Patients with diabetes who have poor glycemic control and high blood pressure (BP) are more likely to have diabetic retinopathy than their better controlled peers, show study findings.

Tien Yin Wong (Singapore National Eye Centre) and colleagues report results from the Singapore Malay Eye Study, which involved 3280 Malay individuals who were aged between 40 and 80 years.

This study focused on the 768 participants with diabetes, defined as a nonfasting glucose level of 200 mg/dl or more, use of antidiabetes medication, or a physician diagnosis of the condition.

The researchers found that only a low percentage of the diabetic cohort had optimal glycemic or BP control - defined as a glycated hemoglobin of 7% or less or a BP of 130/80 mmHg or less - at 26.9% and 13.4%, respectively.

Overall, 272 of the diabetic patients had retinopathy, diagnosed using gradable retinal photographs. Glycemic and BP control was significantly worse in these individuals with only 17.4% and 10.3% achieving optimum levels, respectively.

The researchers found that suboptimal glycemic control was significantly associated with younger age, being unaware of diabetes status, not taking appropriate medication, higher total cholesterol, and presence of diabetic retinopathy.

Patients with poor BP control were more likely to be older, have higher total cholesterol, higher body mass index, and diabetic retinopathy than those with optimal control.

“Our population-based study in this Malay population documented low proportions of persons with diabetes achieving targeted levels of diabetic control, with only one in four achieving optimal glycemic control and one in eight achieving optimal BP control,” summarize the authors. “Among individuals with diabetic retinopathy, this was even lower.”

“Our findings present a challenge to health care policy-makers and professionals regarding effective implementation of diabetes care in Asia,” they conclude.

The results of this study are published in the Archives of Opthalmology.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

Free abstract

Yes, it can and here is how.

The most frequent cognitive deficits noted in persons with diabetes are:

Slowing of information processing speed

Slowing of motor speed

Decreases in vocabulary and intelligence

Lessening of attention span

Decreases in motor strength

Loss of memory

The single most important factor that affects cognitive deficits in diabetes is glycemic or blood sugar control. Both too low (hypoglycemia) and too high (hyperglycemia) blood glucose can affect cognitive function. When you keep your blood glucose as close as possible to normal, all of the above items improve.

Complications such as neuropathy (loss of feeling), retinopathy (loss of eye sight), and nephropathy (loss of kidney funtction) may take years to occur with diabetes. Cognitive deficits can occur much earlier (especially when your hemoglobin A1Cis higher than8.4%).

In elderly diabetic persons this is especially true, with more than 10% showing at least some cognitive deficit due at least in part to poor blood glucose control.

Okay, so what can you do to keep your brain sharp? In other words, how do you keep all your marbles?

You can keep your blood glucose levels as close to normal as possible. In keeping a tight control over your blood glucose you will sharpen your brain and prevent any further deterioration.

There are three main ways of doing this.

The first is to control your diet by counting your carbohydrates. Your health care professional can tell you how many carbohydrates that you should eat.

The second method is to exercise. Exercise has been proven over and over again to lower blood glucose (and it makes you feel better). Exercise can lower your blood glucose for hours to days after you are done. Make sure to check your blood glucose both before and after you exercise to make it remains within a normal level. Your health care provider can tell you what normal levels are for you. Never start an exercise routine without checking with your health care provider.

The third method is medications. Not all diabetics take medications but if you do, make sure you take them properly. If you receive a new prescription for a medication make sure you ask questions of both your physician and your pharmacist until you know:

What the name of the medication is

What the medication is for and why you are taking it

When to take the medicine.

If you still do not understand your new medication, continue to ask questions. Do NOT give up until you understand. (As a nurse I have seen numerous patients admitted to the hospital because they took their medications incorrectly. On one occasion, I know one patient died because of his lack of understanding of his new prescription). Do not be afraid to be a pest. Ask and ask again until you understand your medications (and this is true of your current medications as well. You do not have to wait for a new prescription to gain understanding of your medications.)