Diabetes and the Eye: Latest Concepts and Practices

Douglas R. Lazzaro, Samy I. McFarlane

• Editorial: Bentham Science Publishers
• Año: 2021
• ISBN:
  9789811466465
• Categoría: Medicine
• Categoría: Opthalmology & Optometry

Diabetes and the Eye familiarizes the reader with the relationship between diabetes mellitus and the visual system. It presents a discussion about the diabetes epidemic and the many ways the disease can cause vision loss, with several types of vision disorders covered in separate chapters. Information about new frontiers in the treatment of ophthalmic disorders is also presented to reflect the advances being made in the clinic. Key features: - presents detailed coverage of vision loss in diabetes in 12 organized and easy to read chapters - includes a discussion on the diabetes epidemic - covers a wide range of vision disorders, of different parts of the eye - includes information on current practices in eye care and management for diabetic patients - includes information about relevant diagnostic tools This book serves as a useful handbook for medical students, residents in ophthalmology, community and academic ophthalmologists, as well as members of the internal medicine and family practice communities.

Recent Developments in Diabetes Evaluation and Management: Implications for the Practicing Clinicians

Anna Y. Groysman, Lina Soni, Samara Skwiersky, Samy I. McFarlane^*

Department of Medicine, Division of Endocrinology, State University of New York, Downstate-Medical Center, Brooklyn, NY, USA

Abstract

Diabetes is a major public health problem affecting millions of people around the globe. In the United States alone, over 7.5 million have type 2 diabetes and an alarming 78 million adults have prediabetes and remain largely undiagnosed. This epidemic was ushered in by the ongoing epidemic of obesity and is caused in-part by sedentary life style and aging population. In this chapter we discuss the diabetes epidemic highlighting the major risk factor of diabetes, particularly type 2. We also discuss the complications of diabetes including microvascular complications as well as macrovascular disease including coronary heart disease and stroke, the major cause of morbidity and mortality in the diabetic population. Finally, we present the major therapeutic advances in diabetes including modern pharmacologic agents and their potential effects on cardiovascular risk. We also outline the recent technological advances in diabetes management including closed loop systems, artificial pancreas, stem cell therapy among other ongoing research bound to prevent and/or alleviate the effects of this ongoing epidemic.

Keywords: Complications, Diabetes, Glucose monitoring technology, Modern therapy, Risk factors.

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^* Corresponding Author Samy I. McFarlane: Department of Medicine, Division of Endocrinology, State University of New York, Downstate-Medical Center, Brooklyn, NY, USA; Tel: [phone]; Fax: [phone];
E-mail: [email protected]

INTRODUCTION

Diabetes mellitus is a progressively debilitating condition resulting in vascular complications, including cardiovascular, cerebrovascular, and peripheral vascular disease. This disease, together with microvascular diseases, including retinopathy, nephropathy, and peripheral neuropathy, lead to devastating complications and increased mortality. Although adults are generally afflicted with this condition, rising numbers of children, teenagers, and adolescents are also affected [1].

Driven mainly by a continuous rise in type 2 diabetes, the global epidemic of diabetes, according to data from the World Health Organization, reached over 422 million adults worldwide in 2014, exceeding the previous forecast of 439 million worldwide by 2030 [2].

Diabetes does not affect the population homogeneously and significant disparities exist that are worth noting. Diabetes disproportionally affects racial and ethnic minority groups. African Americans (13.2%), American Indians/Alaska Natives (15.9%), Asian Americans and Pacific Islanders (9.0%), and Latinos (12.8%) are about twice as likely to have been diagnosed with diabetes as non-Hispanic, white (7.6%) adults [6]. Diabetes has also been shown to disproportionally affect people living in rural versus urban areas. Individual factors, such as health literacy, communication barriers, and cultural differences, have been associated with diabetes disparities [7]

The observed disparities have been explained by numerous analyses. A fully adjusted study found that both the prevalence of diabetes and the likelihood of forgoing medical care among people diagnosed with diabetes were higher for those with lower incomes, racial/ethnic minority groups, lower incomes, and living in the South of the U.S [8]. Additionally, “food insecurity” is the inability to regularly obtain nutritious food without resorting to socially unusual practices. Unfortunately, one in seven people in America is “food insecure”. This rate is higher among racial/ethnic minorities and in low-income households. The reason being that people are faced with the difficult choice of buying nutritious but more expensive food versus less expensive, high calorie, and low nutrient containing foods [9].

Many resources have been focused on developing modalities to achieve euglycemia in patients and to reduce the prevalence of macro-and microvascular complications. Unfortunately, the primary cause of mortality in patients with diabetes is cardiovascular disease. Within the next thirty years, the number of people living with diabetes is predicted to double and with it, the prevalence of incapacitating complications [3]. The incidence of diabetes increases with age and as the number of older adults in the United States is growing, so is the prevalence of the disease. The advent of insulin therapy has prolonged the lives of patients with type 1 diabetes (T1D), but every year of life comes with an increased risk of complications. As the prevalence of obesity rises in the United States, T2D occurs at an earlier age. This is because overweight and obese people tend to have an earlier onset of insulin resistance. Such factors are increasing the number of people who need medical care and require interventions to prevent the complications or progression of diabetes complications [4].

The risk of diabetes is increased with non-modifiable factors, such as age, a positive family history, and genetics. However, the list of modifiable risk factors is much longer. Overweight and obesity is rampant in the United States and is the leading cause of diabetes onset. Lack of physical exercise and poor dietary choices or options are significant contributors [2]. Less well-known risk factors include vitamin deficiencies and compositions of gut bacteria [5], which are now being identified and will be further discussed in this chapter.

This chapter aims to elucidate what is known about diabetes, as well as where we are headed. The novel risk factors of diabetes will be explained as well as the pervasive complications. The focus of the chapter will be a discussion of the many medical and technological treatment approaches that have been developed to improve glycemic control or hold a promise to finding a cure. Finally, evidence of diabetes prevention will be discussed as it is as vital as disease treatment in managing this pandemic.

RISK FACTORS OF DIABETES MELLITUS

Non-modifiable Risk Factors (Table 1)

Genetics

The pathophysiology of T2DM has not yet been fully delineated; however, studies find that there is a significant genetic component. This is supported by a high concordance rate in monozygotic twins (96%) to develop T2D. Even 40% of first degree relatives of T2D patients develop diabetes as compared to only 6% observed in the general population [10].

Susceptibility Loci

Since 2007, Genome-Wide Association Studies have identified linkage signals at the same or different chromosomes with T2DM. Seventy-five susceptibility loci that are related to T2DM have been identified. For example, IGF2BP2 is involved in pancreas development and stimulation of insulin action. Unsorted loci for T2DM pathogenesis still remain but may serve to be useful in understanding the condition to eventually find a cure [11, 12].

Modifiable Risk Factors (Table 1)

Lifestyle

Numerous environmental and lifestyle factors have been found to contribute to the development of T2DM. Obesity, which may contribute to the development of insulin resistance, has been found to be the greatest risk factor for T2D. A sedentary lifestyle, physical inactivity, alcohol consumption, and smoking are also major contributors to disease development. Additionally, a low fiber diet with a high glycemic index is associated with an increased risk of developing diabetes [13]. When controlled for BMI, high intake of total and saturated fat was associated with an increased risk of T2D. However, intake of linoleic acid, a polyunsaturated fat, decreased this risk [14]. Greater consumption of water high in sugar was associated with greater weight gain and an increased risk of developing T2D in women [15]. Obstructive sleep apnea (OSA) is a modifiable risk factor in the development of insulin resistance. Numerous studies have shown that the prevalence of prediabetes (20 to 67%) is significantly higher in patients with OSA than subjects who did not suffer from OSA [16].

Vitamins

Vitamin K

Vitamin K is well known for its active role in maintaining bone quality. Recent studies found that vitamin K1 or phylloquinone to benefit euglycemia. Higher intake of vitamin K1 was found to be correlated with increased insulin sensitivity and glycemic control [17]. Further studies are needed to understand the role of vitamin K in protection from diabetes.

Vitamin D

There is a growing evidence that decreased vitamin D may contribute to the development of T2D. One study showed that patients with T2D had lower 25-OHD3 concentrations than patients without diabetes [18]. When non-obese diabetic mice were rendered vitamin D deficient in early life, impaired glucose tolerance was observed by the age of 100 days. Diabetes incidence doubled at 200 days of life [19]. Vitamin D has also been found to have an immunomodulatory role. In the presence of 1a,25(OH)2D3, dendritic cells mature to become tolerogenic cells as seen by their lower expression ...