Transcript Document

OUT OF SIGHT
The Rise and Rise of Diabetes and the Need for
a Nationwide Retinopathy Screening Program
Dr Mohamed Dirani
Health Services and Evaluative Research
Centre for Eye Research Australia
Presentation Outline
1. Diabetes and its Complications
2. The Epidemic of Diabetes
3. Diabetic Eye Disease (diabetic retinopathy)
A. How common is it?
B. Disease progression
C. The causes and risk factors?
D. Indigenous community
E. Current Treatment
F. Prevention
4. Future Challenges and Take Home Messages
Diabetes and its Complications?
• Diabetes is a common chronic disease
• There are 2 main types of diabetes
• Type 1: Failure of insulin production
• Type 2: Insulin resistance
• Complications of diabetes
• Heart disease, peripheral vascular
disease and stroke
• Kidney disease
• Neuropathy
• Diabetic eye disease – “diabetic
retinopathy”
The Epidemic of Diabetes
•
Worldwide in 2013
• 382 million people were living with diabetes
• A further 316 million had impaired glucose tolerance (“pre-diabetes”)
• 5.1 million deaths were caused by diabetes
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The number of people with diabetes is expected to rise to almost half a billion
(471 million) by 2035
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In Australia in the year 2000
• Approximately 1 million adults had diabetes
• The number is expected to double to in excess of 2million in the next ten
years
• It is estimated that up to 50% of people with diabetes have not yet been
diagnosed with the disease
How Common is Diabetic Eye Disease?
• Leading cause of blindness
• 1 in 3 Australians have diabetic retinopathy
• Of those people who have had diabetes for
more than 20 years
• almost 100% of those with type 1
diabetes and more than 60% of those
with type 2 diabetes will develop
diabetic retinopathy
Progression of Diabetic Eye Disease
•
Retinopathy can be classified as either:
 non-proliferative diabetic retinopathy: earlier
in the disease process
 proliferative diabetic retinopathy: later in the
disease process; characterised by new blood
vessel growth and a high risk of vision loss
•
The leakage of fluid from blood vessels in the area
of the retina responsible for detailed vision ( the
macula) is known as diabetic macular oedema
• this is the leading cause of vision loss in
diabetes
Progression of Diabetic Eye Disease
moderate NPDR
severe NPDR
Diabetic retinopathy may
progress to advanced stages
without any symptoms
Regular eye tests and timely
treatment are essential for
people with diabetes
The Causes and Risk Factors
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Complex disease:
 contributions from genetic and
environmental factors
The single most important risk factor for
retinopathy is suboptimal blood glucose
control
 large studies have shown that careful
blood sugar control can dramatically
reduce the risk of retinopathy
Other important risk factors for retinopathy
include
 high blood pressure
 high blood cholesterol (lipid) levels
 Modifiable risk factors – diet and
physical activity
Diabetic Eye Disease in Indigenous Australians
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Indigenous Australians are at least 4 times
more likely than non-Indigenous Australians
to develop diabetes
NIEHS: 37.9% of Indigenous Australians
reported to have diabetes
Much higher proportion of sight-threatening
diabetic retinopathy, such as macular
oedema (10%).
Progression of disease at earlier stages of
diabetes
Current Treatment
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Who needs treatment? People with:
 proliferative retinopathy
 macular oedema
Main aim is to reduce the risk of further vision
Treatments
 improve control of blood glucose, blood
pressure and cholesterol
 retinal laser therapy
 injections into the eye
 Surgery
 Combination of treatments
PREVENTION is key
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•
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Optimise control of:
 blood glucose
 blood pressure
 cholesterol
 body weight
Eat a healthy diet that is appropriate for
people with diabetes
 consult your doctor or a dietician
Regular, moderate physical activity
Almost all cases of sight-threatening
diabetic retinopathy can be prevented!
Have your eyes checked regularly
 by an optometrist or ophthalmologist
The need for a Nationwide Diabetic Eye
Screening Program
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Up to 50% do not get regular diabetic eye
checks
Diabetes related blindness on the rise
No nation wide screening program in
Australia
Proven screening models overseas,
including Poland, Iceland, France and the
UK
Recent UK reports that diabetic retinopathy
is no longer the leading cause of blindness
in working age adults
We are 20 years behind
We need your support to STOP avoidable
blindness
Take Home Messages
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Diabetic retinopathy is a leading cause of vision
loss and blindness in Australian adults
It is on the rise and Australia still has no
nationwide retinopathy screening program
Most vision loss from diabetes is avoidable
through:
– optimal control of:
• blood glucose
• blood pressure
• cholesterol levels
– AND regular eye examinations
The establishment of a CRE; develop and
implement a diabetic eye screening program
Acknowledgements
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FRIENDS OF CERA
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Novartis Pharmaceuticals
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BakerIDI Heart and Diabetes Institute
Associate Professor Jonathan Shaw
Glen Cormick
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Centre for Eye Research Australia
Professor Jonathan Crowston
Dr Peter van Wijngaarden
Stuart Galbraith
Emily Woodhams