• Diabetic macular edema
• Diabetic retinal disease
• Nonproliferative diabetic retinopathy
• Proliferative diabetic retinopathy

• Humans
• Diabetic Retinopathy/therapy
• Diabetic Retinopathy/drug therapy
• Diabetic Retinopathy/diagnosis
• Hypoglycemic Agents/therapeutic use

• Corneal and external diseases
• Diabetic retinopathy
• EPIDEMIOLOGY
• Knowledge

• Humans
• Ethiopia/epidemiology
• Diabetic Retinopathy/epidemiology
• Male
• Female
• Cross-Sectional Studies
• Health Knowledge, Attitudes, Practice
• Adult
• Hospitals, Public/statistics & numerical data
• Middle Aged
• Patient Acceptance of Health Care/statistics & numerical data
• Young Adult
• Aged
• Surveys and Questionnaires

• Madda Walabu University

• awareness
• diabetic retinopathy
• family medicine
• madinah
• ophthalmology
• saudi arabia
• screening

• Nephropathy
• Neuropathy
• Nurse
• Pharmacist
• Retinopathy
• Understanding

• Humans
• Diabetic Retinopathy
• Diabetic Nephropathies
• Retinal Diseases
• Health Personnel
• Diabetes Mellitus, Type 2

• R01 MD011516 NIMHD NIH HHS
• R01 DK129320 NIDDK NIH HHS
• U01 MD010579 NIMHD NIH HHS
• U01MD010579 NIMHD NIH HHS
• R01 DK115687 NIDDK NIH HHS
• R01MD011516 NIMHD NIH HHS
• R21AG071796 NIA NIH HHS
• UL1 TR002240 NCATS NIH HHS
• R43 DK126592 NIDDK NIH HHS
• K24 DK002926 NIDDK NIH HHS
• R01DK130913 NINDS NIH HHS
• P30 DK092926 NIDDK NIH HHS
• R21 AG071796 NIA NIH HHS
• R01 AG059733 NIA NIH HHS
• R25 NS089450 NINDS NIH HHS
• R24 DK082841 NIDDK NIH HHS
• R01DK115687 NIDDK NIH HHS
• P30 DK089503 NIDDK NIH HHS
• P30-DK089503 NIDDK NIH HHS
• UL1TR002240 NCATS NIH HHS
• R01 DK130913 NIDDK NIH HHS
• R01AG059733 NIA NIH HHS
• P30 DK020572 NIDDK NIH HHS
• P30-DK-02926 NIDDK NIH HHS

Diabetic eye disease is strongly associated with the development of diabetic foot ulcers (DFUs). DFUs are a common and significant complication of diabetes mellitus (DM) that arise from a combination of micro- and macrovascular compromise. Hyperglycemia and associated metabolic dysfunction in DM lead to impaired wound healing, immune dysregulation, peripheral vascular disease, and diabetic neuropathy that predisposes the lower extremities to repetitive injury and progressive tissue damage that may ultimately necessitate amputation. Diabetic retinopathy (DR) is caused by cumulative damage to the retinal mic-rovasculature from hyperglycemia and other diabetes-associated factors. The severity of DR is closely associated with the development of DFUs and the need for lower extremity revascularization procedures and/or amputation. Like the lower extremity, the eye may also suffer end-organ damage from macrovascular compromise in the form of cranial neuropathies that impair its motility, cause optic neuropathy, or result in partial or complete blindness. Additionally, poor perfusion of the eye can cause ischemic retinopathy leading to the development of proliferative diabetic retinopathy or neovascular glaucoma, both serious, vision-threatening conditions. Finally, diabetic corneal ulcers and DFUs share many aspects of impaired wound healing resulting from neurovascular, sensory, and immunologic compromise. Notably, alterations in serum biomarkers, such as hemoglobin A1c, ceruloplasmin, creatinine, low-density lipoprotein, and high-density lipoprotein, are associated with both DR and DFUs. Monitoring these parameters can aid in prognosticating long-term outcomes and shed light on shared pathogenic mechanisms that lead to end-organ damage. The frequent co-occurrence of diabetic eye and foot problems mandate that patients affected by either condition undergo reciprocal comprehensive eye and foot evaluations in addition to optimizing diabetes management.

• Foot ulcer
• Diabetic
• Wound healing
• Diabetes complications
• Amputation
• Diabetic retinopathy
• Corneal ulcer

• awareness
• community
• diabetes
• diabetic retinopathy
• eye check

• Age-related cataract
• Nlrp3
• apoptosis
• diabetes
• lens epithelial cells

The store-and-forward camera-based evaluation of the eye, or teleophthalmology, is an effective way to identify diabetic retinopathy, the leading cause of blindness in the United States, but uptake has been slow. Understanding the barriers to and facilitators of implementing teleophthalmology programs from those actively adopting, running, and sustaining such programs is important for widespread adoption.

This study aims to understand the factors that are important in introducing teleophthalmology to improve access to diagnostic eye care for patients with diabetes in primary care clinics by using implementation science.

This qualitative study in 3 urban, low-income, largely racial and ethnic minority–serving safety-net primary care clinics in Rochester, New York, interviewed nurses and physicians on implementing a teleophthalmology program by using questions informed by the Practical, Robust Implementation and Sustainability Model and the Consolidated Framework for Implementation Research.

Primary care nurses operationalizing the program in their clinics saw increased work burden and a lack of self-efficacy as barriers. Continuous training on the teleophthalmology process for nurses, physicians, and administrative staff through in-service and peer training by champions and superusers were identified by interviewees as needs. Facilitators included the perceived convenience for the patient and a perceived educational advantage to the program, as it gave an opportunity for providers to discuss the importance of eye care with patients. Concerns in making and tracking referrals to ophthalmology because of challenges related to care coordination were highlighted. The financial aspects of the program (eg, patient coverage and care provider reimbursement) were unclear to many staff members, influencing adoption and sustainability.

Streamlining processes and workflows, training and assigning adequate staff, effectively coordinating care between primary care and eye care to improve follow-ups, and ensuring financial viability can all help streamline the adoption of teleophthalmology.

• T32 CA102618 NCI NIH HHS

• Northeast Ethiopia
• diabetes mellitus
• use of eye care service

• funding

• Diabetes care
• Health education
• Investigation
• Retinopathy
• Theory of planned behavior

• Aged
• Blood Glucose/analysis
• Diabetes Mellitus, Type 2/complications
• Diabetic Retinopathy/prevention & control
• Female
• Glycated Hemoglobin/analysis
• Health Behavior
• Humans
• Male
• Middle Aged
• Patient Education as Topic/methods
• Single-Blind Method
• Young Adult

• Arak University of Medical Sciences

Diabetes is a major cause of morbidity and mortality worldwide. It can affect many organs and, over time, leads to serious complications. Diabetic retinopathy (DR), a specific ocular complication of diabetes, remains the leading cause of vision loss and vision impairment in adults. This work is the first in Eastern Morocco aimed at identifying the different stages of DR and to determine their frequencies and associated risk factors. It is a case-control study conducted from December 2018 to July 2019 at the ophthalmology department of Al-Irfane Clinic (Oujda). Data were obtained from a specific questionnaire involving 244 diabetic patients (122 cases with retinopathy vs 122 controls without retinopathy). All results were analyzed by the EPI-Info software. This study shows a predominance of proliferative diabetic retinopathy (PDR) with 57.4% of cases (uncomplicated proliferative diabetic retinopathy (UPDR): 23.8%; complicated proliferative diabetic retinopathy (CPDR): 33.6%). The non-proliferative diabetic retinopathy (NPDR) represents 42.6% (minimal NPDR: 8.2%; moderate NPDR: 26.2%; severe NPDR: 8.2%). The determinants of DR were insulin therapy, high blood pressure, poor glycemic control and duration of diabetes. Regarding the chronological evolution, retinopathy precedes nephropathy. Diabetic nephropathy (DN) was present in 10.6% of cases especially in patients with PDR. In summary, the frequency of PDR was higher than that of NPDR. DR appears before DN with a high frequency of DN in patients with PDR. Good glycemic control and blood pressure control, as well as early diagnosis are the major preventive measures against DR.

• Diabetic nephropathy
• Diabetic retinopathy
• Eastern Morocco
• Risk factors

• Selangor
• diabetic retinopathy
• eye screening
• retinal disease awareness programme

• Aged
• China/epidemiology
• Chronic Disease/epidemiology
• Chronic Disease/prevention & control
• Chronic Disease/therapy
• Diabetic Retinopathy/epidemiology
• Diabetic Retinopathy/prevention & control
• Diabetic Retinopathy/therapy
• Female
• Humans
• Male
• Middle Aged
• Public Policy
• Registries/statistics & numerical data
• Rural Population/statistics & numerical data
• Surveys and Questionnaires

• National Natural Science Foundation of China
• Zhejiang Medical and Health Science and Technology Project

• diabetic foot ulcer
• early detection
• remote temperature monitoring
• visual impairment

• Aged
• Diabetes Mellitus, Type 2/complications
• Diabetes Mellitus, Type 2/physiopathology
• Diabetic Foot/physiopathology
• Diabetic Foot/prevention & control
• Diabetic Neuropathies/physiopathology
• Humans
• Male
• Monitoring, Physiologic/methods
• Skin Temperature/physiology
• Standard of Care
• Telemedicine
• Veterans
• Vision Disorders/physiopathology

Diabetic retinopathy is the most common cause of blindness in working-age adults. Characteristics of patients with diabetes presenting to a retina subspecialty clinic have not been adequately studied, limiting our ability to risk stratify patients with diabetic retinopathy. Our goal is to describe an innovative program that collects structured, longitudinal data on patients with diabetes in a retina clinic, and identifies population characteristics to define patient risk stratification.

Demographics, body-mass index, blood pressure, hemoglobin A_1c, smoking history, diabetes type, diabetes duration, kidney disease history, and diagnosis codes were collected on all patients with diabetes at the Kellogg Eye Center retina clinic. A mixed effects negative binomial regression was then performed to assess visit frequency as a function of these variables. Visit frequency was used as a marker for cost of care. A subgroup of patients was surveyed about knowledge of diabetes management goals and barriers to better self-management.

There were 2916 patients in the cohort with 1014 in the subgroup. The cohort was predominantly Caucasian (74.5%), with a mean age of 64 years (range 13–99) and a relatively even distribution of sex (53.2% men). The mean maximum hemoglobin A_1c was 8.0% (range 4.3–15.7%), and 57.1% had a diagnosis of diabetic retinopathy. Patients averaged 3.9 visits (range 1–27) during the 18-month study period. Blood pressure and duration of diabetes were positively associated with visit frequency (p < 0.0001, p < 0.0001, respectively). Of the surveyed patients, 87.6% knew their goal hemoglobin A_1c, while only 45.9% identified the correct blood pressure goal. The most common reported barrier to better self-management was “it’s just not working” (47.1%).

Implementation of this program enables the creation of a longitudinal dataset on patients with diabetes. Resulting data can be used to improve quality of care provided to patients at a retina clinic. The findings suggest considerable healthcare resources are being directed to a small patient population. This enhanced understanding of characteristics of patients with diabetes will improve efforts to preserve vision and utilize health system resources efficiently.

• Blood pressure
• Characteristics
• Diabetes
• Diabetic retinopathy
• HbA1c
• Longitudinal
• Program
• Risk

• Awareness
• compliance
• diabetes mellitus
• diabetic retinopathy
• eye examination

Diabetic retinopathy (DR) is a progressive, sight-threatening long-term complication of diabetes. Diabetes disease management reduces the risk of developing or progression to a severe form of DR. However, there are no reports of the potential role of pharmacists in DR progression.

For this study, we performed a retrospective data analysis of patients with diabetes seen at cardiovascular risk reduction services provided by pharmacists with an objective to determine the potential role of pharmacists in the DR progression. These services involve pharmacists working in collaborative drug therapy management (CDTM), using a collaborative practice agreement (CPA) with primary care physicians.

Patient records and ophthalmological notes were collected for 317 individuals seen by the pharmacists (intervention group) and 320 individuals seen only by a physician (control).

Statistical analysis was performed on 148 individuals in an intervention group and 120 individuals in the control group for which complete records were available. Retinopathy progression remained stable in 89.6 % of individuals in the intervention group compared to 87.9% in the control group. Moreover, the relative risk of retinopathy progressing to a severe form was 1.17 for the control group compared the intervention group.

Our studies provide a proof-of-concept that pharmacists-managed care possesses a potential role in protection from DR, and paves a way for future pharmacists managed care with an emphasis on reducing diabetic complications.

• Diabetes Mellitus
• Diabetic Retinopathy
• Indiana
• Medication Therapy Management
• Pharmacists
• Professional Role
• Retrospective Studies