Association between diabetic eye disease and other complications of diabetes: Implications for care. A systematic review

Abstract

Aims: To evaluate diabetic retinopathy (DR) screening with a portable handheld smartphone-based retinal camera and telemedicine in an urban primary health care setting; to evaluate the learning curve for image acquisition, performed by healthcare personnel without previous experience on retinal imaging. Methods: Prospective study that enrolled patients with type 2 diabetes mellitus (T2DM) followed at a primary healthcare unit in São Paulo, Brazil. After a brief training in image acquisition, there was further continuous feedback during the remote image reading process. Each patient underwent two fundus and one anterior ocular segment images per eye, after mydriasis. Patients were classi ed according need of referral. Results: A total of 627 adult individuals with T2DM underwent retinal evaluation. The population was composed by 63.2% female individuals, age median of 66 years-old, diabetes duration 10.7 ± 8.2 years and A1c 7.7 ± 1.9% (61 + 20.8 mmol/mol). The most prevalent associated comorbidities were arterial hypertension (80.3%) and dyslipidemia (50.2%). Referral decision was possible in 81.2% patients. Most patients had absent or non-referable DR; the main ocular media opacity detected was cataract. After the 7 th day of image acquisition, the daily rate of patients whose images allowed clinical decision was maintained above 80%. A higher A1c was associated with referable DR. Conclusion: A low-cost DR screening strategy with a handheld device and telemedicine is feasible and has the potential to increase coverage of DR screening in underserved areas; the possibility of mobile units is relevant for DR screening in the context of Covid-19 pandemic.

Diabetic Retinopathy Screening in Urban Primary Care Setting with a Handheld Smartphone-based Retinal Camera.

“…The association between poor glycemic control and severity and progression of retinopathy is well established in the literature, in addition to diabetes duration, nephropathy, hypertension, and dyslipidemia [7]. Further, DR has been related to the development of macrovascular complications of diabetes, speci cally, cerebrovascular, cardiovascular and peripheral complications [21]. Ours results also pointed out to the imaging protocol having a poorer diagnostic yield in older patients, who have also experienced a longer duration of the exam.…”

Relationship Between Renal Function and Choroidal Thickness in Type 2 Diabetic Patients Detected by Swept-Source Optical Coherence Tomography

“…However, the value of OCT parameters in predicting renal function needs to be verified in future research with larger populations. 6,33,34 There was double-digit difference in the number of the patients between the groups. If the group with renal impairment had significantly severe DR, the data were skewed because the number of patients with renal impairment was quite small compared with the other.…”

Effect of a Single Intravitreal Bevacizumab Injection on Proteinuria in Patients With Diabetes

“…18,20 UPCR and UACR can be measured from untimed spot urine samples, which makes them easy to investigate on an outpatient basis in clinics, and they are currently recommended for initial evaluation of proteinuria. 19 DN, one of the microvascular complications of diabetes, shares common pathogenesis with DR. 21 Hence, we believe that it is important to analyze the effect of systemic exposure of bevacizumab after intravitreal injection on proteinuria in patients with diabetes. There could be 3 possible courses for this effect; the systemic exposure of bevacizumab (1) is either too weak to have any effect on proteinuria, (2) would increase proteinuria by suppressing the physiological VEGF from podocytes, which is required for the maintenance of endothelial cells, or (3) would decrease proteinuria by suppressing the elevated pathologic VEGF and neovascularization, similar to that observed in proliferative DR (PDR).…”