United Kingdom Prospective Diabetes Study

These studies are notable for two additional findings. First, there is no threshold below which diabetic retinopathy does not occur when glycosylated haemoglobin is elevated rather, there is a linear relationship between achieved glycosylated haemoglobin level and the risk for visual complications of diabetes. Secondly, persons receiving intensive control had a significant rate of hypoglycaemic reactions, which might argue against such aggressive control in every situation. The choice of a...

Delivery of eye care for patients with diabetes

Despite clearly defined clinical guidelines for evaluating and treating diabetic retinopathy in a cost-effective manner, effective interventions, such as laser treatment, are underused, for a variety of reasons. While the available resources and methods differ from country to country, certain basic components of care should be present. Patients should know that they have diabetes mellitus and that the condition requires care. General population screening for diabetes mellitus with existing...

Expected 0UtC03e Recommendation regarding the diabetic retinopathy content of

Diabetic patient education materials. Drafts of screening protocols for the early detection of diabetic retinopathy in different health care settings. Strategies for prevention of blindness due to diabetes with the pubic health perspective and as appropriate to existing resources and different levels of technological application. Identification of opportunities and approaches to improve interaction and collaboration between eye care providers and other members of the diabetes management team.

Global Prevalence Of Diabetes Mellitus And Its Complications

2 ' Current burden Diabetes mellitus is among the leading causes of death, disability and ' economic loss throughout the world (2,3). WHO has estimated that there and trends were 171 million people worldwde with diabetes mellitus in 2000 and predicted that 366 million people will have diabetes mellitus by 2030 (4). The increase will be due mainly to increases in low- and middle-income countries (Figure 1). The International Diabetes Federation has estimated that another 314 million persons have...

Evaluate use by health care workers of standardized reference photographs and direct ophthalmoscopy as a lowcost

As noted in section 5, this approach, involving general health care workers, probably offers an acceptable level of performance, as observed in other areas of eye care delivery (e.g. trachoma). Demonstrating that this is the case will be essential to its widespread adoption and acceptance by the societies and populations that might benefit most from such services. This information will also be necessary to provide the basis for informed decisions about trade-offs between cost and performance.

References

Diabetes care and research in Europe the Saint-Vincent Declaration. Diabetic medicine 7 360-364 1990 2. Roglic G et al. The burden of mortality attributable to diabetes realistic estimates for the year 2000. Diabetes Care, 2005, 28 2130-2135. 3. Beaglehole R, Epping-Jordan J. Preventing chronic diseases, a vital investment. Geneva, World Health Organization, 2005. 4. Wild S et al. Global prevalence of diabetes estimates for the year 2000 and projections for 2030. Diabetes Care, 2004, 27...

Alternatives in eye care for patients with diabetes mellitus

The consultation strongly recommended that, if a screening and detection programme is implemented, resources be found for necessary laser treatment. From a pubic health perspective, detecting disease that cannot be treated is a poor use of resources. The participants recognized the importance of finding new methods for providing the resources necessary to deliver care within the changing international intelectual property rights regime. While education regarding the presence of retinopathy that...

Principles in assessing methods of care

In assessing approaches to improving the care system, through technological means alone or in support of health care providers, four questions must be answered. The first concern is to determine the purpose of any proposed system. The necessary performance standards and criteria by which to judge the success of new approaches or approaches other than gold standards, vary according to the goals of the system. For example, a system designed to screen for a threshold referral level of retinopathy...

Technical issues in the use of standard photographic images

In view of the interest in photographic systems, much work has been devoted to specific technical issues (72,75), including the number of photographs needed the fields to be used if the full seven-field set is not used whether photographs should be taken through dilated pupils and who should interpret the photographs. In 2004, the American Academy of Ophthalmology concluded that, in the United States, single-field photography is adequate for screening for the purpose of detecting diabetic...

Nonophthalmic health professionals

Having to see yet another doctor (an ophthalmologist) presents an additional burden (59). Thus, being able to see just one doctor for comprehensive diabetes care enhances the continuity of care and thus the ability to receive higher quality care. General practitioners are usually best paced to situate the risk for vision loss for each patent as part of the overall care strategy for diabetes, as the known rsk factors for retinopathy are among the conditions managed by the general practitioner or...

Conduct International research into systemic deficiencies in health and eye care that contribute to blindness from

Improvements to increase the cost-effectiveness of eye care for diabetes patients are a global necessity. Blindness due to diabetic retinopathy occurs in part because factors important to both patients and health care providers have not been recognized or incorporated into current diabetes education, screening and treatment programmes. Systems analyses are needed in various cultures to understand better why patients with diabetic retinopathy go bind, particularly when the technical knowledge...

Evaluation and improvement of eye care for patients with diabetes mellitus

In assessing approaches to improving the care system, it is important to (i) determine the purpose of the proposed system, for example, to screen for a threshold referral level of retinopathy or to provide guidance in management (ii) assess the performance of the system relative to that of the gold standard, in order to identify trade-offs (ii) assess the success and actual performance of different eye care systems in various settings and (iv) understand how patients perceive the benefits of...

Principles for organizing an eye health system for the care of diabetic retinopathy

The consultation sought to address care for diabetic retinopathy from a perspective that would be applicable across diverse settings, such that the insights and lessons acquired in one area or context could be shared to make current and future initiatives more effective. The decisions made by each country are adapted to that country's resources, social expectations and available health care infrastructure. There is always a trade-off between technical performance and costs, and no country can...

A uniform classification system should be adopted

It is recommended that the International Clinical Classification of Diabetic Retinopathy (See Annex 3.), which provides a sound scientific bass for a uniform grading system, be used as an acceptable minimum standard for assessing diabetic retinopathy in programmes for prevention of blindness. This system provides a simplified but sound scientific basis for uniform grading by general ophthalmologists who have a basic understanding of diabetic retinopathy and skills in evaluating the retina. It...

Agenda purpose and expected outcome

The global burden of diabetes mellitus and complications Current burden and trends Diagnosis and classification of complications of diabetes mellitus Clinical practice guidelines for diabetes and its complications Eye care deficiencies contributing to blindness from diabetic retinopathy Improving integration of eye care within diabetes management Patient and pubic education and awareness Core content of patient and pubic diabetic retinopathy education Materais Disease and its complications...

Appropriate followup intervals

Once diabetes mellitus has been diagnosed and patients have had an initial eye assessment, of any kind, they must continue eye care. As there is no cure for diabetes mellitus, prevention of vsion loss requires regular examinations. Nevertheless, there are significant problems in ensurng appropriate follow-up. The shortfall in efforts to ensure approprate follow-up is illustrated by studies showing that only 68-85 of patients referred for treatment start the treatment, and only 85 who start...

Use of photographic systems by nonphysician nonprofessional providers

The use of non-physician health care professional examiners for detecting diabetic retinopathy has been coupled with use of photographic systems in the United Kingdom (84,85). The performance of trained photographic readers using a Polaroid camera system has matched or exceeded that of physicians and optometrcs. An accuracy of more than 90 in staging retinopathy has been reported with a modified Early Treatment Diabetic Retinopathy Study system that is similar to the International Clinical...

Education about eye health among patients with diabetes should be patientcentred

Public awareness about diabetes mellitus and diabetic retinopathy is lacking in all societies. It is recommended that health education about these conditions be intensified, and education material and campaigns be oriented to address issues from the patient perspective and not solely that of the provider. Providers and organizations should therefore reassess their educational campaigns and change them into marketing campaigns. Health education must involve local populations and health care...