title: Diabetic retinopathy: a review of general medical factors in patient care.
abstract: Current concepts of the pathogenesis of retinal microangiopathy strongly suggest that it is dependent on the metabolic abnormalities of diabetes mellitus. This has led to speculation that retinal microangiopathy might be prevented or its progression halted by controlling the blood glucose concentration to lower levels than has been possible in the past with conventional insulin therapy and conventional monitoring. Intensive regulation of the blood glucose level in insulin-dependent diabetes mellitus is a therapeutic choice made available by technologic advances: the introduction of devices for insulin delivery and for the patient's self-monitoring of the blood glucose level, as well as of methods for measuring the level of glycosylated hemoglobin. For an individual patient, selection of the optimal insulin regimen and the optimal target for the blood glucose levels should take into account the susceptibility to microvascular complications inherent in the classification of that patient's diabetes, the patient's retinopathy status and the potential risks, such as severe hypoglycemia and, perhaps, acceleration of retinopathy. With normal or nearly normal blood glucose levels many of the metabolic and endocrine abnormalities of diabetes are corrected, but the biologic significance and the impact on diabetic retinopathy of this improvement remain to be clarified.
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis; D003922:Diabetes Mellitus, Type 1 / Q000145:classification / Q000175:diagnosis / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000145:classification / Q000175:diagnosis / Q000628:therapy*; D003930:Diabetic Retinopathy / Q000517:prevention & control*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007003:Hypoglycemia / Q000517:prevention & control; D007332:Insulin Infusion Systems; D008297:Male; D011247:Pregnancy; D012648:Self Care
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin