DIABETES AND THE EYE: WHAT YOU SHOULD KNOW ABOUT IT By David Masihdas, O.D., P.C. (801) 363-2851 uea@xmission.com

Demographics Total prevalence of diabetes Total: 25.8 million children and adults in the United States—8.3% of the population—have diabetes. Diagnosed: 18.8 million people Undiagnosed: 7.0 million people Prediabetes: 79 million people* New Cases: 1.9 million new cases of diabetes are diagnosed in people aged 20 years and older in 2010. 2011 National Diabetes Fact Sheet uses both fasting glucose and A1C levels to derive estimates for undiagnosed diabetes and prediabetes.

Who is affected by Diabetes 0.22 percent of people under the age of 20 years old have diabetes. 10.7 percent of people over the age of 20 have diabetes. 23.1 percent of people over the age of 60 have diabetes. 12 million men in the United States over the age of 20 have diabetes 11.5 million women in the United States aged 20 or older have diabetes African Americans have a 70% higher chance of getting diabetes over Caucasian Americans

24 Concern about diabetes impact has reached mainstream news media as one can see from this Newsweek cover from September 2000. Unfortunately, the number of people with diabetes continues to increase and if we were to udpate this Newsweek cover in 2005, the number of Americans with diabetes would be almost 21 million Nadeem N. Vaidya, M.D.

26 24 Concern about diabetes impact has reached mainstream news media as one can see from this Newsweek cover from September 2000. Unfortunately, the number of people with diabetes continues to increase and if we were to udpate this Newsweek cover in 2011, the number of Americans with diabetes would be almost 26 million Nadeem N. Vaidya, M.D.

Why Does Diabetes Continue to Command Our Attention? According to the CDC EVERY 24 HOURS there are: 4,100 new cases of diabetes, 810 deaths due to diabetes, 230 amputations, 120 kidney failures, and 55 new cases of blindness Nadeem N. Vaidya, M.D.

Obesity Trends 1990 2001 2001 1990 Diabetes Trends These maps show the dramatic increase in obesity and diabetes in the United States from 1990 to 2001. This increase is important because obesity is a major risk factor for type 2 diabetes and because about 55% of adults in the U.S. who have diabetes are also obese (CDC). Reference BRFSS, CDC 1990 – 2001. Centers for Disease Control and Prevention. Prevalence of overweight and obesity among adults with diagnosed diabetes--United States, 1988-1994 and 1999-2002. MMWR. 2004;53:1066-1068. BRFSS, 1990- 2001 Nadeem N. Vaidya, M.D.

Type 2 diabetes - risk factors You have a higher risk for diabetes if you have any of the following: Age greater than 45 years Diabetes during a previous pregnancy Excess body weight (especially around the waist) Family history of diabetes Given birth to a baby weighing more than 9 pounds HDL cholesterol under 35 mg/dL

Additional Risk factors High blood levels of triglycerides, a type of fat molecule (250 mg/dL or more) High blood pressure (greater than or equal to 140/90 mmHg) Impaired glucose tolerance Low activity level (exercising less than 3 times a week) Metabolic syndrome Polycystic ovarian syndrome A condition called acanthosis nigricans, which causes dark, thickened skin around the neck or armpits

The Science of DM Control Nadeem N. Vaidya, M.D.

Diabetes Control and Complications Trial (DCCT) Compared effects of two diabetes treatment regimens – standard therapy and intensive control – on the complications of diabetes in people with type 1 diabetes The Diabetes Control and Complications Trial (DCCT), an NIH-funded clinical trial, was conducted from 1983 to 1993. The DCCT is the largest, most comprehensive diabetes study ever conducted. The study compared the effects of two treatment regimens—standard therapy and intensive control—on the complications of diabetes in people with type 1 diabetes. Reference The DCCT Study Research Group. New England Journal of Medicine, 329(14), September 30, 1993. DCCT. New England Journal of Medicine, 329(14), September 30, 1993. Nadeem N. Vaidya, M.D. 12

DCCT Findings Glucose control is key to preventing or delaying complication of diabetes Any sustained lower of blood glucose helps, even if the person has a history of poor control The DCCT showed that tight glucose control slows the onset and progression of the microvascular complications of diabetes—eye, kidney, and nerve diseases. In fact, it showed that any sustained lowering of blood glucose helps, even if the person has a history of poor control. Reference The DCCT Study Research Group. New England Journal of Medicine, 329(14), September 30, 1993.

DCCT Findings Eye disease by 76% Kidney disease by 50% Lowering blood glucose reduced risk of: Eye disease by 76% Kidney disease by 50% Nerve disease by 60% Study results showed that keeping blood glucose levels as close to normal as possible lowered the risk of: Eye disease by 76% Kidney disease by 50% Nerve disease by 60% Reference The DCCT Study Research Group. New England Journal of Medicine, 329(14), September 30, 1993. DCCT. New England Journal of Medicine, 329(14), September 30, 1993. Nadeem N. Vaidya, M.D. 14

Economic Impact The cost of diabetes to the U.S. economy has increased 32 percent since 2002, or $8 billion a year, reaching $174 billion in 2007, according to estimates from the ADA. 1 in 10 Americans is at risk of being diabetic One out of every five health care dollars is spent caring for someone with diagnosed diabetes, while 1 in 10 health care dollars is attributed directly to diabetes, according to the ADA. Medicine for diabetic cost approx. $7 B per year. Annual cost to treat a pre-diabetic is $5,000, undiagnosed is $10,000 and diabetic with complications $30,000. Cost for a health employee is $ 1721/ yr vs a diabetic which is $22512.

ETDRS Classifications of DR No DR NPDR Mild Moderate Severe Very Severe NPDR PDR Nadeem N. Vaidya, M.D.

Clinically Significant Macular Edema Macular edema that involves or threatens the center of the macula CSME can be present with any level of DR Nadeem N. Vaidya, M.D.

Diabetes and the Eye It affects: Cornea Lids/Lashes Lens Retina

Cornea Dryness Tear deficiency Tissue damage Discomfort Blurred vision

Lids/Lashes Crusty Glands atrophy Loss of integrity Don’t close normally Loss of lashes

Lens

Retina Upper left is dot hemm, upper right Diabetic macular edema, Lower left neovascular lower right proliferative

Diabetes Mellitus Diabetes is the leading cause of preventable new-onset blindness in the United States. Approximately 40% of Americans who would benefit from sight preserving treatment for diabetic retinopathy do not receive necessary care. Nadeem N. Vaidya, M.D.

General referral Guidelines Insulin dependent: * Newly diagnosed every 6 months * Dx 2-5 yrs good control, every 6 months * Dx 6+ yrs good or poor control more frequent Non-insulin dependent Newly diagnosed every year Dx 2-5 yrs, good control every year Dx 6-10 yrs every 6 months

Invitation Visit the Diabetic Eye Center At 150 South 1000 East And see what level of care Is delivered. Call 801.363.2851