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Joint ophthalmic-endocrinology juvenile diabetes mellitus: ‘the new kid on the block'

Poster Details

First Author: S.Lalchan TRINIDAD AND TOBAGO

Co Author(s):    J. Cook   S. Lalchan   V. Singh        

Abstract Details



Purpose:

Juvenile diabetes mellitus has increased by 20% with 90% of patients developing retinopathy by the age of 30yrs. The challenge is even greater in developing counties as education, poor glycemic control and treatment misconceptions are additional hurdles to reduce ophthalmic morbidity. The opportunity to perform retinal screening was merged with the endocrinologist. The joint clinic aims to improve patient education on both glycemic control and retinal screening in this high risk group. An analysis of the first clinic will guide resources and efforts for these children.

Setting:

Mt Hope Hospital, Trinidad and Tobago

Methods:

A consecutive series of Type 1 DM were screened by Consultant-led joint ophthalmology and endocrinology clinic. Patients were invited with their parents with appropriate consent. Patients/parents completed a demographic registration form, followed by an administered questionnaire. Educational videos on HbA1c and diabetic retinopathy were shown. All patients had visual acuity, a slit lamp examination by Consultant Ophthalmologists with dilated fundoscopy. Diabetic retinopathy was graded as per ETDRS. Patients were fast tracked for further investigations and/or treatment.

Results:

The sample size was 34 eyes (n 17). The demographics area as follows: mean age 15yrs; mean duration of DM 6.3yrs; mean HbA1c 8.3%. 70.6% of patients had first/second degree family history of DM. 24% of patients had ocular pathology: 3 cataract-related and 1 patient had mild/moderate retinopathy. The patient questionnaire revealed that 100% felt DM can cause eye diseases and improved glycemic control will reduce the risk of complications. 65% had been seen previously by an ophthalmologist and 29% had no exercise as part of lifestyle modification. Notably, 53% were aware of laser treatment as an option yet 24% opted that diabetic retinopathy should be treated only when a problem develops as opposed to early intervention. 12% felt laser would be of no benefit in preserving vision.

Conclusions:

The diabetes mellitus pandemic is undeniably increasing; both Type 1 and Type 2 have increased by 20% in young patients. These patients are at high risk of morbidity and mortality during their lifetime of which diabetic related eye diseases are prevalent. The benefits of improved glycemic control, continuing education and the role of multidisciplinary team are clearly evident in this population. The dedicated joint clinic and pathway serve to reduce ophthalmic morbidity and importantly dispel misconceptions in developing countries. The authors declare no financial interest FINANCIAL INTEREST: NONE

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