Ophthalmic Examination Among Adults With Diagnosed Diabetes Mellitus

Brechner, Ross J.

doi:10.1001/jama.1993.03510140074032

Cited by 201 publications

(117 citation statements)

References 17 publications

Supporting

Mentioning

110

Contrasting

Unclassified

Order By: Relevance

“…Although at least 250 000 patients are estimated to develop STDR every year in the United States [36], until recently one-third of persons with diabetes had never had a dilated eye examination and about onehalf did not have one over the previous 2 years [37]. Although the best chances of preventing visual loss are when DR is treated before symptoms occur, about 1 in 5 patients are referred late to specialists [38].…”

Section: Diabetes-related Blindnessmentioning

confidence: 99%

Diabetic retinopathy

2002

View full text Add to dashboard Cite

Abstract. Easy observation of the fundus oculi makes retinopathy the most frequently reported chronic complication of diabetes and, consequently, the one we know best in terms of epidemiology and natural history. Achieving near-normal levels of blood glucose and blood pressure provides empirical though powerful tools for clinicians to delay the onset and progression of diabetic retinopathy. Even when these measures have failed and retinopathy becomes sight-threatening, laser photocoagulation has proven remarkably effective. Nonetheless, retinopathy remains a leading cause of blindness and there is little evidence that diabetes-related visual loss is decreasing in industrialized countries. This may result from the mixed blessing of prolonged survival of patients who had become diabetic when metabolic control was pursued less fastidiously than today. Screening for sight-threatening retinopathy is the most cost-effective medical procedure known and should help optimise the use of diagnostic and therapeutic resources, but its widest deployment still meets with inertia and lack of interest within most health care systems. Improving clinical skills and technology, however, allow us to take a more optimistic look at the future, as pathogenesis-targeted forms of treatment are being developed and tested through appropriately powered clinical trials. [Diabetologia (2002[Diabetologia ( ) 45:1617[Diabetologia ( -1634

show abstract

Section: Diabetes-related Blindnessmentioning

confidence: 99%

Diabetic retinopathy

2002

View full text Add to dashboard Cite

show abstract

“…This emphasizes the importance of the results found in this study and indicates a potential approach to reduce disparity. Other studies that have not found significant differences between racial/ethnic groups in health care [33][34][35][36] have either relied on patient survey data, 35,36 one health care procedure, 35 one payer type, 33 or a very small patient sample. It was hypothesized that America's urban safety net system might have achieved amelioration disparity for at least some outcomes given that these institutions have previously addressed a number of the issues which are believed to contribute to such disparity.…”

Section: Discussionmentioning

confidence: 99%

Can America’s Urban Safety Net Systems be a Solution to Unequal Treatment?

2008

View full text Add to dashboard Cite

Eliminating disparities in care for racial and ethnic minorities remains a challenge in achieving overall quality health care. One approach to resolving issues of inequity involves utilizing an urban safety-net system to address preventive and chronic care disparities. An analysis was undertaken at Denver Health (DH), an urban safety net which serves 150,000 patients annually, of which 78% are minorities and 50% uninsured. Medical charts for 4,795 randomly selected adult patients at ten DHassociated community health centers were reviewed between July 1999 and December 2001. Logistic regression was used to identify differences between racial/ethnic groups in cancer screening, blood pressure control, and diabetes management. No disparities in care were found, and in most instances, the quality of care met or exceeded available benchmarks, leading us to conclude that treatment in urban integrated safety net systems committed to caring for minority populations may represent one approach to reducing disparity.

show abstract

“…6,7 Despite the demonstrated effectiveness of laser therapy, it is estimated that only 35% to 60% of diabetic patients currently undergo annual retinal examination. 8 While less frequent screening may be indicated for those considered to be at low risk of developing retinopathy, 78 such as those without retinopathy at baseline and those with excellent glycemic control, formal risk-stratification based on these clinical indicators has not yet been widely implemented.…”

Section: Retinopathymentioning

confidence: 99%

“…Screening and early treatment for diabetic complications have been shown to be effective in reducing the incidence of end-stage disease 6,7 ; despite this evidence, implementation rates of recommended interventions are low. 8 This frequently leads to ineffective or delayed treatment of complications. [9][10][11] Because optimal diabetes care is a complex process, we developed a clinical care guideline to help busy clinicians incorporate prevention, screening, and treatment recommendations into practice.…”

mentioning

confidence: 99%

Screening, prevention, counseling, and treatment for the complications of type II diabetes mellitus

et al. 1997

View full text Add to dashboard Cite

PURPOSE:To summarize current knowledge of interventions that should improve the care of patients with type II diabetes mellitus. Interventions lie within the realms of prevention, screening, and treatment, all of which are focused on office practice. METHODS:Review of the literature by a multidisciplinary team involved in the care of patients with diabetes, followed by synthesis of the literature into a clinical care guideline. Literature was identified through consultation with experts and a focused MEDLINE search. MAIN RESULTS:An algorithm-based guideline for screening and treatment of the complications of diabetes was developed. The emphasis is on prevention of atherosclerotic disease, and prevention, screening, and early treatment of microvascular disease. Implementation of these practices has the potential to significantly improve quality of life and increase life expectancy in patients with type II diabetes mellitus. ype II diabetes is a common condition, affecting 2% to 3% of the adult population, and up to 20% to 25% of the elderly population. 1 Type II diabetes typically occurs in patients who are over 30 years old and weigh more than 120% of ideal body weight, and accounts for 90% of all cases of diabetes mellitus diagnosed in the United States. 1 Minorities have a prevalence of type II diabetes mellitus that is 2 to 6 times greater than that of white persons. The morbidity and mortality are higher for minorities than for white persons, and the rate is increasing. 2 The reasons for this disparity remain unclear, but could include differences in disease severity, comorbidities, or access to care.Diabetes has significant associated morbidity. Prevention and treatment of the complications of diabetes mellitus have the potential to improve quality of life and increase life expectancy. 3 The rate of cardiovascular disease is markedly elevated among patients with type II diabetes, leading to an increased mortality rate compared with the general population. 4,5 In addition, microvascular complications, which include retinopathy, nephropathy, and neuropathy, can progress to end-stage outcomes such as blindness, end-stage renal disease (ESRD), and amputation. Screening and early treatment for diabetic complications have been shown to be effective in reducing the incidence of end-stage disease 6,7 ; despite this evidence, implementation rates of recommended interventions are low. 8 This frequently leads to ineffective or delayed treatment of complications. 9-11 Because optimal diabetes care is a complex process, we developed a clinical care guideline to help busy clinicians incorporate prevention, screening, and treatment recommendations into practice. METHODSA multidisciplinary team was assembled to develop an evidence-based guideline for the prevention and treatment of complications of type II diabetes. The multidisciplinary team included members from endocrinology, family practice, general internal medicine, obstetrics-gyncecology, nursing, and postgraduate medicine departments. Team members have an interest ...

show abstract

Ophthalmic Examination Among Adults With Diagnosed Diabetes Mellitus

Cited by 201 publications

References 17 publications

Diabetic retinopathy

Diabetic retinopathy

Can America’s Urban Safety Net Systems be a Solution to Unequal Treatment?

Screening, prevention, counseling, and treatment for the complications of type II diabetes mellitus

Contact Info

Product

Resources

About