Blindness and microvascular complications of diabetes mellitus are preventable

MR Van Newkirk
Visiting Scholar, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong

This paper reviews the evidence that with early retinal photocoagulation, blindness as a complication of diabetes mellitus is preventable and the new evidence that high blood sugar levels play a major role in the development of the microvascular complications of diabetes mellitus. The screening methods used to detect diabetes mellitus and diabetic retinopathy and the cost-effectiveness of diabetic retinopathy screening are also discussed. The Early Treatment Diabetic Retinopathy Study demonstrates that severe visual loss can be nearly eliminated when proliferative diabetic retinopathy and macular oedema are detected early and treated in a timely manner. The Diabetes Control and Complications Trial and the recently published 10-year follow up report of the Wisconsin Epidemiologic Study of Diabetic Retinopathy strongly suggest that microvascular complications can be prevented when near-normal levels of blood sugar are maintained in patients with insulin-dependent diabetes mellitus and non-insulin�dependent diabetes mellitus. Good management of diabetes mellitus requires a medical screening system and public awareness education. The early diagnosis, proper treatment, and reduction of risk factors can prevent disease complications. Treatment of the severe complications of diabetes mellitus is expensive in terms of health care dollars and the increased morbidity and mortality of patients affected by the disease. Health care dollars would be better spent by developing a system for the early diagnosis of retinopathy and the education of patients in the effective management of their disease. The expensive and catastrophic complications of diabetes mellitus could thereby be prevented.

Hong Kong Med J 1996;2:419-24

Key words: Diabetes mellitus, insulin-dependent; Diabetes mellitus, non-insulin-dependent; Diabetes, gestational; Diaetic retinopathy