Background-There is evidence that altered ocular blood flow is involved in the development and progression of diabetic retinopathy. However, the nature of these perfusion abnormalities is still a matter of controversy. Ocular haemodynamics were characterised with two recently introduced methods. Methods-The cross sectional study was performed in 59 patients with type 1 diabetes with a diabetes duration between 12 and 17 years and an age less than 32 years and a group of 25 age matched healthy controls. Scanning laser Doppler flowmetry and laser interferometric measurement of fundus pulsation amplitude were used to assess retinal and pulsatile choroidal blood flow, respectively. In addition, colour contrast sensitivity along the tritan axis was determined. Results-Fundus pulsation amplitude, but not retinal blood flow, increased with the progression of diabetic retinopathy. Retinal blood flow was influenced by plasma glucose levels (r = 0.32), whereas fundus pulsation amplitude was associated with HbA 1c (r = 0.30). In addition, a negative correlation between the colour contrast sensitivity along the tritan axis and retinal blood flow was observed. Conclusions-The present study indicates that pulsatile choroidal blood flow increases with the progression of diabetic retinopathy. Increased retinal blood flow appears to be related to loss of colour sensitivity in patents with type 1 diabetes. (Br J Ophthalmol 2000;84:493-498) Altered ocular blood flow may contribute to the development and progression of diabetic retinopathy. However, the exact nature of ocular blood flow abnormalities in diabetes has not yet been established and the results obtained in patients with type 1 diabetes and type 2 diabetes strongly depend on the technique used for the assessment of ocular haemodynamics. Both, increased 1-3 and decreased retinal blood flow 4 5 have been observed in patients with diabetes compared with healthy controls. A recent study using laser Doppler velocimetry for the assessment of retinal blood flow indicates that retinal perfusion is already increased in patients with type 1 diabetes before the clinical onset of diabetic retinopathy.6 This observation has further supported the concept that increased retinal blood flow may have a key role in the development of diabetic retinopathy. 8The purpose of the present study was to determine whether retinal and choroidal blood flow are altered in the early stages of diabetic retinopathy. Retinal blood flow was assessed with scanning laser Doppler flowmetry.9 Pulsatile choroidal blood flow was assessed with laser interferometric measurement of fundus pulsation. 10Ocular haemodynamic factors were compared with the results of colour contrast sensitivity testing. This was done in an eVort to establish a relation between alterations in ocular haemodynamics and loss of colour contrast sensitivity. In order to minimise the eVect of potentially confounding factors such as duration of diabetes or age we focused on a study population with type 1 diabetes with a duration of 1...

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Objective: To investigate the frequency, treatment and outcome of patients with diabetes due to severe insulin resistance syndromes (SIRS). Research Design and Methods: Based on data from the multicenter prospective Diabetes Registry DPV, we analyzed diagnosis, treatment and outcome of 636,777 patients with diabetes from 1995 to 2022. Results: Diabetes due to SIRS was documented in 67 cases (62.7% females), 25 (37%) had lipodystrophies (LD) and 42 (63%) had congenital defects of insulin signaling. The relative frequency compared to type 1 diabetes (T1D) was about 1:2300. Median age at diabetes diagnosis in patients with SIRS was 14.8 years (interquartile range [IQR] 12.8–33.8). 38 patients with SIRS (57%) received insulin and 34 (51%) other antidiabetics, mostly metformin. 16% of patients with LD were treated with fibrates. Three out of eight patients with generalized LD (37.5%) were treated with metreleptin and one patient with Rabson-Mendenhall syndrome was treated with recombinant IGF-1. The median HbA1c at follow-up was 7.1% [54 mmol/mol]. Patients with LD had higher triglycerides than patients with T1D and T2D (P<0.001 and P=0.022, respectively), and also significantly higher liver enzymes and lower HDL cholesterol than patients with T1D (P<0.001). Patients with insulin receptor disorders were significantly less likely to be treated with antihypertensive medication than patients with T2D (P=0.042), despite having similar levels of hypertension. Conclusions: Diabetes due to SIRS is rare diagnosed and should be suspected in lean children or young adults without classical type 1 diabetes. Awareness of cardiovascular risk factors in these patients should be raised.

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Wood J, Rami B. Report of the 35th ISPAD‐Meeting, Ljubljana, Slovenia, 2‐5 September 2009.