These results demonstrate that an inverse linear relationship exists between performance on this diabetes test and HbA1c values. Improvement in patient knowledge of diabetes and the importance of treatment may indeed improve glycemic control and ultimately decrease complications. Studies aimed at empowering patients with disease knowledge may help control the ramifications of the growing diabetes epidemic.

Background and aims T his paper investigates the roles of retinal perfusion pressure and pulse pressure in progression to sight-threatening diabetic retinopathy. Retinal perfusion pressure is dependent upon the systemic blood pressure and the intra-ocular pressure. We have examined the hypothesis that the early deleterious effect of hypertension on the retinal circulation which leads to perfusion pressure damage is due to a unique relationship between the intra-ocular pressure and the systemic blood pressure. Clinically this is manifest as hypertensive retinopathy and diabetic retinopathy. Materials and methodsFrom a prospective database, data on all new patients with background diabetic retinopathy referred during a three year period (n=104) were analysed for progression to sight-threatening diabetic retinopathy. ResultsRetinal perfusion pressure and pulse pressure were found to be the strongest predictors of progression to sight-threatening diabetic retinopathy (Chi Square linear trend statistic, relative risk ratios). Progression to maculopathy by quartilesFor retinal perfusion pressure, the relative risk ratios increased from 1.00 in the first quartile (39.7-50.1 mmHg), to x 5.8 in the second quartile (50.2-56.1 mmHg), to x 6.4 in the third quartile (56.2-60.0 mmHg), to x 9.

BackgroundA CE inhibitors have a special role in diabetes care. They have been proven to reduce urinary albumin excretion and reduce the rate of progression of diabetic nephropathy and retinopathy. 1-3 There is proven benefit post myocardial infarction, with a greater beneficial effect in patients with diabetes in comparison to those without. 4 The effect of ACE inhibitors in patients who have low ejection fractions or overt cardiac failure is well described. 5 More recent studies indicate other benefits of ACE inhibitors such as improving dyslipidaemia and insulin sensitivity.Cardiovascular disease is the commonest cause of mortality among patients with type 2 diabetes. A recent study reports the standardised mortality ratio to be considerably higher in people with diabetes with the vast majority of the excess due to cardiovascular disease (type 1 diabetes: women x 6.41, men x 2.94, type 2 diabetes: women x 1.6, men x 1.41). 6 Patients with type 2 diabetes who have no evidence of previous coronary heart disease were found to be at the same risk of myocardial infarction and cardiovascular death as non-diabetic patients who had already suffered from a myocardial infarction. 7 The diabetes subject cohort of the HOPE Study, (Heart Outcomes Prevention Evaluation Study), sought to investigate whether ACE inhibitor treatment with ramipril in high-risk patients with diabetes lowers the risk of cardiovascular events. 8 Within this main study the MICRO-HOPE substudy investigated the effect of ACE inhibitor treatment with ramipril on microalbuminuria and diabetic retinopathy. 9 The aim of this article is to offer a clinical summary of the above studies and suggest recommendations for clinical practice.