| 1. |
|
|
| 2. |
- Kärvestedt, Lars, et al.
(author)
-
The prevalence of peripheral neuropathy in a population-based study of patients with type 2 diabetes in Sweden
- 2011
-
In: Journal of diabetes and its complications. - : Elsevier BV. - 1056-8727 .- 1873-460X. ; 25:2, s. 97-106
-
Journal article (peer-reviewed)abstract
- Aims To assess peripheral neuropathy following a standardized foot examination protocol in a representative population-based cohort of subjects with type 2 diabetes. Methods In a geographically defined population, aged 40–70 years with diabetes prevalence of 3.5% according to medical records, we investigated 156 type 2 diabetic subjects, 95% Caucasian, mean age 61.7±7.2 years, duration of diabetes 7.0±5.7 years, and HbA1c 7.3±2.4% (6.4% Mono-S), by questionnaires, clinical examinations, blood sampling, and review of medical records. Foot examination included clinical signs of peripheral neuropathy and tests of sensibility with monofilament, tuning fork, and assessments of the vibration perception thresholds (VPT). Results Peripheral autonomic neuropathy (PAN) as judged by two or more signs of dysfunction was the most common and affected 43%. The prevalence of peripheral sensory neuropathy (PSN) was 15% by monofilament, 24% by tuning fork, and 28% by VPT expressed as ZscoreVPT ≥2.0 S.D. Twenty-nine percent had a VPT ≥25 V. Signs of peripheral motor neuropathy (PMN) affected 15%. Peripheral neuropathy, at least one variable, affected 67%, whereas 25% were affected by more than one variable of neuropathy, i.e., polyneuropathy. Exclusion of other identified causes for neuropathy than diabetes reduced the prevalence of diabetic polyneuropathy to 23%. Concurrent diabetic complications were 29% for retinopathy, 14% for incipient nephropathy, and 8% for overt nephropathy. The prevalence of macrovascular complications was 62% for CVD, 26% for PVD, and 11% for cerebrovascular lesion (CVL). Conclusion Peripheral neuropathy was common in this representative type 2 diabetes population. Clinical signs of PAN were the most frequent followed by diminished perception of vibration and touch.
|
|
| 3. |
- Nilsson, Maria, et al.
(author)
-
Macular structure and function and the development of retinopathy in diabetes
- 2012
-
In: Clinical and experimental optometry. - : Informa UK Limited. - 0816-4622 .- 1444-0938. ; 95:3, s. 306-310
-
Journal article (peer-reviewed)abstract
- Background: The aim of this study was to evaluate the relationship between structural and functional changes identified with the Rarebit fovea test (RFT) in diabetic patients over two years. In addition, we evaluated whether the RFT changes at baseline can predict vascular changes detectable by conventional screening methods four to six years later. Methods: Forty-two patients with diabetes and 42 age-matched healthy subjects underwent an initial examination. Two years later, 25 of the diabetic patients and 20 of the controls were re-examined in the same way. Four to six years later, 40 of the diabetic patients underwent a standard screening examination including fundus photography. After two years, all subjects were examined with the RFT and visual acuity (VA) was assessed. In addition, optical coherence tomography (OCT) and fundus photography were performed on the diabetic patients. At a screening examination of the diabetic patients after four to six years, fundus photographs were reviewed. Results: After two years, a marked difference in RFT results was observed between the 20 normal subjects and the 25 patients with diabetes. Results from other tests (VA and central retinal thickness, as measured with OCT) were unchanged compared with the initial examinations. Fundus photography four to six years later of 40 of the 42 diabetic patients showed an increased incidence of retinopathy unrelated to the RFT findings at baseline. Conclusions: The findings in the current study indicate that the RFT might detect macular dysfunction in diabetic eyes without microvascular changes. This dysfunction increased during a two-year period and presumably reflects neural impairment in diabetes mellitus but did not predict development of retinopathy during the four to six year period.
|
|
| 4. |
- Wendt, Gunvor von
(author)
-
Screening for diabetic retinopathy : aspects of photographic methods
- 2005
-
Doctoral thesis (other academic/artistic)abstract
- Diabetic retinopathy (DRP) is a major cause of acquired blindness and visual impairment among people of working age as well as those aged 65 years or more. About 3-4% of the population has diabetes mellitus, 35-65% of the diabetic patients have some type of DRP and 10-35% have sight-threatening retinopathy. Regular eye examinations with a sensitive method are important in order to detect the treatment needing, usually asymptomatic, lesions in time. Only then laser treatment reduces the risk of visual impairment by 50-90%. Forty-five degree photography from one or two fields using colour transparencies or Polaroid pictures has so far been the predominant photographic screening method. Field definitions, especially for the macular field, have varied according to different recommendations. Sixty degree wide-field photography offers large field coverage and might, despite less magnification, improve detection of diabetic retinopathy abnormalities. Furthermore, the detectability of vascular structures and red lesions might improve when using red-free light at photography. The technique of using a monochromatic green filter enhances the contrast of retinal blood vessels and haemoglobin containing structures. In this methodological study varying photographic screening methods for the detection of DRP were evaluated. Using wide-field 6C degrees cameras it was studied whether DRP was more easily detected from red-free film based or digital black-and-white pictures as compared to corresponding colour transparencies. Furthermore, it was evaluated whether two 60 degrees photographic fields were needed or whether one 60 degrees field was enough for screening purposes. The field coverage of one and two 60 degrees fields was compared with that of the Gold Standard (30 degrees seven-field photography). We also studied how retinal neovascularizations (NVEs) were detected from one and two 45 degrees fields and compared the results with that of one- and two-field 60 degrees photography. Furthermore, in order to find out whether any of three varying 45 degrees macular fields was superior in detecting NVEs, the number of NVEs detected in each of them was compared with the number detected from the 60 degrees fovea-centred field. Our results show that especially early DRP lesions (red dots) but also intra-retinal microvascular abnormalities and venous beading, both indicating severe DRP, are more easily detected from monochrome red-free digital images and photographs, compared to colour transparencies. This is important as the detection of the first abnormalities as well as of the severe DRIP lesions influences both future screening intervals and decisions for referral or treatment. "White lesions", e.g. cotton wool spots, were the only abnormalities which were less easily detected with the red-free technique. For further prognosis these lesions are, however, not considered as important as the former ones. Single-field 60 degrees photography can be advocated only when the finding in this field is normal otherwise severe lesions can be missed. One and two-field 60 degrees photography covers 60% and 80%, respectively, of the areal coverage of that of 30 degrees seven-field photography (Gold Standard). One- and two-field 45 degrees photography disclosed 53% and 77%, respectively, of the NVEs which were detected from two-field 60 degrees photography. Of the 45 degrees macular fields investigated, the field centred most temporally turned out to disclose NVEs most appropriately.
|
|
