A cross-sectional survey with the aim to study the prevalence of diabetes and long-term complications was carried out in a health care district in Sweden with 125,500 inhabitants. Information was extracted from the medical records. 4127 people with diabetes were identified of whom 87% were classified as NIDDM (non-insulin-dependent diabetes mellitus), 12% as IDDM (insulin-dependent diabetes mellitus) and 0.7% as secondary or unclassified diabetes. The prevalence of diagnosed diabetes was 3.3%. A total of 83% received their regular routine care at primary health care centres, 31% were treated with diet only, 36% had oral hypoglycaemic agents, 31% had insulin and 2% had combination therapy. The mean HbA1c was 7.2% (ref. range 4.0-5.3%). Of the adults (> 18 years) 27% had retinopathy, 13% had nephropathy and 27% had loss of pallaesthesia. 50% had hypertension, 21% angina pectoris, 11% had had myocardial infarction, 11% stroke, 21% had signs of peripheral arterial disease, 2% had been amputated and 21% were smokers. The conclusion is that in a population of patients with diabetes with acceptable metabolic control, complications are still a great problem.
PURPOSE AND METHODS: Adolescent patients with insulin-dependent diabetes mellitus (IDDM) were retrospectively analyzed for the occurrence and possible predisposing factors of diabetic cataract in a population-based series of some 600 pediatric diabetics followed up during the years 1975-1995. RESULTS: Six patients (1%) needed cataract surgery. At the diagnosis of cataract they were 9.1-17.5 years old, and the duration of diabetes was between 0 months and 3 years 11 months. The type of cataract was similar in all patients characterized by bilateral snowflake type cortical deposits and posterior subcapsular cataract. Four of the six patients had at least a six-month history of diabetic symptoms before the treatment was started, and five patients had ketoacidosis at initial admission to hospital. In one of the 11 operated eyes diabetic retinopathy was observed immediately after surgery. Three patients developed proliferative retinopathy within 7-10 months after the operation, after 6.3-11.8 years of diabetes. CONCLUSIONS: The prevalence of diabetic cataract was around 1% in the pediatric diabetic population. In the pathogenesis of cataract long duration of diabetic symptoms and ketoacidosis prior to the commencement of treatment may be of significance. Good metabolic control after diagnosis did not protect for cataract. Diabetic cataract can safely be treated by modern surgical techniques, but close monitoring of the fundi for retinopathy after the operation is crucial, as proliferative retinopathy may develop rapidly after cataract surgery despite relatively short duration and acceptable metabolic control of diabetes.
Insulin edema (IE) has been known for a long time as one of complications caused by insulin therapy, but even today its pathogenesis stays unclear, and epidemiology unknown. IE incidence in patients over 15 years of age receiving treatment in the year 2003 for diabetic ketoacidosis (DKA) in the city of Donetsk (adult population 858200) has been retrospectively studied according to clinical archives and national diabetics register data. Presented are three own observations on the development of IE after DKA treatment. 13 (17%) out of 76 DKA patients had IE. Keeping in mind reoccurring DKA incidents--16%. During IE the known duration of Diabetes Mellitus came out to be 5 years on average, and did not differ from insulin therapy duration, whereas the Diabetes Mellitus duration in non DKA group without edemas exceeded the continuance of insulin treatment by over two years (P