Complications of condition are serious

Eye disease is a micro-vascular complication of diabetes

Up to 20 per cent of people who have type II diabetes also have diabetic retinopathy at the time that their diabetes is diagnosed, studies show. This would indicate that they had had pre-clinical diabetes for a number of years.

Complications arising from the condition can be extremely severe. Eye disease, kidney disease and nerve disease are grouped together as micro-vascular complications of diabetes.

It is very important that patient screening for such complications of type II diabetes be carried out, because the symptoms of such complications may not be manifest until it is too late – particularly in the case of eye disease. There are a number of methods to screen for eye disease in this patient group.

“In our clinic, we dilate the pupils and use an ophthalmoscope to examine the retina,” said Dr John McDermott, Consultant Endocrinologist at Connolly Memorial Hospital. The aim is to detect diabetic retinopathy.

A bleed in fragile blood vessels at the back of the eye can result in detachment of the retina and can even lead to blindness. Patients diagnosed with diabetes should be screened a minimum of once a year for eye complications.

The Irish Endocrine Society is currently examining diabetic foot complications in a bid to gauge the number of cases here. Diabetic neuropathy involves nerve damage and mainly affects the feet.

This can cause symptoms of burning, tingling, numbness and even pain, said Dr McDermott. That, in itself, can be very distressing – for example, it can prevent sleep. Feet can also lose their protective sensation, which can lead to ulceration.

Symptoms can be improved with treatment. Foot care advice, improved blood supply and specialist shoes can help.
It is difficult to construct an algorhythm or treatment plan for type II diabetes that would be applicable in all cases, said Dr McDermott.

In the past, insulin, metformin and sulphonylureas were the main available treatments. Now there is a greater range of treatments, which work to lower the frequency of hypoglycaemia and may also reduce microvascular risk by cutting HbA1c levels.

The two treatment approaches that have been used for the longest amount of time are metformin and the sulphonylureas. Metformin is a firstline treatment in overweight and obese patients and it is also proven to be safe.

A great many new medications have emerged over recent years, however. Thiazolidinediones or TZDs (including rosiglitazone and pioglitazone) and glucagon-like peptide-1 (GLP-1) analogs have emerged. There are also dipeptidyl peptidase 4 (DPP-4) inhibitors.

Many patients who are overweight or obese opt for the GLP-1 analog injections, because there is a possibility of weight loss. These can be used with metformin.

Experience with the new treatments is not as extensive as with some other treatments. Once-weekly GLP-1 analog injections are becoming available.

If it emerges with time that these injections can have an impact on the progression of the disease and are safe, that would be encouraging, Dr McDermott said.