A program was developed to improve independence, self-esteem, and glycemic control in patients with diabetes and blindness. Twenty-nine individuals with both insulin-dependent and noninsulin-dependent diabetes mellitus entered 12-week programs that included education focusing on diabetes self-management skills for the visually impaired, monitored exercise sessions, and group support. Glycated hemoglobin values fell from 13.0% +/- 0.6% (SEM) to 11.4% +/- 0.5% (P = .001). Exercise tolerance in a 12-minute walk test improved from 0.48 +/- 0.04 to 0.64 +/- 0.05 miles (P = .001). Marked improvements occurred in psychosocial indices, demonstrated through changes in the Rand Mental Health Index from 155 +/- 6 to 174 +/- 5 (P = .0001), the Rosenberg Self-Esteem Scale from 22 +/- 1 to 19 +/- 1 (P = .001), the Zung Depression Scale from 0.50 +/- 0.02 to 0.44 +/- 0.02 (P = .001), and the Diabetes Self-Reliance Test from 60 +/- 3 to 74 +/- 2 (P = .0001).
In addition to laboratory assessments of glucose meters, monitoring systems designed for the visually impaired must include adequate tactile and audible feedback features to allow for the acquisition and placement of appropriate blood samples.
A case report D iabetic retinopathy is one of the major complications of diabetes, and it is the most common cause of blindness. Following the recommendation of the management guidelines for type 2 diabetes, we have established a routine screening for diabetic complications in our clinics (1). Although nonmydriatic fundus photography was widely used for screening of diabetic retinopathy, less attention has been directed toward the correlation between asymmetric retinopathy (i.e., more advanced retinopathy in one eye and no retinopathy in the other) and carotid artery disease. Here, we are reporting on a diabetic patient with asymptomatic internal carotid artery (ICA) occlusion who presented with significantly asymmetric retinopathy found by nonmydriatic fundus photography in our routine screening clinic.A 59-year-old man with a known history of hypertension, type 2 diabetes, and dyslipidemia for ϳ10 years was regularly followed up in our hospital. Routine screening with nonmydriatic fundus photography found asymmetric retinopathy with hemorrhagic and cotton wool spots in the left eye and no retinopathy in the right eye ground. (Fig. 1). After noting this finding, we asked the patient about possible neurological symptoms. Only mild vision deterioration in the left eye was noted in the past 10 days. Because it did not hinder his daily life, he had not paid attention to the condition. He denied any other motor, sensory, or visual disturbances. There was no history of cigarette smoking, alcohol consumption, or previous surgical operation. On physical examination, his height and weight were 170 cm and 69 kg, respectively. His blood pressure was 138/90 mmHg, with a regular pulse and no carotid bruit or heart murmur. Examinations of the chest and abdomen produced normal results. No pitting edema was found in the extremities, the distal circulation was intact, and the bilateral ankle/brachial index was 1.06/1.06. No remaining evidence of any other neurological deficits was noted during normal sensory examinations and measurements of deep tendon reflexes and muscle power.The laboratory studies revealed a hemoglobin level of 13.4 g/dl, a platelet count of 258 ϫ 10 9 /l, fasting plasma glucose level of 175 mg/dl, a postprandial plasma glucose level of 153 mg/dl, HbA 1c value of 6.9%, a creatinine level of 0.8 mg/dl, total cholesterol level of 275 mg/dl, triglyceride 690 mg/dl, and urinary albumin excretion count of 30-300 mg/g creatinine. We further performed a carotid ultrasound examination, and found total occlusion of the left ICA and mild plaque in the right ICA (Fig. 2). After weighing the risk of stroke during medical management versus the risks of surgery, the patient was prescribed aspirin 650 mg/day for antiplatelet L E T T E R S , normal in the right eye, (A) and preproliferative retinopathy with cotton wools and hemorrhagic spots in the left eye fundus (B). 1430DIABETES CARE, VOLUME 23, NUMBER 9, SEPTEMBER 2000 Letters therapy, buflomedil 150 mg 3 times a day for reducing risks of myocardial infarction, stroke...
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