Case 58 ...proliferative
- Male, dob 1964, dm 2010, presented 2011, Hba1c 11 ; 2012 HbA1c 6%
- thin, none smoker
- detected by the screening program
- 6/9 vision r/l
new vessels at the disc: a lot easier to see using redfree/green light
- The patient controlled his diabetes soon after it was diagnosed. Despite this the retinopathy progressed, and he developed new vessels (~2011) and needed lots of laser. Tightening control will help in the long term, but may make the retinopapthy worse in the short term.
- His retinopathy developed in 2011, 1 year after he was diagnosed with diabetes (2010). But we know it takes >9 years to develop retinopathy, so he must have been diabetic many years and not known about it.
- If we are to prevent such cases, we must screen people for diabetes (e.g. an HbA1c every 3y).
- The retinopathy developed despite the good control..the retinopathy has a 'memory' of the high glucose levels. We generally say it takes 3 years of good control before the retinopathy comes under control and stops progressing, but this patient illustrates it may take a lot longer.
- The retinopathy was detected early by the excellent screening program.
- this patient was not high risk for diabetes..he was thin, did not smoke, etc : all people must be screened for diabetes systematically (eg all patients >40y, HbA1c every 3 years, earlier with younger patients with risk factors such as smoking, obesity, diabetes in the family)
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