How is patients’ annualized risk determined? Was the algorithm clinically validated?
The annualized risk is calculated by a proprietary algorithm based upon major, well-established risk factors for the development of sight-threatening diabetic retinopathy. The algorithm has been validated for high predictive accuracy in Icelandic, Danish and Dutch diabetes cohorts.
Is the algorithm applicable to a variety of patient races and ethnicities?
The algorithm has been clinically validated in Northern European diabetes cohorts, which include a variety of races and ethnicities. Our team plans future validation for other populations in the near future. The processes implicated in sight-threatening diabetic retinopathy within all populations are predominantly dependent upon metrics employed by our algorithm, including blood glucose control, blood pressure status, disease duration, gender, diabetes sub-type, and presence or absence of non-proliferative retinopathy.
A number of emerging risk factors for sight-threatening diabetic retinopathy are not part of the clinical data entered into the calculator, including obstructive sleep apnea, obesity, and history of other diabetes complications like non-healing limb ulceration. Why not?
The algorithm accounts for 80% of established risk in patients with diabetes based upon a preponderance of research data, and has been validated for accuracy in large populations of patients with diabetes by accounting for the significant majority of total risk. These emerging factors probably account for 20% of total risk and may very well be important for refinement of predictive power, but require further validation. The personalized report form generated for each patient does, however, allow health care providers to communicate the presence of at least some of these emerging risk factors and recommend additional preventative strategies for patients based upon clinical judgment and new research findings.
What is diabetic retinopathy?
Diabetic retinopathy is an eye problem caused by diabetes mellitus and is the most common cause of vision loss in people with diabetes. It affects the retina, which is the light sensitive tissue at the back of the eye. Retinopathy occurs when diabetes damages the tiny blood vessels in the retina. In some people with diabetic retinopathy, blood vessels may swell and leak fluid. The longer you have had diabetes, and the more the blood sugars fluctuate, the more likely you are to have retinopathy. The damage can lead to problems with your vision, including blindness. Annual eye screening will keep a close check on these early changes and make sure that any signs that there could be a progression to more serious stages of retinopathy are detected early and treated appropriately. Other parts of the eye may be affected by diabetes such as the lens, causing cataracts. Retinopathy can occur with all types of diabetes. It is the leading cause of blindness worldwide for people who are between 20 and 74 years old (working age). However, 90% of blindness and vision loss caused by diabetic eye disease can be prevented with regular eye screening programs and timely interventions.
What causes diabetic retinopathy?
The longer a person has diabetes, the higher their chances of developing diabetic retinopathy. Prolonged periods of high blood sugar levels cause damage to the small blood vessels in the retina at the back of the eye. The retina is the film at the back of the eye, which receives light images and sends them to your brain. A healthy retina is essential for good vision. These blood vessels initially become leaky and then may become blocked off. The leaky vessels can lead to hemorrhages (spots of bleeding), fluid and exudates (fats) to escape from the blood vessels onto the retina. This may also cause swelling, known as edema of the retina. The blocked vessels can starve the retina of oxygen, leading to the growth of new abnormal vessels from the retina, and damage to the retina due to lack of oxygen. Good control of diabetes by controlling the blood sugar level helps to reduce the chances of developing retinopathy.
What are the symptoms of diabetic retinopathy?
Diabetic retinopathy may be asymptomatic until at an advanced stage and then it is often too late for effective treatment. Therefore, effective management of diabetes and regular eye examinations are imperative. Initially diabetic retinopathy may cause few or mild symptoms but, as the disease progresses, it can lead to blindness. The main symptoms of diabetic retinopathy are blurred vision, black spots, flashes of light, holes in your vision. Diabetic retinopathy usually affects both eyes.
How can I help prevent eye problems with diabetes?
Effective management of diabetes is essential to prevent or delay the onset of diabetic eye disease, particularly diabetic retinopathy. Working with your medical doctor to control blood sugar, blood pressure, and cholesterol are the most important steps you can take to prevent eye problems if you have diabetes. Maintain a normal weight, limit unhealthy fats, substitute complex carbohydrates for simple carbohydrates, participate in an exercise program and do not smoke. Regular eye exams are particularly important if you have diabetes. A thorough eye exam can identify problems early on while there are still options for treatment. Using the Retina Risk app on a regular basis is useful to assess and monitor your risk of developing Diabetic Retinopathy. Early treatment can help stabilize the eye and prevent further vision loss.
How is it treated?
Early detection, before the retina has been badly damaged, is extremely important in reducing vision loss from this disease. Laser treatment is usually very effective at preventing further vision loss. Your eye surgeon may use the laser to seal leaking blood vessels or destroy abnormal vessels. Surgical removal of the vitreous gel (vitrectomy) may also help improve vision if the retina has not been severely damaged. Sometimes injections of anti VEGF (vascular endothelial growth factor) medicine help to shrink new blood vessels in proliferative diabetic retinopathy.
How can I take care of myself?
As long as you have diabetes, there is a chance you will develop retinopathy. However, careful control of your blood sugar levels will help delay and possibly prevent vision loss. People with diabetes need to play an active role in managing their disease to prevent complications affecting their quality of life. By maintaining good glycemic and blood pressure control, a person with diabetes can prevent complications such as sight-threatening diabetic retinopathy. Schedule regular eye exams to make sure you get treatment when you need it. Tell your doctor if you have any change in your vision. Use the Retina Risk app on a regular basis to assess and monitor your individualized risk of developing Diabetic Retinopathy based on your clinical values (blood sugar and blood pressure).
What is diabetes?
- Type 1 diabetes is a chronic autoimmune disease in which the immune system destroys the insulin-producing cells in the pancreas. People with type 1 diabetes need lifelong treatment with insulin on a daily basis to control blood glucose. The onset of type 1 diabetes is common in children and young adults but can affect people of any age.
- Type 2 diabetes accounts for most cases of diabetes and is characterized by insulin resistance and insufficient insulin production. Type 2 diabetes can often be controlled through diet, weight loss where necessary and increased physical activity. It can also require treatment with medication, including insulin. Type 2 diabetes usually occurs in adults but is increasingly seen in children and adolescents. Many people live with type 2 diabetes for long periods without recognizing symptoms or being aware of their condition. By the time of diagnosis, their organs may already be damaged by excess blood glucose and complications such as retinopathy may already be evident.
- Gestational diabetes develops during pregnancy and usually resolves after the woman gives birth. Women who have gestational diabetes remain at significant risk of developing type 2 diabetes later in life.
What is Hb1AC?
The HbA1C is a blood test that will help you know whether your blood sugar has been at target over the past 3 months. A lower HbA1C will reduce your risk of eye problems and other diabetes related complications, such as heart disease, stroke, kidney disease, nerve damage, and foot problems. The goal for most people with diabetes is to have an HbA1C of 7% (53 mmol/mol) or less but you should talk to you doctor about the HbA1C target that is right for you. A higher HbA1C target may be safer for certain people. Targets and medications should be adjusted to prevent low blood sugars. You should have this blood test done every 3 months when blood sugar targets are not being met or when you are making changes to your diabetes management.
What should my blood pressure be?
Higher blood pressure can damage your blood vessels, and cause heart disease, stroke, kidney disease and eye problems. The target blood pressure for most people with diabetes is less than 130/80 mmHg. A higher blood pressure may be safer for certain people if they are at risk of falls. Your blood pressure should be checked regularly. Ask your health-care provider if checking your blood pressure at home might be helpful.
Why is exercise so important?
Physical activity often improves blood sugar control and helps with weight loss but has many other health benefits even if weight and blood sugar control do not change. Avoid sitting for long periods of time. 150 minutes per week of aerobic exercise (like walking) is recommended. Using a step monitor (pedometer) can be helpful in tracking your activity. In addition to aerobic exercise, 2 sessions per week of strength training (like exercises with weights) is also helpful. Food is key in the management of diabetes and reducing the risk of heart attack and stroke. A registered dietitian can help you develop a personalized meal plan that considers your culture and nutritional preferences to help you achieve your goals.
How do patients with diabetes know that their disease is well controlled?
A glycated hemoglobin (HbA1c) test accurately assesses how well the blood glucose has been controlled over a period of 2–3 months. For non-diabetic individuals, the normal HbA1c level is usually below 5.5%. In people with diabetes, an HbA1c level below 7.0% indicates good control.