From the ACP Diabetes Care Guide

Arrange to have this form completed when your patient visits the ophthalmologist.

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From the ACP Diabetes Care Guide

Persons with diabetes are at increased risk for macrovascular disease; microvascular disease, including retinopathy and nephropathy; peripheral and autonomic neuropathies; and lower extremity disease.

• Diabetic retinopathy is the leading cause of noncongenital blindness among adults.
• Diabetes is the most common cause of endstage kidney disease in the United States, especially among Native American, Hispanic, and African American persons. One quarter to one third of patients with type 1 or type 2 diabetes develop some degree of nephropathy.
• Diabetes doubles the risk for cardiovascular disease in men and triples it in women (data from the Multiple Risk Factor Intervention Trial [MRFIT]).
• Patients with diabetes are several-fold more likely to have peripheral arterial disease than patients without diabetes.
• Peripheral arterial disease and foot ulcers in patients with diabetes account for two thirds of all nontraumatic amputations performed in the United States.

Screening for and prevention of these complications are fundamental to the care of patients with diabetes and are important components of quality of care initiatives for diabetes.

NOTE: You may order free copies of the complete ACP Diabetes Care Guide (book and CD-ROM).

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Diabetes is responsible for most cases of legal blindness in adults in the United States. Early changes include hard exudates, microaneurysms, and minor hemorrhages on funduscopic examination, referred to as background diabetic retinopathy. This finding is not typically associated with any decline in visual acuity, but is a marker for the future development of more significant abnormalities that can lead to visual loss.

The condition termed preproliferative retinopathy is manifested by the presence of "cotton-wool spots," which are indicative of retinal infarcts. This ischemia eventually provides a stimulus for the growth of new blood vessels (termed neovascularization).

The vessels that form are abnormal in both appearance and structure and are prone to hemorrhage. In the condition termed proliferative retinopathy, blood vessel fragility predisposes to significant retinal and vitreous hemorrhage.

Note: Subscription to MKSAP 14 is required to view this material. For more information, visit www.acponline.org.

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Question
In patients with poorly controlled type 2 diabetes, how does intensive glucose control compare with standard control for reducing cardiovascular (CV) events?

Conclusion
Intensive glucose control and standard control did not differ for reducing cardiovascular events or death in patients with poorly controlled type 2 diabetes.

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Question
In type 2 diabetes, does intensive glucose control prevent adverse outcomes more than standard glucose control?

Conclusion
Compared with standard glucose control in type 2 diabetes, intensive glucose control with gliclazide and other drugs had no effect on macrovascular events, prevented new or worsening albuminuria, but led to greater hypoglycemia.

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Question
In patients with type 2 diabetes and cardiovascular disease or risk factors, does intensive glucose control prevent cardiovascular events more than standard glucose control?

Conclusion
In patients with type 2 diabetes and cardiovascular disease or risk factors, intensive glucose control increased mortality and did not prevent cardiovascular events more than standard glucose control.

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Question
In patients with type 2 diabetes, does pioglitazone reduce cardiovascular events, other adverse events, and mortality or improve health-related quality of life?

Conclusions
Based on 1 randomized trial, pioglitazone does not reduce risk for mortality or cardiovascular events in patients with type 2 diabetes. Some evidence exists that pioglitazone increases risk for such adverse events as weight gain, decrease in hemoglobin level, and edema.

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