The Type of Diabetes Mellitus Associated with Diabetic Retinitis

Abstract

A remarkable reduction in insulin requirement was observed in the case of an adult woman with diabetes; after requiring 80 units of insulin daily, she later managed without insulin and had normal blood sugar tests. The dominant clinical feature in later years was renal insufficiency. At autopsy, extensive renal changes of the Kimmelstiel-Wilson type were found.Because of the apparent relation of the amelioration of the diabetes to the development of renal disease in this case, the incidence of renal changes and the severity of the diabetic state were studied in 190 cases of diabetes mellitus autopsied in recent years. These cases were divided into three groups: those with no renal disease, those with renal disease other than the Kimmelstiel-Wilson type and those with the KimmelstielWilson renal lesions.The criterion used for the Kimmelstiel lesion was solely the lumpy loop or hyaline mass in the glomerulus. There were 57 patients with the lesion-an incidence of one-third of the diabetic study group. The duration of the diabetes did not differ from that in the two other groups. In general, the patients with the lesion were obese, became hypertensive, developed refractory edema, -died in uremia. Their kidneys characteristically showed marked arteriolarsclerosis and arteriosclerosis.In 60 per cent of the diabetics with the Kimmelstiel lesion, the amount of insulin required progressively decreased as time went on. In a few cases, the diminution of the insulin requirement was so marked that diabetics previously requiring large amounts of insulin became hypoglycemic during treatment with small doses. This illustrates the need for caution. The tendency to amelioration appeared late in the course of the diabetic dis-

Diabetic Retinopathy and Diabetic Macular Edema

“…Interestingly, DR was formerly termed ‘diabetic retinitis’ [40] before the inflammatory component was understood. The clinical picture of DR provides numerous clues to the presence of chronic inflammation, including diffuse vascular dilation, tortuosity, leakage and neovascularization, atrophy of the retinal neural parenchyma, edema of the macula, and eventual fibrosis.…”

Diabetic Retinopathy

“…Inflammation is a prominent component of many diseases, including primary retinal degenerations, insulin resistance, and diabetes (59). Diabetic retinopathy was initially termed, "diabetic retinitis" (60), although this usage fell out of favor in the 1970s. Chronic inflammation is characterized by increased vascular permeability, edema, inflammatory cell infiltration, cytokine and chemokine expression, tissue destruction, neovascularization, and attempts at repair (61), and diabetic retinopathy exhibits most of these features (Table 1).…”

18 Diabetic Retinopathy and Diabetic Macular Edema

“…Inflammation is an early and intrinsic feature of systemic insulin resistance and diabetes that involves the release of cytokines from adipose tissue that impairs insulin action, and affects patients with both type 1 and type 2 diabetes [38,39]. Interestingly, DR was formerly termed 'diabetic retinitis' [40] before the inflammatory component was understood. The clinical picture of DR provides numerous clues to the presence of chronic inflammation, including diffuse vascular dilation, tortuosity, leakage and neovascularization, atrophy of the retinal neural parenchyma, edema of the macula, and eventual fibrosis.…”