C. Kloos

Abnormal retinal autoregulation is detected by provoked stimulation with flicker light in well-controlled patients with type 1 diabetes without retinopathy.

AIMS Investigation of retinal vasodilation under flickering light is considered a dynamic analysis in contrast to the static analysis of retinal vessel equivalents (mean retinal vessel diameter). We investigated whether dynamic analysis apart from the static one in type 1 diabetic patients without diabetic retinopathy with well-controlled diabetes could lead to additional information regarding retinal autoregulation. METHODS 18 normotensive type 1 diabetic patients without retinopathy and 19 healthy subjects were included. Diameter of retinal vessels was measured with Dynamic Vessel Analyzer. Changes in vasodilation are expressed as percent change over baseline values. RESULTS HbA(1c) was 7.5+/-1.0% in diabetic patients. In arteries, the response to flicker was diminished in diabetic patients compared to healthy volunteers (p<0.023). In patients flicker stimulation increased arterial diameter by +2.7% in contrast to +4.4% in controls. Venous vessel diameter increased by +3.1% in diabetic individuals and by +5.3% in the control group (p<0.002). There were no differences in static analysis between both groups. CONCLUSIONS Diabetic patients without retinopathy with relatively good glycemic control show reduced retinal vasodilation after flicker indicating dysfunction in retinal autoregulation. The use of provocation test in conjunction with static analysis could lead to additional information regarding abnormal retinal autoregulation.

Differences in the quality of diabetes care caused by social inequalities disappear after treatment and education in a tertiary care centre.

Diabet. Med. 29, 640–645 (2012)

Flexible, intensive insulin therapy and dietary freedom in adolescents and young adults with Type 1 diabetes: a prospective implementation study

Aims  To assess the outcome of a Diabetes Treatment and Teaching Programme (DTTP) on glycated haemoglobin (HbA1c), severe hypoglycaemia (SH) and severe ketoacidosis (SKA) in adolescents and young adults with Type 1 diabetes.

Improved Metabolic Control Results in Better Myogenic Response of Retinal Arterioles in Patients with Diabetes Mellitus Type 1

Aims: The retina is protected against high blood pressure by the myogenic constriction of arterioles (the Bayliss effect). Hyperglycemia impairs this retinal autoregulation by endothelial dysfunction. The purpose of this prospective pilot study was to test whether improved metabolic control results in a measurable effect on the myogenic response of human retinal arterioles to acute increases in blood pressure. Methods: The Bayliss effect was measured in 25 patients with diabetes mellitus by the Retinal Vessel Analyzer (RVA), both before and after participation in a treatment and teaching program for intensified insulin therapy with the goal of improved metabolic control. After 12 months, 17 subjects still fulfilled the inclusion criteria and underwent an identical measurement. The Wilcoxon test was used for statistical analysis. Results: During the first session, a rise in mean arterial pressure (MAP) of 20.2 ± 8.6 mm Hg was followed by an arterial vasoconstriction of –3.2 ± 2.9%. The educational program resulted in a significant drop in HbA1c levels (9.4 ± 1.9 vs. 6.9 ± 0.98%). Eight subjects did not meet the inclusion criteria after 12 months. Seventeen subjects were remeasured and a rise in blood pressure of 19.5 ± 9.9 mm Hg in the second session was associated with a significantly improved arterial vasoconstriction of –5.9 ± 2.7% (session I vs. session II, p = 0.006). Conclusion: The myogenic response of the arterial wall in human retinal arterioles was significantly improved by the therapeutic intervention.

Frequency of self-adjustment of insulin dose and metabolic control in Type 2 diabetes –is there an association?

To investigate the supposition that self‐adjustment of insulin dose will improve metabolic control in patients with Type 2 diabetes.

Use of snacks in insulin-treated people with diabetes mellitus and association with HbA1c, weight and quality of life: a cross sectional study

Insulin therapies with prandial injections offer the possibility to skip snacks or omit meals. It is unclear how many people with insulin‐treated diabetes mellitus eat snacks and whether they snack for their own comfort or only on the recommendation of healthcare professionals.

Diabetes-Related Burden and Distress is Low in People with Diabetes at Outpatient Tertiary Care Level

OBJECTIVE The importance of diabetes-related distress (DRD) for the treatment of diabetes is emphasized in national and international guidelines recommending routinely screening for psychosocial problems. To detect DRD, the PAID (Problem Area In Diabetes) questionnaire provides a valid and reliable instrument. RESEARCH DESIGN AND METHODS 783 patients with diabetes mellitus type 1 (DM1, n=191, age 54.5 y, diabetes duration 22.5 y, HbA1c 7.2% (55 mmol/mol)) and type 2 (DM2, n=592, age 66.6 y, diabetes duration 15.6 y, HbA1c 7.0% (60.1 mmol/mol)) were interviewed with the PAID and WHO-5 questionnaire in a University outpatient department for endocrinology and metabolic diseases in 2012. A PAID score≥40 (range 0-100) was considered as high DRD. RESULTS The mean PAID score was 17.1±15.1 in all participants. Only 8.9% of all responders showed high DRD (score≥40). The PAID score neither differed in people with DM1 and DM2, nor between participants with DM2 with or without insulin therapy. Females achieved significantly higher scores than men (19.0±16.6 vs. 15.6±13.7, p=0.003). A strong negative correlation existed between the PAID score and the WHO-5 Well-being Index (r=- 0.482, p<0.001). A 10 points higher WHO-5 Well-being Index was associated with 15.9 points lower PAID score in people with DM1 (p<0.001), and 9.2 points lower PAID score in DM2 (p<0.001), respectively. One percent higher HbA1c was associated with an increase of diabetes-related distress by 2.5 points in people with DM1 and by 2.0 points in people with DM2. CONCLUSIONS Less than 10% of our outpatients with diabetes showed high diabetes-related distress.

Prevalence of injection–meal interval usage and its association with variables of metabolic control in patients with Type 1 and Type 2 diabetes

Diabet. Med. 28, 223–226 (2011)

Influence of Flickering Light on the Retinal Vessels in Diabetic Patients Response to Nguyen, Cheung, and Wong

OBJECTIVE Stimulation of the retina with flickering light increases retinal vessel diameters in humans. Nitric oxide is a mediator of the retinal vasodilation to flicker. The reduction of vasodilation is considered an endothelial dysfunction. We investigated the response of retinal vessels to flickering light in diabetic patients in different stages of diabetic retinopathy. RESEARCH DESIGN AND METHODS We studied 53 healthy volunteers, 68 type 1 diabetic patients, and 172 type 2 diabetic patients. The diameter of retinal vessels was measured continuously online with the Dynamic Vessel Analyzer (DVA). Diabetic retinopathy was classified using Early Treatment Diabetic Retinopathy Study criteria. Changes in vasodilation are expressed as percent change over baseline values. RESULTS After adjustments for age, sex, and antihypertensive treatment, the response of retinal arterioles to diffuse luminance flicker was significantly diminished in patients with type 1 diabetes compared with healthy volunteers. The vasodilation of retinal arterioles and venules decreased continuously with increasing stages of diabetic retinopathy. The retinal arterial diameter change was 3.6 +/- 2.1% in the control group, 2.6 +/- 2.5% in the no diabetic retinopathy group, 2.0 +/- 2.7% in the mild nonproliferative diabetic retinopathy (NPDR) group, 1.6 +/- 2.2% in the moderate NPDR group, 1.8 +/- 1.9% in severe NPDR group, and 0.8 +/- 1.6% in proliferative diabetic retinopathy group. CONCLUSIONS Flicker responses of retinal vessels are abnormally reduced in diabetic patients. This decreased response deteriorated with increasing stages of retinopathy. The response was already reduced before clinical appearance of retinopathy. The noninvasive testing of retinal autoregulation with DVA might prove to be of value in early detection of diabetic vessel pathological changes.

Prevalence and Progression Rate of Diabetic Retinopathy in Type 2 Diabetes Patients in Correlation with the Duration of Diabetes

AIMS We examined prevalence and progression of retinopathy in dependence on diabetes duration in order to estimate the probability of progression. PATIENTS/METHODS In a retrospective cohort-analysis from an academic outpatient department of endocrinology and metabolic diseases we analyzed 17461 consultations of 4513 patients with DM2 from 1987 to 2014. 50.3% of the patients (n=2272) had at least one documented result of funduscopy. RESULTS 25.8% of the patients had retinopathy (20.2% non-proliferative, 4.7% proliferative, 0.7% were not classified, 0.1% blindness). The prevalence of retinopathy in dependence on diabetes duration was 1.1% at diagnosis, 6.6% after 0<5 years, 12% after 5<10 years, 24% after 10<15 years, 39.9% after 15<20 years, 52.7% after 20<25 years, 58.7% after 25<30 years and 63% after ≥30 years. In a subset of 586 (25.7%) patients with retinal photography of 3 consecutive years 7.0% showed deterioration after one and 12.2% after two years; 2.6% improved after one and 2.8% after two years. 201 (34.3%) of this group had<10 years diabetes and lower deterioration (4.5% worsened after one and 9.5% after two years). Their retinopathy mainly transformed from no retinopathy to non-proliferative. Four patients (2.0%) developed proliferative retinopathy. CONCLUSIONS/INTERPRETATIONS Within the first 10 years of diabetes duration, the prevalence of retinopathy is low and the progression infrequent. Most patients have a non-proliferative form which can be reversible and rarely requires interventions. Patients with DM2 without retinopathy and good glycaemic control do not run into additional risk from expanding funduscopy intervals to biennial.