 and type 2 diabetes are associated with retinal microvascular changes. Long-standing hyperglycemia contributes to vascular endothelial dysfunction, resulting in

LIMITING FACTORS IN PATIENTS UNDERSTANDING OF DIABETES AND OCULAR HEALTH

While medical personnel may understand the ocular complications of diabetes, knowledge of diabetes and related complications among people with diabetes is less clear. Furthermore, lack of knowledge by patients with diabetes may represent a barrier to appropriate and important preventive examinations. To better understand the knowledge, attitudes and perceptions of patients with diabetes, the National Eye Health Education Program and the National Eye Institute collaborated to assess individuals

CURRENT ROLE OF TELEMEDICINE

Telemedicine (telecommunication for diagnostic and therapeutic intervention) is proving itself as a useful tool in the future of medicine, particularly in rural communities with limited access to specialists. For example, one study using teleophthalmology to detect diabetic retinopathy in Canada showed that telemedicine benefits rural communities by decreasing time to treatment, allowing patients to be followed remotely, and prevented unnecessary referrals.²⁰ Other studies evaluating the

THE FUTURE OF TELEMEDICINE

A study conducted in rural South Carolina was the first of its kind to conduct a clinical trial to evaluate a remote comprehensive DSME intervention that included a remote retinal assessment. The study was set in an underserved and rural community, which was primarily African American. To improve adherence to American Diabetes Association guidelines, a registered dietitian and a nurse certified diabetes educator conducted the DSME intervention. The remote DSME intervention was implemented as a

CONCLUDING REMARKS

The microvascular complications of diabetes may affect several ocular structures including the cornea, lens and retina as well as ocular function such as vision and intraocular pressure. The role of telemedicine to facilitate, prevent and treat diabetes and ocular diseases is evolving. Telemedicine may efficiently and effectively improve diabetes knowledge and provide remote health services that promote early recognition of retinopathy, as well as the adoption of self-care practices such as

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Cited by (41)

Sustained release gel based on CT image inspection for treatment of diabetes fundus macular lesions
2024, Medical Engineering and Physics
Currently, slow-release gel therapy is considered to be an effective treatment for fundus macular disease, but the lack of effective evaluation methods limits its clinical application. Therefore, the purpose of this study was to investigate the application and clinical effect of slow-release gel based on CT image examination in the treatment of diabetic fundus macular disease. CT images of fundus macular lesions were collected in a group of diabetic patients. Then the professional image processing software is used to process and analyze the image and extract the key parameters. A slow-release gel was designed and prepared, and applied to the treatment of diabetic fundus macular disease. CT images before and after treatment were compared and analyzed, and the effect of slow-release gel was evaluated. In a certain period of time after treatment, the lesion size and lesion degree of diabetic fundus macular disease were significantly improved by using slow-release gel therapy with CT image examination. No significant adverse reactions or complications were observed during the treatment. This indicates that the slow-release gel based on CT image examination is a safe, effective and feasible treatment method for diabetic fundus macular disease. This method can help improve the vision and quality of life of patients, and provide a new idea and plan for clinical treatment.
Improving Access to Eye Care: A Systematic Review of the Literature
2022, Ophthalmology
Citation Excerpt :
Even during the current COVID-19 pandemic, vulnerable patients who were already disproportionately affected were able to access clinics via telehealth services in one tertiary university-based ophthalmic program.179 Similarly, telemedicine screening may improve rates of surveillance, reduce socioeconomic disparities, and improve access to care across a broad range of populations.180,181,182 However, George et al183 cautioned that practitioners must be sensitive to potential knowledge gaps in the delivery of telemedicine.
The goals were to develop a working and inclusive definition of access to eye care, identify gaps in the current system that preclude access, and highlight recommendations that have been identified in prior studies. This manuscript serves as a narrative summary of the literature.
Health care disparities continue to plague the nation’s well-being, and eye care is no exception. Inequities in eye care negatively affect disease processes (i.e., glaucoma, cataracts, diabetic retinopathy), interventions (surgical treatment, prescription of glasses, referrals), and populations (gender, race and ethnicity, geography, age).
A systematic review of the existing literature included all study designs, editorials, and opinion pieces and initially yielded nearly 2500 reports. To be included in full-text review, an article had to be US-based, be written in English, and address 1 or more of the key terms “barriers and facilitators to health care,” “access,” and “disparities in general and sub-specialty eye care.” Both patient and health care professional perspectives were included. One hundred ninety-six reports met the inclusion criteria.
Four key themes regarding access to eye care from both patient and eye care professional perspectives emerged in the literature: (1) barriers and facilitators to access, (2) utilization, (3) compliance and adherence, and (4) recommendations to improve access. Common barriers and facilitators included many factors identified as social determinants of health (i.e., transportation, insurance, language, education). Utilization of eye care was largely attributable to having coverage for eye care, recommendations from primary care professionals, and improved health status. Geographic proximity, age, and lack of transportation surfaced as factors for compliance and adherence. There were a variety of recommendations to improve access to eye care, including improving presence in community health clinics, reimbursement for physicians, and funding of community-based programs such as DRIVE and REACH.
The eye care profession has abundant evidence of the disparities that continue to affect marginalized communities. Improving community-based programs and clinics, addressing social determinants of health, and acknowledging the effects of discrimination and bias on eye care serve as ways to improve equity in this field.
Assessing diabetes mellitus knowledge among Syrian medical students: A cross-sectional study
2021, Heliyon
Citation Excerpt :
DM complications are responsible for significant morbidity and mortality [32]. Ocular microvascular complications include glaucoma, cataracts, and retinopathy [33]. DM Retinopathy is the leading cause of blindness in middle-aged and elderly people [34].
Diabetes mellitus is the fastest growing global health emergency of the 21st century. The Middle East and North Africa region have the highest prevalence of diabetes in the world. Since medical students are the pillars of future healthcare systems, their knowledge of the disease must be evaluated, updated, and enhanced appropriately.
A cross-sectional study was conducted at the Syrian Private University (SPU) in November 2019 on World Diabetes Day in Damascus, during the Syrian war crisis. Data were collected through self-administered questionnaires and analyzed using the Statistical Package for Social Sciences version 25.0 (SPSS Inc., United States).
Of the 275 students, 74 (26.9%) were preclinical students and 201 (73%) were clinical students with a mean age of 21.9 (±3.70) years. 67 (25.0%) are overweight, and 26 (9.7%) are obese. Students revealed a good level of knowledge regarding clinical features, risk factors, and complications; however, a lack of knowledge was noticed in the general information and the diagnostic criteria section. Clinical year students (4th, 5th, 6th) demonstrated higher levels of awareness compared to students in pre-clinical years (1st, 2nd, 3rd).
Knowledge and awareness of medical students about diabetes mellitus were found to have some gaps. Health education efforts are required to reinforce its identification and management at all levels, while also encouraging lifestyle modifications among our students.
Diosmin ameliorates the effects of oxidative stress in lenses of streptozotocin-induced type 1 diabetic rats
2017, Pharmacological Reports
Citation Excerpt :
Long-term hyperglycemia is one of the major factors inducing ocular complications including diabetic retinopathy, glaucoma, dry eye disease and cataract [1].
Diabetic cataractogenesis is a complex process connected with hyperglycemia and oxidative stress. Free radicals induce many unfavorable changes in the activity of the antioxidative enzymes and may also lead to oxidative damage. Since diosmin, a plant-derived flavonoid, reveals antioxidative activity, the aim of the study was to investigate if this substance may counteract the oxidative stress in the lenses of diabetic rats.
The study was conducted on the male Wistar rats with streptozotocin-induced type 1 diabetes. After the administration of diosmin at the doses of 50 and 100 mg/kg for 4 weeks the oxidative stress markers in the lenses of these rats were evaluated. Tested markers included: activity of superoxide dismutase, catalase and glutathione peroxidase, as well as levels of total and soluble protein, level of glutathione, vitamin C, advanced oxidation protein products and malonyldialdehyde.
The obtained results indicate that the administration of diosmin to the diabetic rats counteracted the unfavorable changes induced by diabetes in the lenses.
It can be assumed that diosmin may be a promising compound in prevention or delaying the cataract formation during diabetes.
Relationship Between Disease and Treatment Factors in Diabetes With Vision Difficulty: A Cross-Sectional, Population-Based Analysis
2024, Ophthalmic Surgery Lasers and Imaging Retina
Risk of cataract and glaucoma among older persons with diabetes in India: a cross-sectional study based on LASI, Wave-1
2023, Scientific Reports

View all citing articles on Scopus

Presented in part at the Diabetes Initiative of South Carolina Symposium, September 20–21, 2012, Charleston, SC.

The authors have no financial or other conflicts of interest to disclose.

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Symposium ArticleOcular Disease, Knowledge and Technology Applications in Patients With Diabetes

Abstract

Section snippets

THE DIABETES EPIDEMIC

Retinopathy

LIMITING FACTORS IN PATIENTS UNDERSTANDING OF DIABETES AND OCULAR HEALTH

CURRENT ROLE OF TELEMEDICINE

THE FUTURE OF TELEMEDICINE

CONCLUDING REMARKS

Progress in Retinal and Eye Research

J Diabetes Complications

Am J Ophthalmol

Ophthalmology

Diabetes Metab

Diabetes Metab

Diabetes Fact Sheet, Center for Disease Control and Prevention (CDC)

Vision disorders in diabetes

Prevalence of diabetic retinopathy in the United States, 2005-2008

JAMA

Screening guidelines for diabetic retinopathy

Clinical guideline. Ophthalmology

Ophthalmic examination among adults with diagnosed diabetes mellitus

JAMA

Diabetic retinopathy screening update

Clin Diabetes

The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus

N Engl J Med

Symposium Article
Ocular Disease, Knowledge and Technology Applications in Patients With Diabetes