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Dear Readers,
The World Diabetes Day has just been celebrated the world over on November 14. It brought to the forefront the seriousness of this disease which is becoming an epidemic. This has become a silent killer not only of life but also of vision. In this issue of Sitenews we feature Diabetes and the Eye. The importance of this is highlighted through the magnitude of the problem. Next the various linkages between Diabetes and the eye are highlighted. One of the major barriers to addressing this issue is the lack of symptoms and therefore the persons lack of awareness of the problem of diabetic retinopathy starting. One of the foremost strategies required is awareness creation and the efforts already in place are provided. Diabetic retinopathy is the most common condition affecting diabetes people and resources about that as well as Glaucoma and Diabetes, Cataract and Diabetes is also provided. Coordination among various stakeholders whether the eye care providers or the diabetologists is very critical for care to be provided properly to diabetic retinopathy people. The resources provided also include the different screening models to identify diabetic retinopathy persons in the community.

The featured personality is Mr.Lloyd M. Aiello. A glimpse into history of diabetes is provided with the kind of dietary advice that was given early on. The featured organisation is INTERNATIONAL DIABETES FEDERATION

We wish you happy reading and do look forward to receiving your feedback.

Wish you a productive reading!

Happy reading!

Regards,

Vision 2020 e-resource team
The Issue Features...
DIABETES AND EYE
Vol. 6 No. 11 November 2009
•   Magnitude
•   Impact Of Diabetes
on Eye

•   Awareness Creation
•   Diagnosis and Treatment
•   Providers Role
•   Different Screening Model
•   History of Diabetes
•   Featured personality
•   Featured Organisation
•   Talk to Us
•   Past Issues

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Diabetes epidemic is underway. An estimated 30 million people worldwide had diabetes in 1985. A decade later, the global burden of diabetes was estimated to be 135 million. The latest WHO estimate for the number of people with diabetes, worldwide, in 2000 is 171 million. This is likely to increase to at least 366 million by 2030. Two major concerns are that much of this increase in diabetes will occur in developing countries, due to population growth, ageing, unhealthy diets, obesity and sedentary lifestyles, and that there is a growing incidence of Type 2 diabetes which accounts for about 90% of all cases at a younger age. In developed countries most people with diabetes are above the age of retirement. In developing countries those most frequently affected are in the middle, productive years of their lives, aged between 35 and 64.



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Diabetes can contribute to the development of eye disease and can impact the quality of vision experienced by diabetic patients.

The disease causes numerous changes in the eye, which can increase the risk for developing several eye-related conditions and diseases. Some of the changes in the eye include those to lens thickness and curvature, which can produce alterations in the refractive state of the eye, impacting acuity.



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Even among policy makers at an international and national level, awareness about the public health and clinical importance of diabetes remains low. Diabetes is widely perceived as a condition of low importance to the poorer populations in the world. In the low- and middle-income countries, the impact of diabetes is largely unrecognized. Yet the world is facing a dramatic rise in diabetes prevalence, most of which will occur in the low- and middle-income countries.

This will have a major impact on the quality of life of hundreds of millions people and their families, overwhelm the capability of many national health-care systems, and impact adversely upon the economy of those countries that are in most need of development.



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This condition is very common in people who have had diabetes for a long time. Your vision will be normal with no threat to your sight. At this stage the blood vessels in the retina are only very mildly affected, they may bulge slightly (microaneurysm) and may leak blood (haemorrhages) or fluid (exudates). The macula area of the retina mentioned earlier remains unaffected.

  • DIABETES AND DIABETIC RETINOPATHY

  • This article tells in detail about how the diabetes paves the root cause for Diabetic Retinopathy.

  • DIABETIC RETINOPATHY - CLINICAL FINDINGS AND MANAGEMENT

  • This article describes in brief about the prevalence of diabetic retinopathy, its causes, clinical classification and the treatment availability. It also tells in detail how the DR patients have been screened.

  • DIABETIC RETINOPATHY BEST PRACTICES

  • This presentation lists out the Domain areas and the main focus of the domain areas for the prevalence of Diabetic Retinopathy among the rural public.

  • DIABETIC RETINOPATHY THE FACTS

  • This leaflet sets out to answer some of your questions about the changes that may occur, or have occurred in eyes if you have diabetes.

  • DIABETIC RETINOPATHY AWARENESS STRATEGIES

  • This article reveals the need for awareness creation in the community since any successful programme to combat any disease relies on the effectiveness of the awareness among the people and also the strategies that could be used to create such awareness in the community.

  • DIABETIC RETINOPATHY CLINICAL FEATURES AND MANAGEMENT

  • This article describes in detail about the different types of Diabetic retinopathy, its features which are used to determine the level of risk to vision and also suggest suggests how to manage different types of Diabetic Retinopathy.

  • DIABETIC RETINOPATHY IN ASIA

  • This article tells in detail about the current status and the prevalence of Diabetic Retinopathy in Asia. It also lists out the various risk factors, screening, treatment procedures and the risk factors due to the effect of Diabetic Retinopathy.

    GLAUCOMA AND DIABETES

    People with diabetes are 40% more likely to suffer from glaucoma than people without diabetes. The longer someone has had diabetes, the more common glaucoma is. Risk also increases with age. Retinal detachment

  • GLAUCOMA AND DIABETES

  • This article highlights the about Glaucoma which is caused due to diabetes and the most common form of glaucoma and also its types.

  • TYPE 2 DIABETES INCREASES THE RISK OF GLAUCOMA IN WOMEN

  • The study supports the notion that type 2 diabetes is associated with an increased risk of glaucoma.

  • THE LINK BETWEEN DIABETES, BLINDNESS AND GLAUCOMA


  • TEMPORARY BLURRING

    This may occur as one of the first symptoms of diabetes although it may also occur at any time when your diabetes is not well controlled. It is due to a swelling of the lens of the eye and will clear without treatment soon after the diabetes is brought under control again.

  • WATCH OUT, DIABETES CAN CAUSE BLURRED VISION OR EVEN BLINDNESS


  • CATARACT AND DIABETES

    Many people without diabetes get cataracts, but people with diabetes are 60% more likely to develop this eye condition. People with diabetes also tend to get cataracts at a younger age and have them progress faster.

  • SURGERY FOR CATARACT IN DIABETES

  • This section talks about the surgery procedure adopted for cataract in diabetes and complications of surgery.

  • CATARACTS IN DIABETES

  • This article highlights in general about cataract and need for controlling diabetes during surgery and also the extra risks in diabetes.

  • CATARACT SURGICAL OUTCOMES IN DIABETIC PATIENTS: CASE CONTROL STUDY

  • The purpose of this study was to determine the visual outcome of cataract surgery in diabetes mellitus with advanced cataract in a tertiary institution in Nigeria.

  • EPIDEMIOLOGICAL AND BIOCHEMICAL STUDIES OF CATARACT AND DIABETES

  • A survey has been made of the prevalence of diabetes among patients who have a senile cataract extracted, and the carbohydrates in senile cataractous lenses of diabetics and nondiabetics have been exaviined to determine whether the lens of the diabetic human, like that of the diabetic animal, accumulates sorbitol.



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    EYE CARE PROVIDERS

    The role of ophthalmologists must broaden to combat the increasing prevalence of diabetic eye diseases, which will involve them joining forces with other health care professionals involved in the management of Type 2 diabetes to help patients control their diabetes before eye complications worsen.

    By 2050, the number of Americans with diabetic retinopathy is projected to triple from 5.5 million to 16.0 million, and the number of those with vision-threatening retinopathy will increase from 1.2 million to 3.4 million,

  • DIABETES PREVENTION AND MANAGEMENT TOOLKIT

  • This link contains diabetes prevention and management toolkit.

    DIABETOLOGIST

    Diabetes educators are professional healthcare providers who are qualified to work with people in the management of their diabetes. The role of diabetes educators is dynamic and shaped by the environment in which they practise and by developments in research and technology. Core components are clinical care, education, counselling, research, and management. The role of the diabetes educator encompasses health promotion and the prevention of diabetes and its complications, and is undertaken by healthcare providers from a variety of disciplines and, in some cases, people with a non-medical background. The degree of emphasis that is placed on the components listed above and their related tasks varies between settings, and between healthcare disciplines, which involve different scopes of practice.

  • ROLE OF DIABETOLOGIST IN EVALUATING DIABETIC RETINOPATHY

  • The objective of the study was to evaluate the ability of diabetologists to screen diabetic patients for diabetic retinopathy.

  • DOUBLE TRANSPLANT:A DIABETOLOGISTS RETURN FROM DIABETES

  • In this article, diabetologist Silvia Iancu describes her 25-year return diabetes journey, and reports on the positive results of her successful double transplant operation.



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The effective implementation of screening programmes for diabetic retinopathy is complicated by factors including barriers to attending screening examinations, technical issues around sensitivity and specificity, and the requirement to reliably refer people for diagnosis and treatment of sight-threatening retinopathy.



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1. Do you know that

     a. by 2025 total 300 million of the worldwide population will be affected by diabetes.

     b. every 21 seconds, someone is diagnosed with diabetes

Diabetes is not a newly born disease, it has been with human race from long back but, we came to knew about it in 1552 B.C. Since this period, many of Greek as well French physicians had worked on it and made us aware of the nature of disease, organs responsible for it etc. In 1870s, a French physician had discovered a link between Diabetes and diet intake, and an idea to formulate individual diet plan came into picture.

Diabetic diet was formulated with inclusion of milk, oats and other fiber containing foods in 1900-1915. Function of insulin, its nature, along with its use started from 1920 -1923, discovered by Dr. Banting, Prof. Macleod and Dr .Collip, who were awarded a Noble prize. In the decade of 1940, it has been discovered that different organs like kidney and skin are also affected if diabetes is creeping from a long term. A major turn in this research was in the year 1955, when the oral hypoglycemic drugs had been manufactured.

Diabetes was recognized with complete details and its types (Type 1and Type 2 diabetes - that is insulin dependent and non insulin dependent) in the year, 1959. As we know this is one of the old diseases, existing in many individuals and still on rising charts. Hence, scientists are continuously working to relieve us from it, by discovering the relevant drugs and making new researches.

According to W.H.O estimates, by 2025 total 300 million of the worldwide population will be affected by diabetes. For every 21 seconds, someone is diagnosed with diabetes, an estimation given by American Diabetes Association. And, there are 20.8 million diabetics in US at present, which is roughly estimated as 7% of US population, out of this figure about 6.2 millions are unaware of the diabetes existence in there life.





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Lloyd M. Aiello, MD, emerged from a period before 1960s where his patients went blind every year, mostly young adults, suffering from a complication of diabetes in which weak, leaky blood vessels proliferate in the retina, leading to hemorrhage and vision loss. Mr. Lloyd and his team in the year 1967 developed a new laser technology to create scars in the retinas of young women and men without destroying the entire eye. The researchers developed a way to focus a parallel beam of light on each patients retina, creating several hundred lesions on tiny regions of tissue , this technique is known as Panretinal photocoagulation. The patients remained awake for this laser surgery.

Aiello joins an elite group of physician-scientists and researchers, seven of whom have also won the Nobel Prize. Aiello received the prestigious Warren Alpert Foundation Prize on September 29 during a ceremony at Harvard Medical School (HMS) for improving the lives of patients with diabetes.

Reference:http://www.warrenalpert.org/award/


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THE INTERNATIONAL DIABETES FEDERATION
http://www.idf.org

The International Diabetes Federation (IDF) is an umbrella organization of over 200 national diabetes associations in over 160 countries. It represents the interests of the growing number of people with diabetes and those at risk. The Federation has been leading the global diabetes community since 1950. IDF's mission is to promote diabetes care, prevention and a cure worldwide. Led by the International Diabetes Federation, the Unite for Diabetes campaign secured a United Nations Resolution on diabetes in December 2006. The Federation continues to lead the global effort to implement Resolution 61/225 under the Unite for Diabetes banner. The Resolution encourages UN Member States to develop national policies for the prevention, treatment and care of diabetes in line with the sustainable development of their health-care systems, taking into account the internationally agreed development goals, including the Millennium Development Goals.



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Lions Aravind Institute of Community Ophthalmology,
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