BMJ  2006;333:601-602 (16 September), doi:10.1136/bmj.333.7568.601-b

Letter

Preventing and detecting early vascular effects of diabetes

Improvement must continue or costs will escalate

The first 150 words of the full text of this article appear below.

EDITOR—As editor of a diabetic retinopathy website with patients regulary sending letters, I agree with Marshall and Flyvberg's comments.1 Care is rapidly improving across the United Kingdom, but around a quarter of patients with retinopathy still present with severe retinopathy at time of diagnosis of diabetes. They have not been screened for diabetes, despite having it for 5-10 years and having been recommended screening by medical professionals.2

Thus, in addition to Marshall and Flyvberg's suggestions, screening for diabetes itself must improve if retinopathy is to be prevented; and people must make the lifestyle changes to avoid type 2 diabetes.3

If control of diabetes improves from a poor level yielding a significantly lower HbA1c, however, well established retinopathy may progress rapidly: good control will help in the long but not the short term. This has played a part in worsening severe retinopathy in many people.

Basal bolus insulin . . . [Full text of this article]

D J Kinshuck, associate specialist, ophthalmology

Good Hope Hospital, Sutton Coldfield, Birmingham B75 7RR david.kinshuck@goodhope.nhs.uk


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Relevant Article

Prevention and early detection of vascular complications of diabetes
Sally M Marshall and Allan Flyvbjerg
BMJ 2006 333: 475-480. [Extract] [Full Text] [PDF]

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