macrovasculares y microvasculares. complicaciones microvasculares y macrovasculares. Se diabetes mellitus ocupa el segundo lugar como causa de . Variables sociodemograficas, epidemiologicas de la DM, factores de riesgo cardiovasculares, presencia de La prevalencia de complicaciones aumento: microvasculares, del 33,4 al 42,1%, y macrovasculares, del 22,3 al 37,2%. El impacto de las complicaciones microvasculares y macrovasculares en la morbilidad, la mortalidad y la calidad de vida convierten a la diabetes mellitus en .

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Prevalence of diabetic retinopathy in Peruvian patients with type 2 diabetes: Yoshiyama II ; Javier E. Hilario IV ; Lawrence M.

complicaciones microvasculares y macrovasculares de la diabetes mellitus pdf – PDF Files

To estimate the prevalence of diabetic retinopathy DR in patients with type 2 diabetes and to determine any association with clinical factors. This hospital-based screening project was designed to prospectively detect the presence of DR in patients with type 2 diabetes by grading images acquired with a digital retinal camera. Of 1 patients screened, appropriate retinal images were obtained in 1 subjects DR was detected in patients In 32 patients The frequency of DR was the same in both sexes.

Prevalence of blindness was microvascilares as frequent in patients with DR as in those without it 9. The frequency of DR at diagnosis was 3.

The prevalence of DR in these patients with type 2 diabetes was Nonproliferative retinopathy accounted for Microvvasculares less prevalent than in a previous report, it doubled the frequency of blindness in the people affected. A national screening DR program should be considered in order to detect this prevalent condition early and treat it in a timely fashion.

Diabetic retinopathy; diabetes mellitus; telemedicine; Peru. Diabetes mellitus is increasing dramatically throughout the world. It is estimated that, fordiabetes mellitus affects million adult people globally, including Diabetic retinopathy DRa specific vascular complication of diabetes, is the leading cause of blindness in workingage individuals in developed countries 2.

Randomized clinical trials have clearly demonstrated that intensive glucose control reduces the risk of occurrence of DR and the risk of developing severe visual loss from proliferative DR, and macular edema can be significantly diabeyes through the use of timely laser photocoagulation 10, Therefore, screening for early detection microvascylares DR to prevent blindness and impaired visual conditions is mandatory and costeffective 12, To investigate the prevalence of DR in Peruvian patients with type 2 diabetes, a screening project was established using retinal telescreening.

The results are presented here. This is a prospective observational and intervention study. Inthe Center for the Americas at Vanderbilt University in the United States of America convened a work group to begin a collaborative project to increase access to preventive eye care in Latin America.

Its multidisciplinary team dd to investigate whether a telescreening model used in Tennessee 14 could be adopted for use in Peru. The work group provided seed funding for training and salary support for a nurse, an endocrinologist, and an ophthalmologist. It also acquired a retinal camera, associated software, computer equipment for image grading, and long-distance telecommunications equipment, which were placed at the Endocrine Unit of the Hospital Nacional Cayetano Heredia.

From 18 September to 9 September1 diabetic patients were referred to the project by their treating endocrinologist for a cost-free evaluation of DR as part of the patient’s diabetes care. According to criteria of the American Diabetes Association, 1 had type 2 diabetes mellitus 15 Each patient signed an informed consent document. Participants were seated in a dark room to allow their pupils to dilate naturally in preparation for the retinal imaging capture performed by the nurse.


If the pupil was not sufficiently dilated for retinal complicaciojes to be clearly recorded on the optic nerve and within one disc diameter of the fovea, pharmacologic dilation was achieved by instilling a 1.

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One image was centered on the fovea and the other image was centered on the optic nerve. The digital images were temporarily stored in a laptop computer attached to the camera. They were later transmitted to a workstation established at the Universidad Peruana Cayetano Heredia for grading. A trained ophthalmologist at Vanderbilt University graded all the images. Severity of DR was categorized by using the proposed international clinical DR and diabetic macular edema disease severity scales For the first year of the project, images and grading were also reviewed by the Vanderbilt Ophthalmic Imaging Center as part of a quality assurance initiative.

Matching for grading between the centers was The project nurse used a Snellen chart to test distance visual acuity. Spectacle correction was used when available. The nurse asked participants about their age, sex, race, ethnicity, educational attainment illiterate, less than high school, high school education, or higherfamily income, and employment status. History of microvascular retinopathy, nephropathy, and neuropathy, both peripheral and autonomic and macrovascular coronary heart disease, cardiac failure, cerebrovascular disease, and peripheral vascular disease complications, history of arterial hypertension, and risk factors for DR-such as hemoglobin A1c HbA1clipids, duration of diabetes, systolic and diastolic blood pressure, body mass index BMIwaist circumference, current smoking status, and diabetic treatment-were ascertained by the treating endocrinologist from the clinical chart and were registered on a special form.

Statistical analyses were conducted using Stata TM Characteristics of the study diagetes were described by using medians and interquartile ranges for continuous variables and percentages for categorical variables. A chisquared test was used for categorical variables.

The median age of patients was 59 years interquartile range, Appropriate retinal images were obtained in 1 patients In 89 patients 6. The frequency of DR was the same for men and women. The grade of DR was concordant in both eyes in patients Eyes were unevenly affected in 38 patients maccrovasculares Clinically significant macular edema was found in 28 patients 2.

It was unilateral in half of them, and 19 had nonproliferative DR. Blindness occurred twice as frequently in patients with DR as in those without it 9. Similarly, low vision was more prevalent in those with DR than in those without it DR had a peak frequency in the sixth and seventh decades of age Figure 1. Of patients with DR, 3. With regard to income, There was no difference in DR frequency among those groups.

Complicaciones de la diabetes mellitus

DR was more prevalent in patients with arterial hypertension and in those with any macrovascular, neuropathic, or miicrovasculares complication Figure 3. The frequency of DR was the same in patients with and without the antecedent of any lipid disorder DR was present in DR prevalence was the same in patients with abdominal waist circumference above and below cutoff values for metabolic syndrome DR was more prevalent in patients who used insulin alone or in combination with oral drugs macrovasfulares Patients on metformin only had the lowest frequency of DR A DR prevalence of A previous study from Peru 20 using binocular indirect ophthalmoscopy in patients with type 2 diabetes reported a DR prevalence of Mean ages of patients and duration of diabetes were almost the same in both series.

Although the different technology used in both studies may explain this difference, other factors, such macrovacsulares quality of metabolic control and treatment options, may also be involved.

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The previously reported prevalence of DR was closer to that found in users of insulin or sulfonylureas in this study. In Brazil, mfllitus and neuropathy were the complications that contributed the most to years lived with disability in the population The prevalence and severity of DR vary according to ethnicity: This difference may be due to differences in dietary habits, physical activity, overweight prevalence, late diagnosis of diabetes, access to medical care, compliance with diabetes medication, or genetic factors 41, The same prevalence of DR was found in women and men.

In the National Health and Nutrition Examination Survey 43male gender was a significant and independent risk factor for DR, and in the United Kingdom Prospective Diabetes Study 44 it was a factor for progression of retinopathy in those with DR present at baseline.

Patients with DR had twice the frequency of blindness and a higher prevalence of low vision than those without DR. The overall prevalence of presenting visual impairment in the National Health and Nutrition Examination Survey among participants with diabetes was macrovasuclares No difference in DR was found among those less than and more than 65 years old.

DR was less prevalent in those with higher education, with no difference in prevalence regarding family income and actual economic activity. There is a known inverse socioeconomic morbidity and mortality gradient in people with diabetes 49although it is largely due to conventional cardiovascular risk factors. A review of 51 studies 34 found that diabetic patients from ethnic minorities had increased mortality rates and higher risk of diabetes complications.

These differences almost disappeared after adjustment for risk factors such as smoking, diabets status, income, years of education, and BMI, with the exception of increased risk of DR for African American and Hispanic diabetics in the United States 4, Family aggregation and genetic factors may explain this persistent increased risk 41, Duration of diabetes is a mifrovasculares risk factor associated with the development of DR.

The prevalence of DR in Hispanic patients with diabetes longer than 15 years varies between DR was present in 3.

Complicaciones de la diabetes mellitus – Wikipedia, la enciclopedia libre

An increased prevalence of DR was found in patients with any macro- or microvascular complication. Hyperglycemia is a key factor for both conditions, producing vascular damage through mitochondrial overproduction of superoxide secondary to an increased flux through the polyol pathway, intracellular production of advance glycosylated end products, protein kinase C activation, and increased hexosamine pathway activity Arterial hypertension is another factor that is important for DR 10, 11, Intensive management of hypertension has been demonstrated to slow the progression of retinopathy In addition, controlling blood pressure significantly reduced the clinical complications of diabetic eye diseases-including microaneurysms, retinal complkcaciones, and loss of visual acuity Adiposity has been associated with increased prevalence of DR 46, This has been described in three studies 30, 57, Low BMI reflects poor metabolic control, decreased pancreatic insulin reserve, and the need for insulin therapy.

DR occurred more frequently in patients treated with insulin alone or in combination microvascuoares in those taking sulfonylureas. The same findings were reported previously 20, 43, macrovascularse The severity of hyperglycemia is the key alterable risk factor associated microvascularew the development of DR.