Surgery

David Levy, MD, FRCP      Cataract Diabetes is a strong risk factor for cataract, and it occurs earlier and progresses faster than in the non-diabetic population. Cortical cataract is the most frequent, with its typical radial spoke opacities. Indications for cataract surgery include impairment of vision that reduces quality of life, and …

David Levy, MD, FRCP      Pre-proliferative retinopathy An important diagnosis, as there is a very high risk of progression to proliferative retinopathy and significant visual loss. Pre-proliferative changes are characterized by the following. Multiple (> 5) cotton-wool spots. Multiple large blot hemorrhages. Venous abnormalities: irregularities, beading, looping or reduplication. Intraretinal microvascular abnormalities: …

David Levy, MD, FRCP      Non-proliferative diabetic retinopathy Background retinopathy Microaneurysms Small, red, intraretinal lesions usually found at the posterior pole of the eye, around the disc and macula. They occur in areas of capillary non-perfusion and show leakage of fluorescein. It is worthwhile estimating the number of microaneurysms as it has …

David Levy, MD, FRCP      Introduction Diabetic retinopathy is the most common clinically significant microvascular complication of diabetes, but cataract is the most common ocular complication, with a prevalence of about 60% in those aged 30–54, five times more frequent than in those without diabetes. Diabetes is also associated with raised intraocular …

Patients shed pounds and had fewer comorbidities with minimally invasive procedure… Apollo Endosurgery, Inc., a leader in minimally invasive endoscopic surgical products for bariatric and gastrointestinal procedures, announced the presentation of results from the ORBERA Pivotal Trial at this year’s Digestive Disease Week (DDW) conference. The study showed that ORBERA …

A low CD34+ count also diminished the protective effects of ACE inhibitors/ARBs on microalbuminuria progression… Low circulating progenitor cells have been shown to predict future cardiovascular events and mortality in patients with CKD and low levels in diabetic patients may indicate microvascular complications. Diabetes lowers the levels of circulating and …

Scientists saw dramatic effects on risk factors for colon cancer when American and African volunteers swapped diets for just two weeks… Western diets, high in protein and fat but low in fiber, are thought to raise colon cancer risk compared with African diets high in fiber and low in fat …

In this week’s Homerun Slides, we continue with the 2015 ADA Guidelines with slides on: Correlation of A1c With Average Glucose, Management of Hypoglycemia, and Bariatric Surgery in Type 2 Diabetes….

David Levy, MD, FRCP Renal replacement therapy The decision to start dialysis is often difficult. The clinical decision is based on many factors, including the presence of uremic symptoms and weight loss, and biochemical measurements including serum creatinine (e.g. serum creatinine 700–800 μmol/L(small mu), eGFR < 12–14 mL/min, falling albumin, hyperkalemia). …

David Levy, MD, FRCP Diabetic foot infections (see also Chapter 10) Multidisciplinary teamwork with specialist podiatrists is crucial. Patients in primary care must be referred for specialist wound débridement and dressing, which are as important as antibiotic treatment. Worsening clinical features of infection are associated with increasing rates of hospitalization and …