With the twin epidemics of obesity and diabetes in the U.S., it comes as no surprise that we are seeing more and more patients in our offices with diabetic eye disease. 29.1 million Americans, representing 9.3% of the U.S. population, had diabetes in 2012, according to the National Diabetes Statistics Report, 2014, the latest government report available. Diabetic individuals are generally divided into two types: Type 1 and Type 2. Type 2 diabetes is the more common of the two types, and accounts for 95% of individuals with diabetes. Type 1 diabetics have autoantibodies directed against the insulin-producing islet cells of the pancreas which damages them and results in very little or no insulin secretion. These individuals have the onset of their diabetes early in life, often during childhood or the teenage years. Type 2 diabetics, on the other hand, are able to make insulin, but either not enough of it or resistance to its action develops impairing the uptake of glucose by the cells of the body. In both cases, abnormally high levels of glucose in the bloodstream results. Type 2 diabetics typically have the onset of their disease after age 40, and this type of diabetes is strongly correlated with obesity, high carbohydrate diets, and lack of exercise. Approximately 1.25 million children and young adults have Type 1 diabetes. Nearly a quarter of seniors, aged 65 or older, are diagnosed with diabetes, and 1.7 million new cases of diabetes are diagnosed each year. Diabetes rates vary by race and ethnicity also. The highest rates of diagnosed diabetes are among the Native Americans and Alaska Natives (15.9%), Puerto Ricans (14.8%), Mexican Americans (13.9%), and non-Hispanic blacks (13.2%), according to the National Diabetes Statistics Report, 2014. Diabetes is associated with several serious co-morbid conditions, including a 1.5 times increased risk for stroke and a 1.8 times increased risk of heart attack. High blood pressure and high cholesterol and/or triglyceride levels, which many diabetics also have, add to these risks. Kidney failure and the possible need for kidney dialysis, peripheral neuropathy, and diabetic retinopathy and vision loss are other possible serious complications of diabetes.
If one is at risk to develop diabetes, the so-called pre-diabetics, or has been diagnosed as having diabetes, there are several things one needs to do to reduce their chances of becoming diabetic or to improve their diabetic control. Reducing your intake of foods high in sugar and avoiding sugar-sweetened beverages such as sodas, sweet tea, and fruit juices is just the first step. One needs to be physically active every day. Participants in the Diabetes Prevention Program who exercised 30 minutes per day at least 5 days per week reduced their risk of developing diabetes by 71%. One can get this exercise by simply taking brisk walks, going to the gym and exercising, or by taking exercise classes. Your goal should be to be physically active every day. Another lifestyle change involves making wise food choices. Reduce the serving sizes of the foods you eat. Your doctor or a dietician can help you determine the total number of calories you should have per day. Increase the amount of fresh fruits and vegetables in your diet, and reduce the kinds of amounts of food containing fats, like cheese and other dairy products. Limit your fat intake to about 25% of your total calories. Good control of cholesterol and triglyceride levels is equally important as is glucose control in the diabetic patient. Limit your sodium (salt) intake to about 2300 milligrams, or about 1 teaspoon full, per day. If your blood pressure and/or cholesterol/triglyceride levels cannot be adequately controlled with diet and exercise alone, your doctor may prescribe medications to lower them. Finally you should strive to reach and maintain a reasonable body weight. Being overweight keeps your body from making and using insulin properly, and contributes to high blood pressure. Dietary changes and increased physical activity are the keys to weight loss. One should set a long-term goal of the loss of 5 – 7% of their total body weight if you are overweight or obese. If one cannot achieve normal blood glucose and hemoglobin A1C readings with a combination of diet, exercise, and weight loss, then your doctor may prescribe oral anti-diabetic medications or insulin for you.
Since the prevalence of diabetes and diabetes-associated retinopathy is increasing both in the United States and worldwide, it is most important for all diabetics to have regular screening eye examinations to detect the presence of any vision-threatening retinopathy. Presently, only about 60% of individuals with diabetes are getting these eye examinations. The current Diabetic Retinopathy PPP – 2014 published by the American Academy of Ophthalmology recommends that individuals diagnosed with Type 1 diabetes should have annual screening examinations beginning 5 years after the onset of their diabetes mellitus, and those with Type 2 diabetes should be examined at the time of their diagnosis and at least annually thereafter. There are several special diagnostic tests used to assess the presence and severity of diabetic retinopathy, and a wide range of treatment options specific to the eye are available now. These are the subject of other articles on this topic on our website.
Written by: Gary R. Cook, M.D.