The Goal is in Sight: Eye Care Concerns for Patients with Diabetes
description
Transcript of The Goal is in Sight: Eye Care Concerns for Patients with Diabetes
![Page 1: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/1.jpg)
The Goal is in Sight:Eye Care Concerns for Patients with Diabetes
Richard Savoy, OD, MPH, FAAO
Wilson McGriff, OD, MPH
![Page 2: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/2.jpg)
Workshop Objectives
Review the epidemiology of diabetes in the U.S. and Tennessee
Discuss the effects and potential impact of diabetes on vision
Instruct in the use of the Health Belief Model to promote behavior change
Review initiatives and recommendations for preventing and minimizing diabetic complications
![Page 3: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/3.jpg)
Diabetes: A Definition
Failure of the pancreas to produce sufficient amounts of insulin
-OR- Resistance of the body’s cell to the action of insulin
![Page 4: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/4.jpg)
Epidemiology of Diabetes in the US
29.1 million people have diabetes 1.7 million people 20 years old and older diagnosed
in 2012 86 million people have prediabetes 15-30% of people with prediabetes will develop
diabetes (Type 2) within 5 years
![Page 5: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/5.jpg)
![Page 6: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/6.jpg)
Complications: Diabetes in the US is…
The 6th leading cause of death The LEADING cause of:
Kidney failure
Non-traumatic lower limb amputation
New cases of blindness in adults
A MAJOR contributor to: Heart disease (2nd leading cause of death)
Stroke (4th leading cause of death)
![Page 7: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/7.jpg)
Some Bad News and Some Good News with Diabetes
Bad: Medical costs for people with diabetes are twice as high as
for people without diabetes
Risk of death for adults with diabetes is 50% higher than for adults without diabetes
Good: Prediabetics who lose weight by eating healthy and being
more active can cut their risk of getting Type 2 diabetes in half
![Page 8: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/8.jpg)
Diabetes by Age (Years)Tennessee, 2005
18-24 25-34 35-44 45-54 55-64 65+0
2
4
6
8
10
12
14
16
18
20
0.81.5
4.9
10.5
18.419
Perc
ent
wit
h D
iabete
s
![Page 9: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/9.jpg)
Diabetes by Gender and Race Tennessee, 2005
White Males White Females AA Males AA Females0
2
4
6
8
10
12
14
9 8.88.4
13.2
Perc
ent
wit
h D
iabete
s
![Page 10: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/10.jpg)
Diabetes by Educational AchievementTennessee, 2005
< High School Educa-tion
High School/GED Some Post-High School College Graduate0
2
4
6
8
10
12
14
16
1816.7
9.6
7.9
6.1
Perc
ent
wit
h D
iabete
s
![Page 11: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/11.jpg)
Diabetes and Cardiovascular DiseaseTennessee, 2005
Coronary Heart Disease
Stroke High Blood Pressure
0
10
20
30
40
50
60
70
80
16
10.1
66.7
3.6 2.4
26.3With Diabetes
Pe
rce
nt
wit
h D
esi
gn
ate
d C
ar-
dio
va
scu
lar
Co
mo
rbid
ity
![Page 12: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/12.jpg)
Diabetes and Specific Risk FactorsTennessee, 2005
Overweight or Obese
Sedentary Lifestyle
0
10
20
30
40
50
60
70
80
90
80.1
60.454.9
30.7
With DiabetesWithout Diabetes
Pe
rce
nt
wit
h R
isk F
act
or
![Page 13: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/13.jpg)
Types of Diabetes Mellitus
Type 1 5-10% of cases
Loss of ability to produce insulin
Type 2 90-95% of cases
Loss of ability to use insulin
Gestational and other types Hyperglycemia is the defining feature of all
types
![Page 14: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/14.jpg)
Effects of Chronic Hyperglycemia
Microvascular disease Retinopathy
Diabetic nephropathy
Diabetic neuropathy
![Page 15: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/15.jpg)
Ocular Symptoms of Diabetes
Blurry vision at near or far General decline in visual acuity Spots or floaters Straight lines do not look straight Double vision Persistent, red, painful eye Increasing sense of pressure in the eye
![Page 16: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/16.jpg)
Refractive Error and Cataracts
Excess glucose causes the crystalline lens to swell May alter or delay glasses prescription 40% increase in risk for developing cataracts
![Page 17: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/17.jpg)
Twice as likely in persons with diabetes Gradual destruction of optic nerve More likely to cause vision loss
Glaucoma
![Page 18: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/18.jpg)
Diabetic Retinopathy
Most significant ocular complication Leading cause of blindness: ages 20-74
Slow progression in the beginning Incidence increases with duration of diabetes
>10 years: >50% incidence of retinopathy
>15 years: ~90% incidence of retinopathy
![Page 19: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/19.jpg)
Diabetic Retinopathy
Photos: National Eye Institute / National Institutes of Health
![Page 20: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/20.jpg)
Severity of Diabetic Retinopathy
Depends on Disease Duration
High Blood Pressure
Smoking status
Hemoglobin A1c level (HbA1c)
![Page 21: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/21.jpg)
Hemoglobin A1c (HbA1c)
AVERAGE blood sugar level over 3 months Normal HbA1c is below 5.7%
Average patient with diabetes is around 8.5%
Goal is <6.5% for newly diagnosed
Predicts likelihood of disability and death Only 24% of persons with diabetes can remember
their last HbA1c value
![Page 22: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/22.jpg)
HbA1c and Retinopathy
Adapted from The Diabetes Control and Complications Trial Research Group, Diabetes 44:968, 1995
![Page 23: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/23.jpg)
Healthy Retina
Häggström, Mikael. "Medical gallery of Mikael Häggström 2014". Wikiversity Journal of Medicine 1 (2).
DOI:10.15347/wjm/2014.008. ISSN 20018762.
![Page 24: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/24.jpg)
Diabetic Retinopathy
Mild Moderate Severe
Neo of the optic disc Neo elsewhere Pre-retinal hemorrhageImages from the Early Treatment Diabetic Retinopathy Study
![Page 25: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/25.jpg)
Clinically Significant Macular Edema
Responsible for nearly HALF of all vision loss in diabetes!
Referred for immediate treatment
Images from the Early Treatment Diabetic Retinopathy Study
![Page 26: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/26.jpg)
Other Ocular Manifestations
Cranial Nerve Palsies
Corneal UlcersAnterior Ischemic Optic Neuropathy
![Page 27: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/27.jpg)
Prevention and Treatment of Diabetic Eye Disease Prevention
Annual dilated exams
~75% reduction of diabetic retinopathy with proper control
Less than 50% of persons with diabetes get annual dilated eye exams
Treatment Laser Injections Invasive surgery
![Page 28: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/28.jpg)
Health Insurance and Diabetes
Medicare BlueCare/TennCare/United/AmeriGroup Private insurance Affordable Care Act
![Page 29: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/29.jpg)
Diabetes Health Promotion Programs
National Level Initiative:Healthy People 2020
![Page 30: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/30.jpg)
Healthy People 2020
D-1 Reduce the number of new cases of diabetes D-2 Reduce the death rate D-3 Reduce the diabetes death rate D-4 Reduce the rate of lower extremity
amputations
![Page 31: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/31.jpg)
Healthy People 2020
D-5 Glycemic control D-6 Lipid control D-7 Blood pressure control D-8 Annual dental examination D-9 Annual foot examination D-10 Annual dilated eye examination
![Page 32: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/32.jpg)
Healthy People 2020
D-11 Twice a year glycosylated hemoglobin measurement
D-12 Annual urinary microalbumin measurement D-13 Once daily self-blood glucose-monitoring D-14 Formal diabetes education D-15 Diagnosed proportion of persons with
diabetes D-16 Prevention behaviors in persons with
prediabetes Retrieved from: http://www.healthypeople.gov/2020/topicsobjectives2020/default.aspx on 09/02/14
![Page 33: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/33.jpg)
Diabetes Health Promotion Programs
State Level Initiative:Project Diabetes
![Page 34: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/34.jpg)
Tennessee’s Project Diabetes
Goals: Decrease the prevalence of overweight/obesity
across the State and, in turn, prevent or delay the onset of Type 2 diabetes and/or the consequences of this devastating disease.
Educate the public about current and emerging health issues linked to diabetes and obesity
Promote community, public-private partnerships to identify and solve regional health problems related to obesity and diabetes
![Page 35: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/35.jpg)
Tennessee’s Project Diabetes
Goals Advise and recommend policies and programs
that support individual and community health improvement efforts
Evaluate effectiveness of improvement efforts/programs that address overweight, obesity, prediabetes, and diabetes
Disseminate best practices for diabetes prevention and health improvement.
Retrieved from: http://health.state.tn.us/projectdiabetes.htm on 09/02/14
![Page 36: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/36.jpg)
Social Ecology of Health Model
A. Level I: Intrapersonal B. Level II: Interpersonal C. Level III: Organizational D. Level IV: Community E. Level V: Societal
![Page 37: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/37.jpg)
Diabetes Health Promotion Programs
Patient Level Initiative:Intrapersonal/Interpersonal
Behavioral Change
![Page 38: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/38.jpg)
Health Belief Model
Cue to Action
Self-Efficacy
Perceived Susceptibility
Perceived Severity
Perceived Benefits
Perceived Barriers
BEHAVIOR CHANGE!!
1. Coreil, J. (Editor)(2010). Social and Behavioral Foundations of Public Health, 2nd Edition. Thousand
Oaks, CA:Sage.2. Retrieved from: http://www.utwente.nl/cw/theorieenoverzicht/theory%20clusters/health%20communication/health_belief_model/ on 09/02/14
![Page 39: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/39.jpg)
Health Promotion and Social Support “People, unlike fish, are unable to swim upstream for any
length of time. When the entire responsibility for health enhancement and risk reduction rests with the individual, independent of the health norms……….the probability for success is very small”
Bellingham, 1990
![Page 40: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/40.jpg)
Diabetic “Bullets”
![Page 41: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/41.jpg)
Potential Benefits of Preventing and Treating Diabetes
Feel better Fewer symptoms Longer, healthier life Good vision Reduce the risk for complications involving eye,
foot, kidney, heart, and nerve disease
![Page 42: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/42.jpg)
Basic Recommendations for Preventing and Minimizing Diabetic Eye Disease1. In consultation with a physician knowledgeable
about diabetes care, and through proper diet, exercise, and medication:A. Keep blood sugar levels as close to normal as possible
B. Check and control even mild high blood pressure
C. Check and improve blood lipid profile
2. Check blood sugar levels at home on a regular basis, and know HbA1c levels
3. Quit smoking
4. Have a dilated eye examination each year, more often if specifically recommended
![Page 43: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/43.jpg)
Diabetes “Team”
Family Physician Optometrist Podiatrist Dentist Retinal Specialist Diabetic Educator Dietician
![Page 44: The Goal is in Sight: Eye Care Concerns for Patients with Diabetes](https://reader035.fdocuments.in/reader035/viewer/2022081519/56813f05550346895da986f2/html5/thumbnails/44.jpg)
Additional Acknowledgements
Some information courtesy of your American Optometric Association