Proliferative retinopathy or macular edema in diabetics.

Some years ago just after I became a diabetic, I found this presentation by Professor Roy Taylor, MD, FRCP. Roy Taylor is one of the foremost diabetes experts in the UK. Roy deals in facts not fiction and the presentation left me stunned. Part of the general gist was the fact that diabetes was a progressive disease and good control did not change finale outcomes by an appreciable factor. “not because it's getting better. Unfortunately the people with the complication die” a sobering statement yes. I thought about this presentation and came to few conclusions that may be highly relevant to many diabetics. That it very important how a diabetic gets to good blood glucose numbers and also age is a very important factor. We know ramming down BG numbers with medication is not the answer, the ACCORD study proved this. Also some of the data although accurate and relevant was from a time when the majority of type two diabetics were older at diagnosis, i.e. middle aged or old aged. This could explain the high death rates in the type two slide.

Eddie


Let's consider type 1 diabetes with the prevalence of proliferative retinopathy or macular edema. The bars show the proliferative retinopathy. And by 30 years of diabetes about half of the type 1 diabetic patients studied in Wisconsin some years ago had proliferative change. Macular edema is peaking at about 15%. Retinopathy is common. Serious retinopathy is also common.

We move on to consider type 2 diabetes. Type 2 diabetes is somewhat different. The retinopathy plateau here is less, 65%. Why might that be? In the previous example when you saw that the prevalence of serious retinopathy declined with increasing duration, that's not because it's getting better. Unfortunately the people with the complication die. The others are the survivors. But in type 2 diabetes we have a rapid attrition, a high mortality, and the prevalence would actually continue to rise if we were plotting it as a cumulative figure.

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