Study methodology and diabetes control in patients from the non-English diabetes management project (NEDMP).

BACKGROUND: To describe the clinical characteristics of non-English speaking patients from the Diabetes Management Project (NEDMP), and compare their diabetes management and severity of diabetic retinopathy (DR) with the English-speaking DMP sample (EDMP). DESIGN: A prospective study was conducted on non-English speaking adults with diabetes who attended the Royal Victorian Eye and Ear Hospital. PARTICIPANTS: 136 (90.1%) non-English speaking adults were assessed, with a mean age of 72.2 years (range: 50-88 years); 74 (54.4%) were male. METHODS: Participants completed interviewer-administered questionnaires and underwent visual acuity, fundus photography, optical coherence tomography, biochemistry and anthropometric measurements. The EDMP assessed 609 patients in 2009 using a similar protocol. MAIN OUTCOME MEASURES: Type and duration of diabetes, diabetes control and diabetic retinopathy. RESULTS: A total of 127 (93.4%) and 8 (5.9%) participants reported having type 2 and type 1 diabetes, respectively, with a median (IQR) duration of 17 (14) years. The proportion of patients with poor diabetes control (HbA1c ≥ 7%) in the NEDMP was similar to the EDMP (64.0% and 68.2%, respectively; P = 0.411). A significantly higher proportion of patients with DR in the NEDMP were found to have poor diabetes control (HbA1c ≥ 7%) compared to those without DR (80.9% vs. 50.0%, P = 0.003). Almost two-thirds of NEDMP patients (74/118) had DR and 23% (27/115) had diabetic macular edema. The prevalence of DR was similar between the NEDMP and EDMP studies, ranging from 25-30% and 28-29%. CONCLUSIONS: The clinical characteristics, diabetes control, and DR severity of English and non-English-speaking patients were similar. The high proportion of poor diabetes management in non-English speaking patients with DR suggests educational and behavioural interventions to improve glycaemic control are warranted.

Relationship between diabetic retinopathy, diabetic macular oedema and erectile dysfunction in type 2 diabetics.

BACKGROUND: To investigate the relationship of diabetic retinopathy and diabetic macular oedema with erectile dysfunction in patients with type 2 diabetes. DESIGN: Hospital-based, cross-sectional study. PARTICIPANTS: Three hundred twenty-four men with diabetes from the Diabetic Management Project were recruited. METHODS: Participants underwent a comprehensive interview, a complete eye examination, fasting blood tests, and had retinal and macula assessments using fundus images and optical coherence tomography, respectively. Diabetic retinopathy was categorized as none, mild, moderate, severe non-proliferative and proliferative, and diabetic macular oedema as none, mild, moderate and severe. Erectile dysfunction was defined as problems achieving or maintaining an erection and was assessed using a self-reported questionnaire. MAIN OUTCOME MEASURES: Erectile dysfunction. RESULTS: The mean ± standard deviation age of 324 men with type 2 diabetes was 65.2 ± 11.1 years. Compared with patients without diabetic retinopathy, those with any retinopathy (odds ratio 2.06, 95% confidence interval 1.22-3.48, P = 0.007) had a twofold increased odds of having erectile dysfunction. Patients with severe non-proliferative diabetic retinopathy (odds ratio 4.39, 95% confidence interval 1.48-13.0, P = 0.008) and proliferative diabetic retinopathy (odds ratio 2.74, 95% confidence interval 1.44-5.19, P = 0.002) had fourfold and threefold increased odds of having erectile dysfunction, respectively, compared with those without diabetic retinopathy. Diabetic macular oedema, irrespective of presence or severity, was not independently associated with erectile dysfunction. CONCLUSION: The presence and severity of diabetic retinopathy but not diabetic macular oedema are independently associated with self-reported erectile dysfunction.

Longer axial length is protective of diabetic retinopathy and macular edema.

PURPOSE: To assess the association of ocular biometric parameters and refractive error with diabetic retinopathy (DR) and diabetic macular edema (DME) in persons with diabetes. DESIGN: Cross-sectional, clinic-based study. PARTICIPANTS: Patients with diabetes aged 18 years or more from the Royal Victorian Eye and Ear Hospital, Victoria, Australia. METHODS: Spherical equivalent (SE) refraction was assessed using objective autorefraction. Axial length (AL), corneal curvature (CC), and anterior chamber depth (ACD) were measured using the IOLMaster (Carl Zeiss Meditech AG, Jena, Germany). Diabetic retinopathy was graded from 2-field retinal photographs using the modified Airlie House classification system. Diabetic macular edema was defined as absent or present from fundus photographs and confirmed by optical coherence tomography (Stratus, Carl Zeiss Meditech AG). MAIN OUTCOME MEASURES: Severity of DR was grouped as no DR, mild DR (Early Treatment of Diabetic Retinopathy Study [ETDRS] = 20), moderate DR (ETDRS = 31-43), and severe DR (ETDRS >43). Diabetic macular edema severity was classified as mild, moderate, or severe. RESULTS: A total of 208 of 630 eyes (33.0%) had DR. In multivariate models, eyes with longer AL were less likely to have mild (odds ratio [OR], 0.58; 95% confidence interval [CI], 0.41-0.83; P = 0.006 per mm increase), moderate (OR, 0.73; 95% CI, 0.60-0.88; P = 0.002), and severe DR (OR, 0.67; 95% CI, 0.53-0.85; P=0.01), and had a lesser risk of mild (OR, 0.70; 95% CI, 0.56-0.86; P < 0.001) and moderate DME (OR, 0.72; 95% CI, 0.56-0.93; P=0.002) but not severe DME. No association was found for SE, ACD, and CC with DR. CONCLUSIONS: In persons with diabetes, eyes with longer ALs are less likely to have DR and DME.

Methodology and early findings of the Diabetes Management Project: a cohort study investigating the barriers to optimal diabetes care in diabetic patients with and without diabetic retinopathy.

BACKGROUND: The Diabetes Management Project is investigating the clinical, behavioural and psychosocial barriers to optimal diabetes care in individuals with and without diabetic retinopathy. DESIGN: Prospective cohort. PARTICIPANTS: Two hundred and twenty-three and 374 patients without and with diabetic retinopathy, respectively. METHODS: All individuals underwent a comprehensive dilated eye test, anthropometric measurements, blood and urine samples, and psychosocial questionnaires. MAIN OUTCOME MEASURES: Good glycaemic control was defined as glycosylated haemoglobin < 7%, good blood pressure control as systolic and diastolic values ≤130 and 80 mmHg, respectively, and good diabetes control as glycosylated haemoglobin < 7% and blood pressure values ≤130 and 80 mmHg. RESULTS: Four hundred and one males (65.4%) and 212 females (34.6%) aged 26-90 years (mean age ± standard deviation = 64.6 ± 11.6) were examined. The median glycosylated haemoglobin for all participants was 7.5% (interquartile range = 1.7%). Average systolic and diastolic blood pressure values were 139.7 mmHg (standard deviation = 18.8) and 92.7 mmHg (standard deviation = 30.9), respectively. Initial data analyses indicate that over two-thirds of participants with diabetes have poor glycaemic control, which was worse in those with diabetic retinopathy compared with those without (76.3% vs. 49.3%; P < 0.001). Blood pressure control was similar for those with and without diabetic retinopathy, with almost a third (28.5%) of the total sample having poor blood pressure control. Overall, those with diabetic retinopathy had poorer diabetes control than those without (24.3% vs. 13.7%; P = 0.002). CONCLUSIONS: Our findings substantiate the implementation of the Diabetes Management Project, developed to assess factors associated with suboptimal diabetes care.

The relationship of retinal vessel caliber with erectile dysfunction in patients with type 2 diabetes.

PURPOSE: To investigate the relationship of retinal vessel caliber with erectile dysfunction (ED) in males with type 2 diabetes. METHODS: A hospital-based cross-sectional study. Male patients with type 2 diabetes were recruited from the Diabetic Management Project. All underwent a complete eye examination, a comprehensive interview, and blood and urine tests. Retinal vessel diameter was measured from retinal photographs by trained graders using semiautomated software. ED was defined as problems achieving or maintaining an erection and was assessed using a self-reported questionnaire. RESULTS: A total of 289 male patients with a mean (±SD) age of 65.3 years (±11.2) were assessed. After adjusting for age, diastolic blood pressure, duration of diabetes, HbA1c, total cholesterol, presence of diabetic retinopathy, and any diabetic complication, narrower retinal arteriolar diameter (odds ratio [OR] 1.66; 95% confidence interval [CI] 1.09-2.54; P = 0.019) and wider venular diameter (OR 1.58; 95% CI 1.03-2.44; P = 0.038) were associated with ED. CONCLUSIONS: Narrower retinal arteriolar and wider venular diameter are independently associated with an increased risk of self-reported ED. These results suggest a microvascular component in the pathogenesis of this condition.

Impact of diabetic retinopathy on patients' beliefs about diabetes.

BACKGROUND: The aim was to compare beliefs about diabetes and determine their associations with psychological well-being, self-management behaviour and glycaemic control in those with and without diabetic retinopathy (DR). METHODS: We recruited 400 patients with diabetes aged 18 years or more from specialised eye clinics, as part of the Diabetes Management Project (DMP). Two-field retinal photographs were taken to assess DR and detailed clinical and psychological well-being examinations were performed following standardised procedures. Glycaemic control was determined using glycated haemoglobin levels. We assessed beliefs about diabetes (diabetes-specific version of the Revised Illness Perception Questionnaire [IPQ-R]), self-management behaviour (Summary of Diabetes Self Care Activities [SDSCA]) questionnaire) and depression and anxiety (the Hospital Anxiety and Depression Scale [HADS]). RESULTS: Patients with DR (n = 256, 64 per cent) believed that they experienced more symptoms related to their diabetes, that diabetes had a greater impact on their life and that this condition was more unpredictable compared with those without DR (p < 0.05 for all). Patients with DR were also more engaged in glucose testing compared with those without DR. Furthermore, negative beliefs about diabetes were significantly associated with higher levels of depression and anxiety (p < 0.01) but not glycaemic control, regardless of DR and other diabetic complications. CONCLUSIONS: Patients with DR had more negative beliefs about diabetes than those without. We identified strong and consistent associations between negative beliefs and psychological outcomes regardless of diabetic complications. These findings suggest that management for patients with DR could include strategies to address negative beliefs about diabetes and manage the emotional implications of diabetes in addition to medical treatment.