Analysis of changes in the organ of vision in patients with long-term diabetes mellitus based on the endocrinology department of the A. Novak Transcarpathian Regional Clinical Hospital (Transcarpathian Regional Council)
DOI:
https://doi.org/10.32782/2077-6594/2024.1/15Keywords:
diabetic retinopathy, diabetic macular edema, vascular endothelial growth factor inhibitors, pan-retinal laser angioplasty, closed vitrectomy, monitoringAbstract
Results of the study and their discussion. As a result of the examination in both groups, more than half of the patients had a condition on the fundus that threatens to lose visual function soon. In the group with type I diabetes (12 patients), proliferative diabetic retinopathy was detected in 14 eyes (58,3%) and diabetic macular edema in 7 (29,1%) eyes. Accordingly, in the group with type II diabetes, proliferative diabetic retinopathy was detected in 6 eyes (20,0%), and diabetic macular edema was diagnosed in 12 eyes (40,0%). In addition to changes in the fundus, complicated cataracts were diagnosed in 12 eyes (50,0%) in the first group and 24 eyes (80,0%) in the second group. In the group of patients with type I diabetes mellitus, at the time of the examination, 8 eyes (33,3%) underwent closed vitrectomy, 8 eyes had already undergone pan-retinal laser coagulation, and 6 eyes had intravitreal injection of a vascular endothelial growth factor inhibitor according to the scheme. To stabilize the disease process, it is necessary to perform a closed vitrectomy in one eye, pan-retinal laser coagulation in 9 eyes, continue intravitreal medication in 6 eyes, and start in 7 other eyes. When asked, only 5 out of 12 patients (41,6%) agreed to treatment shortly. In the group of patients with type II diabetes mellitus, at the time of the examination, PRLA was performed in 4 eyes, the treatment, namely intravitreal injection of VEGF ("Eylea") according to the scheme is underway in 4 eyes. To stabilize the disease process shortly, it is necessary to perform closed vitrectomy in two eyes, pan-retinal laser coagulation in 14 eyes, continue intravitreal injection in 4 eyes, and start in 6 other eyes. During the survey, only 8 patients out of 15 (53,3%) agreed to be given treatment soon. In both groups, in addition to the surgical interventions required to stabilize the fundus, it is necessary to perform surgical interventions for lens opacification. In the group with type I diabetes in 12 eyes, and in the group with type II diabetes in 24 eyes. Conclusions. Changes in the organ of vision in patients with diabetes mellitus types I and II with a disease period of more than 25 years are severe and can lead to irreversible loss of visual functions. The necessary treatment in order to preserve the visual functions and prevent the hard complications in the given category of patients should be individual and comprehensive and include high surgical technologies.
References
Атлас: Діабет в Україні. 2021;(1):140. ttps//diabetesatlas.com.ua/ua.
Sims EK, Alice LJ, Carr ALJ, et al. 100 years of insulin: celebrating the past, present and future of diabetes therapy. Nat Med. 2021 Jul; 27(7): 1154–1164. DOI: 10.1038/s41591-021-01418-2
Tambascia MA, Eliaschewitz FG. Degludec: the new ultra-long insulin analogue. Diabetol Metab Syndr. 2015 Jun 26;7:57. DOI: 10.1186/s13098-015-0037-0. PMID: 26136850; PMCID: PMC4486707.
Becker RH, Dahmen R, Bergmann K, et al. New insulin glargine 300 Units/mL-1 provides a more even activity profile and prolonged glycemic control at steady state compared with insulin glargine 100 Units/mL-1. Diabetes Care. 2015;38(4):637-643. DOI: 10.2337/dc14-0006.
Davis A, Kuriakose J, Clements JN. Faster Insulin Aspart: A New Bolus Option for Diabetes Mellitus. Clin Pharmacokinet. 2019;58(4):421-430. DOI: 10.1007/s40262-018-0696-8
Cito M, Pellegrini S, Piemonti L, Sordi V. The potential and challenges of alternative sources of β cells for the cure of type 1 diabetes. Endocr Connect. 2018 Mar;7(3):R114-R125. DOI: 10.1530/EC-18-0012. PMID: 29555660; PMCID: PMC5861368.
Pellegrini S, Sardi V, Pemonti L. Zameshchenie beta-kletok podzheludochnoi zhelezy pri sakharnom diabete // Sakharnyi diabet. 2013;16(3):11-20. DOI: 10.14341/2072-0351-812
Kovatchev BP, Breton M, Man CD, Cobelli C. In silico preclinical trials: a proof of concept in closed-loop control of type 1 diabetes. J Diabetes Sci Technol. 2009;3(1):44-55. DOI: 10.1177/193229680900300106
Kesavadev J, Saboo B, Krishna MB, et al. Evolution of Insulin Delivery Devices: From Syringes, Pens, and Pumps to DIY Artificial Pancreas. Diabetes Ther. 2020;11:1251-1269. DOI:10.1007/s13300-020-00831-z
Schernthaner G., Schernthaner G-H. The right place for metformin today. Diabetes Research and Clinical Practice. 2020; 159.107946, ISSN 0168-8227, DOI: 10.1016/j.diabres.2019.107946.
Чекман ІС, ОВ Клименко. Комбінована фармакотерапія цукрового діабету 2-го типу. Раціональна фармакотерапія. 2016;2 (39):25–31 https://rpht.com.ua/ua/archive/2016/2%2839%29/pages-25-31/kombinovana-farmakoterapiya-cukrovogo-diabetugo-tipu-
Aguilar RB. Evaluating Treatment Algorithms for the Management of Patients With Type 2 Diabetes Mellitus: A Perspective on the Definition of Treatment Success. Clinical Therapeutics. 2011. 33(4): 408-424 DOI 10.1016/j.clinthera.2011.04.008
Perusicová J. Inkretinová strategie lécby diabetes mellitus 2. typu--inhibitor DPP-IV sitagliptin [Incretin strategy in the treatment of type 2 diabetes mellitus--the DPP-IV inhibitor sitagliptin]. Vnitr Lek. 2007 Oct;53(10):1109-13. Czech. PMID: 18072437.
Vivian E.M. Dapagliflozin: A new sodium–glucose cotransporter 2 inhibitor for treatment of type 2 diabetes. Am J Health-Syst Pharm. 2015; 72 (1): 361-372. DOI: 10.2146/ajhp140168
Blonde L, Montanya E. Comparison of liraglutide versus other incretin-related anti-hyperglycaemic agents. Diabetes, Obesity and Metabolism. 2012; 14 ( 2): 20-32. DOI: 10.1111/j.1463-1326.2012.01575.x
Bourne RR, Stevens GA, White RA, Smith JL, Flaxman SR, Price H, et al. Causes of vision loss worldwide, 1990-2010: a systematic analysis. Lancet Glob Health. 2013;1(6):339-349. DOI: 10.1016/S2214-109X(13)70113-X
Cavan D, Makaroff L, Fernandes J, da Rocha et al. The Diabetic Retinopathy Barometer Study: Global perspectives on access to and experiences of diabetic retinopathy screening and treatment. Diabetes Research and Clinical Practice. 2017, 129:16-24, ISSN 0168-8227. DOI: 10.1016/j.diabres.2017.03.023.
Kropp M, Golubnitschaja O, Mazurakova A, Koklesova L, Sargheini N, Vo TKS, de Clerck E, Polivka J Jr, Potuznik P, Polivka J, Stetkarova I, Kubatka P, Thumann G. Diabetic retinopathy as the leading cause of blindness and early predictor of cascading complications-risks and mitigation. EPMA J. 2023 Feb 13;14(1):21-42. DOI: 10.1007/s13167-023-00314-8. PMID: 36866156; PMCID: PMC9971534.
Blindness and Vision Impairment Collaborators; Vision Loss Expert Group of the Global Burden of Disease Study, "Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: The Right to Sight: an analysis for the Global Burden of Disease Study," Lancet Glob Health.2021;9:144. PMID: 33275949 DOI: 10.1016/S2214-109X(20)30489-7
Wolfensberger TJ, Hamilton AM. Diabetic retinopathy – an historical review. Semin Ophthalmol. 2001;16(1):2−7. DOI: 10.1076/соф.16.1.2.4220
Shah AR, Gardner TW. Diabetic retinopathy: research to clinical practice. Clin Diabetes Endocrinol. 2017;3(1):9. DOI: 10.1186/s40842-017-0047-y
Shukla UV, Tripathy K. Diabetic Retinopathy. [Updated 2023 Aug 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560805/
International Council of Ophthalmology. ICO guidelines for diabetic eye care. ICO; 2017. Available from: http://www.icoph.org/downloads/ICOGuidelinesforDiabeticEyeCare.pdf
Das A, Stroud S, Mehta A, Rangasamy S. New treatments for diabetic retinopathy. Diab Obes Metab. 2015;17(3):219−230. DOI: 10.1111/dom.12384
American Diabetes Association. Glycemic targets: standards of medical care in diabetes 2019. Diabetes Care. 2019;42(Suppl 1):S561−S570. DOI: 10.2337/dc19-S006
De Boer IH, Bangalore S, Benetos A, et al. Diabetes and hypertension: a position statement by the American diabetes association. Diabetes Care. 2017;40(9):1273−1284. DOI: 10.2337/dci17-0026
Chew EY, Ambrosius WT, Davis MD, et al.; ACCORD Study Group, ACCORD Eye Study Group. Effects of medical therapies on retinopathy progression in type 2 diabetes. N Engl J Med. 2010;363(3):233−244. DOI: 10.1056/NEJMoa1001288
Kawasaki R, Tanaka S, Tanaka S, et al. Risk of cardiovascular diseases is increased even with mild diabetic retinopathy: the Japan diabetes complications study. Ophthalmology. 2013;120(3):574−582. DOI: 10.1016/j.ophtha.2012.08.029
Kramer CK, Rodrigues TC, Canani LH, et al. Diabetic retinopathy predicts all-cause mortality and cardiovascular events in both type 1 and 2 diabetes: meta-analysis of observational studies. Diabetes Care. 2011;34(5):1238−1244. DOI: 10.2337/dc11-0079
