Purpose To clarify the relationship between diabetic retinopathy (DR) and maculopathy (DM) and explore the clinical implication of independent graduation of DM. Methods Fundus fluorescein angiography and routine ophthalmological examination were performed on 582 cases of diabetes.Their ocular fundi and macular impairments were graded. Results In general,the severity of diabetic macular impairment was accompanied by retinal involvement,but discrepancy existed between DM and DR.Degree I DM occurred in 5.4% (16/294) among cases without DR,in stage IV DR,degree Ⅲ DM accounted for the most part ,54.5% (116/213).There were still 5.1% (2/39) cases without DM in stage Ⅴ DR. Conclusion The degree of the macular lesions in DM is often not in parallel with the gradation of general affections in retinal tissue other than in macular region in DR,therefore,independentg radation of diabetic maculopathy has its clinical significance for choosing the optimal period of treating maculopathy and preserving the macular function. (Chin J Ocul Fundus Dis,2000,16:153-154)
ObjectiveTo observe and analyze the correlation between time within target glucose range (TIR) and hemoglobin A1c (HbA1c) and the risk of diabetic retinopathy (DR). MethodsA retrospective clinical study. From March 2020 to August 2021, 91 patients with type 2 diabetes mellitus (T2DM) who were hospitalized in Department of Endocrinology and Metabolic Diseases, Affiliated Hospital of Weifang Medical University, were included in the study. All patients underwent Oburg's no-dilatation ultra-wide-angle laser scan ophthalmoscopy, HbA1c and continuous glucose monitoring (CGM) examinations. According to the examination results and combined with the clinical diagnostic criteria of DR, the patients were divided into non-DR (NDR) group and DR group, with 50 and 41 cases respectively. The retrospective CGM system was used to monitor the subcutaneous interstitial fluid glucose for 7 to 14 consecutive days, and the TIR was calculated. Binary logistic regression was used to analyze the correlation between TIR, HbAlc and DR in patients with T2DM0. At the same time, a new indicator was generated, the predicted probability value (PRE_1), which was generated to represent the combined indicator of TIR and HbA1c in predicting the occurrence of DR. The receiver operating characteristic curve (ROC curve) was used to analyze the value of TIR, HbAlc and PRE_1 in predicting the occurrence of DR. ResultsThe TIR of patients in the NDR group and DR group were (81.58±15.51)% and (67.27±22.09)%, respectively, and HbA1c were (8.03±2.16)% and (9.01±2.01)%, respectively. The differences in TIR and HbA1c between the two groups of patients were statistically significant (t=3.501,－2.208; P=0.001, 0.030). The results of binary logistic regression analysis showed that TIR, HbA1c and DR were significantly correlated (odds ratio=0.960, 1.254; P=0.002, 0.036). ROC curve analysis results showed that the area under the ROC curve (AUC) of TIR, HbA1c and PRE_1 predicting the risk of DR were 0.704, 0.668, and 0.707, respectively [95% confidence interval (CI) 0.597-0.812, P=0.001; 95%CI 0.558-0.778, P=0.006; 95%CI 0.602-0.798, P=0.001]. There was no statistically significant difference between TIR, HbA1c and PRE_1 predicting the AUC of DR risk (P>0.05). The linear equation between HbAlc and TIR was HbAlc (%) = 11.37－0.04×TIR (%). ConclusionsTIR and HbA1c are both related to DR and can predict the risk of DR. The combined use of the two does not improve the predictive value of DR. There is a linear correlation between TIR and HbAlc.
Objective To verify the effect of Evans blue dye on determining the retina blood vessel leakage． Methods Male Sprague-Dawley rats were used in this study． The VEGF induced retinal blood vessel leakage was checked with Evans blue dye． Then the bloodretina barrier breakdown of 1 week diabetic animals was quantified with Evans blue．The dye was extracted from retina by formamide and the extraction was checked with spect rophotometer． Evans blue leakage was normalized against wet or dry retina weight． Results The retinal Evans blue content of eyes treated with VEGF was remarkably higher than that of the controls (n=17 ,Plt;0．0001)． And the eyes of 1 week diabetic duration animals had more Evans blue dye than that of the normal controls (Plt;0．05)． Conclusion Evans blue dye is a sensitive tracer in quantitatively diagnosing the blood retina barrier breakdown． (Chin J Ocul Fundus Dis, 2001,17:221-223)
Objective To investigate the effect of the damage and functional change of vascular endothelial cells (VEC) on diabetic retinopathy(DR). Methods Circulating endothelial cell (CEC) number and plasma endothelin(ET) level were measured in 18 normal control subjects and 55 patients with diabetes mellitus (DM) consisting of 20 cases of DM with out retinopathy,20 cases of DM with-background diabetic retinopathy and 15 cases of DM with proliferative diabetic retinopathy. Results CEC number and plasma ET level in DM were significantly higher than those in normal subjects(Plt;0.001)respectively.With the progression of DR,CEC number was significantly elevated and plasma ET level was gradually elevated.There was significant positive correlation between CEC number and plasma ET level (r=0.738,Plt;0.001,n=55). Conclusion VEC damage and elevated plasma ET level induced by VEC damage may play an important role in the development and progression of DR. (Chin J Ocul Fundus Dis,2000,16:166-168)
Objective To evaluate the change of blood sugar in diabetic patients after vitrectomy and analyze the relative reasons. Methods Nineteen diabetes II patients (20 eyes) who underwent vitrectomies received the tests of blood sugar preoperatively, and 1～2 hours, 1, 3, and 5 days postoperatively. Analysis of variance, apaired Studentrsquo;s t-test, and correlation analysis were used to analyze the change of postoperative blood sugar and correlation between postoperative blood sugar change and its relative factors. Results Postoperative blood sugar increased significantly compared with the preoperative one (Plt;0.05),reached the peak 1～2 hours postoperatively, and reached almost the preoperative level 5 days postoperatively (Pgt;0.05). There was a positive correlation between blood sugar increase and operation time, preoperative blood sugar level, and diabetic duration (Plt;0.05). Postoperative blood sugar was relative to potentiated anesthesia. Conclusion There is a regularity that blood sugar increases just postoperatively and reaches the preoperative level 5 days postoperatively. The relative factors to blood sugar change include preoperative blood sugar level, diabetic duration, operation time, and potentiated anesthesia. (Chin J Ocul Fundus Dis,2000,16:157-159)
The Standards of Medical Care in Diabetes released by the American Diabetes Association (ADA) is one of the most important guidelines for clinicians. Based on the latest evidence of clinical studies, the Standards of Medical Care in Diabetes is annually updated by ADA. The statements of ADA on diagnosis, assessment, and management in diabetes are recommended for clinicians, patients, and researchers. The latest edition of Standards of Medical Care in Diabetes was published in a supplementary issue of Diabetes Care in January 2018. This interpretation will focus on the updated contents and their best evidence and clinical importance in this guideline.
Purpose To study changes of cell cycle of vascular endothelial cell in non-proliferative diabetic retinopathy. Methods Alloxan induced Wistar-rats were employed and immunohistochemistry,Western blotting methods were used. Results The vascular endothelial cells of retinas of 8～20 weeks diabetic rats were observe to be cyclinD1,cyclinD3,cyclinB1,p21 and p27 positive stained with light and electronmicroscopies.CyclinE immuno-stained vascular endothelial cells was observed occasionally.Meanwhile,the evidences of morphologic changes of the vascular en dothelial cells were proved:less plasma,thinner cell,more bubble organelles than those of controls.But,the ultra-structures of pericytes and other type of retinal cells did not change and they also immunostain negative.Komas blue and Western blotting methods also proved that the vascular endothelial cells of retina of 20th week diabetic rats expressed cyclinD1,cyclinB1,p21 and p27 protein. Conclusion Glucose induced retinal vascular endothelial cells of 8～20th weeks diabetic rats enter cell cycle and were arrested at G1/S restriction point.This study also suggested that retinal vascular endothelial cells may possess the ability to resist glucose damage and mechanism of selfstability during very early stage of diabetes. (Chin J Ocul Fundus Dis,2000,16:173-176)
Objective To investigate the correlation between systemic immune inflammatory index (SII) and other metabolic indicators and diabetic epiretinal membranes (dERM). MethodsA retrospective case-control study. From March 2022 to July 2023, 81 patients (81 eyes) with dERM in Department of Ophthalmology, Affiliated Jinhua Hospital of Zhejiang University of Medicine School diagnosed by fundus screening were included in the study. A total of 81 patients (81 eyes) with diabetes who were matched in age, gender, and duration of diabetes and had no dERM or diabetic macular edema in both eyes during fundus screening were selected as the control group. All patients underwent optical coherence tomography (OCT) examination and laboratory tests for peripheral blood neutrophil, lymphocyte, platelet counts, serum albumin, blood lipids, uric acid, and glycosylated hemoglobin (HbA1c). SII was calculated. Random urine samples were collected for urinary albumin/creatinine ratio (ACR) testing. The OCT device's own analysis software obtained the macular volume coefficient, including central foveal thickness (CMT), macular volume, and average macular thickness. The macular volume coefficient, SII, serum albumin, blood lipids, uric acid, HbA1c, and ACR between the two groups were compared using paired t tests or Mann-Whitney U tests. Conditional logistic regression analysis was performed to evaluate the risk factors for dERM; Spearman correlation test was used to analyze the correlation between CMT, SII, ACR, disorganization of retinal inner layers (DRIL), intraretinal cyst (IRC), and hyper-reflective foci (HRF) in patients with dERM. ResultsThere were significant differences in CMT, macular volume, average macular thickness, SII, serum albumin, and ACR between the dERM group and the control group (Z=−7.234, −6.306, −6.400, −3.063, −2.631, −3.868; P＜0.05). Conditional logistics regression analysis showed that high SII [odds ratio (OR)= 3.919, 95% confidence interval (CI) 1.591-9.654, P=0.003] and ACR (OR=4.432, 95%CI 1.885-10.420, P=0.001) were risk factors for dERM. Spearman correlation analysis showed that HRF, IRC, DRIL were positively correlated with CMT (Rs=0.234, 0.330, 0.248; P=0.036, 0.003, 0.026); HRF was positively correlated with SII and ACR (Rs=0.233, 0.278; P=0.036, 0.012). ConclusionElevated SII and ACR are independent risk factors for the occurrence of dERM.
Objective To explore the situation and causes of misdiagnosed hypoglycemia in China so as to develop some strategies for reducing misdiagnosis.Methods We searched CBMdisc, CMCC, CJFD and VIP (Jan. 1994-Dec. 2003). All the publisled studies about the misdiagnosis of hypoglycemia were collected to analyse their classifications and causes.Results A total of 172 studies involving 1 478 patients met the inclusion criteria. The studies were either case reports or clinical reviews. The 1 478 cases were misdiagnosed as 31 sorts of diseases, mainly including stroke (71.18%), transient ischemia attack (4.87%), epilepsy (4.13%) and hepatic coma (2.64%) . The causes of misdiagnosis could be classified into 14 categories, including complex manifestations of hypoglycemia (29.07%), lack of knowledge of hypoglycemic encephalopathy (16.44%), insufficient medical history collection (10.21%) and interference of compound diseases (9.86%) etc..Conclusions The misdiagnosis of hypoglycemia is mainly caused by the poor professional skills of doctors or their lack of responsibility, and poor patient management, especially when hypoglycemia are manifested by brain disability.
Objective To determine the trend in the causes of admission among diabetic patients in West China Hospital from 1996 to 2005. Methods The medical records of diabetic inpatients from January 1996 to December 2005 were retrieved, and half of them were randomly selected. A questionnaire was completed and SPSS13.0 software was used for statistical analyses. Results The most common causes of admission for diabetic patients were diabetic chronic complications (20.2%), infection (19.5%), hyperglycemic symptoms (11.7%), malignant tumor (8.9%) and diabetic acute complications (5.8%). The constituent ratios of diabetic macrovascular disease and malignant tumor as the admission causes tended to increase, while the constituent ratios of diabetic microvascular disease, hyperglycemic symptoms and diabetic acute complications tended to decrease. Infection remained as one of the main causes of admission among diabetic patients. Conclusion The main cause of admission to West China Hospital for diabetic patients from 1996 to 2005 was diabetic chronic complications.