Wellness

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Diabetes Mellitus: 4 Diabetic-Friendly Breakfast Recipes That Are Healthy And Delicious If you are a diabetic, it is imperative for you to keep an eye on what you include or exclude in your everyday diet. Since diet plays a crucial role in managing diabetes, you must steer clear of foods that have a high glycaemic index, or loaded with refined sugars and trans-fats.

Food | Shubham Bhatnagar | Updated: February 08, 2019 13:18 IST

by Taboola

 S

If you are a diabetic, it is imperative for you to keep an eye on what you include or exclude in your everyday diet. Since diet plays a crucial role in managing diabetes, you must steer clear of foods that have a high glycaemic index, or loaded with refined sugars and trans-fats. In fact, you must follow a balanced diet, filled with healthy and fibrous fruits and veggies. To eat healthy, you need to start right. Health experts and nutritionists say that the first meal of the day plays an important role in determining your energy levels.

Always make sure that your first meal of the day is well-balanced, meaning your breakfast must include protein-rich foods and vegetables, along with good carbohydrates (complex carbs). There are a plethora of food combinations that you can try to make your breakfast as enticing as possible, without worrying about spike in blood sugar levels. So, for times when your taste buds scream for something little more flavourful and delightful than basic oatmeal or cornflakes in breakfast, we have got you some interesting yet healthy diabetic-friendly breakfast ideas that you can make easily at home.

Here Are Four Diabetic-Friendly Breakfast Recipes:Strawberry Quinoa Pancakes

Roasted quinoa pancake is a perfect way to start your morning on a healthy note. Soaked in milk, dipped in orange essence and loaded with strawberries, this breakfast recipe makes for a healthy diabetic-friendly breakfast meal.

Banana Oat Bread

Made using whole wheat and oat flour, banana oat bread is a healthy alternative to your regular wheat bread. In this recipe, butter is replaced with olive oil and refined sugar with dark brown sugar, so that you can easily have it as your everyday breakfast bread. This yummy breakfast delight surely knows how to keep your tummy full and happy, without shooting your blood sugar levels.

Spinach Pancake

Try this healthy yet yummy whole wheat spinach pancake with a scrumptious filling of cheese and mushrooms. A healthy breakfast recipe that is packed with essential nutrition, without compromising on the taste quotient. You can even pack these yummy delights in lunch box for your kids, as they are rich in iron and protein. You can pair your spinach pancakes with hummus or yogurt-based sauce and fresh tomato salad.

Baked Eggs

Raise your hand if you are done with your scrambled eggs! This healthy breakfast egg recipe can easily be a part of your diabetic-friendly breakfast meal. If the findings of a study, published in 'The American Journal of Clinical Nutrition', are to be believed, then eating four eggs a week may help you manage Type-2 diabetes. So treat yourself with this delicious yet healthy breakfast recipe, without any second thoughts.

Kick-start your day on a healthy note with these healthy diabetic-friendly recipes; but before adding any food to your diet, do consult your dietician or diabetologist.

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Print

Smashed Potatoes

Prep Time

15 mins

Total Time

21 mins

Servings: 6 servings

Author: Megan

Ingredients

• 2-1/2 pounds New, Red, or small Yukon Gold potatoes washed
• avocado oil for drizzling
• sea salt to taste

Instructions

1. Place potatoes in large pot. Cover with water by 1". Boil slowly until fork tender. Drain and cool potatoes. Refrigerate them overnight or for several hours.
2. Preheat oven to 400 degrees Fahrenheit. With the back of an offset spatula smash each potato and place into a cast iron skillet or onto cookie sheet. Drizzle generously with avocado oil and sprinkle with sea salt. (Use your fingers to rub to top of each potato with the oil.)
3. Bake 15 minutes, then flip each potato and bake 15 additional minutes. Serve.

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Reducing Risk of Macrovascular Disease With Bariatric Surgery

Feb 2, 2019

Editor: Joy Pape, MSN, FNP-C, CDE, WOCN, CFCN, FAADE

Author: Michael Zaccaro, Pharm. D. Candidate 2019, LECOM School of Pharmacy

Patients with severe obesity and type 2 diabetes and without bariatric surgery are assessed to determine comparative incidence of macrovascular disease.

The umbrella term macrovascular disease encompasses both cardiovascular disease and cerebrovascular disease. These are among the most concerning complications of type 2 diabetes and, as such, are the subject of many preventative clinical interventions. Current evidence indicates that interventions focused on weight reduction confer a corresponding reduction in the risk of developing macrovascular disease. With regards to weight reduction via bariatric surgery, there is a small body of evidence that suggests a similar preventative benefit to other weight-reducing techniques. However, the quality of study that provides this evidence is a bit lacking, as the sample sizes are typically low and BMI is often not a measurement of interest. The aim of this study is to determine if there is a correlation between bariatric surgery and reduced macrovascular risk in patients with type 2 diabetes and severe obesity, while addressing the shortcomings of other studies with similar aims.

This study is a retrospective cohort study in design. The data used for the study was procured from the electronic medical records from four branches of the Health Care Systems Research Network (Kaiser Permanente Washington State as well as Northern and Southern California, and HealthPartners of Minnesota). Patient data was considered for use if the patient had a diagnosis of type 2 diabetes and underwent bariatric surgery between the years of 2005 and 2011. Patient data was excluded if there was less than 1 year of continuous enrollment in their respective health system, a history of cancer, pregnancy, metformin as the only indication of diabetes diagnosis, gestational diabetes, pre-existing cardiovascular or cerebrovascular disease, pre-procedure BMI of < 35, absent pre-procedure BMI or HbA1c, or unable to find characteristic matched patient without surgery. The non-surgical matched patients were considered based on the same criteria as the surgical patients (with the exception of undergoing bariatric surgery) then matched to a corresponding surgical patient based on pre-surgical baseline characteristics. The primary outcome of interest was time to first major macrovascular event (myocardial infarction, unstable angina, stent placement, ischemic or hemorrhagic stroke, etc.). Time to each individual type of event was assessed secondarily. Statistical significance was determined via the Cox proportional hazards regression model.

Of the 9,109 surgical cases that were considered for inclusion, 5,301 were deemed eligible and included in the study. There were 14,934 non-surgical matched patients who were also identified and included in the study. For the primary outcome, the patients who underwent a bariatric procedure had a lower incidence of macrovascular events at 5 years post-surgery when compared to their non-surgical matched counterparts (2.1 vs. 4.3% respectively). Likewise, there was a statistically significant reduction in cardiovascular events, favoring the surgical group during the same timeframe (1.6 vs. 2.8% for the surgical and non-surgical group respectively). There was no significant difference between groups with regards to occurrence of cerebrovascular events.

The results of this study indicate that undergoing bariatric surgery may provide a macrovascular risk reduction if the patient has severe obesity and has type 2 diabetes. This suggests that bariatric surgery may be an effective clinical option in this patient population if conventional lifestyle and pharmacologic options have failed. However, as this study is observational in nature, causation cannot be inferred. Therefore, further study, preferably with randomized controlled trials, is necessary in order to validate these findings.

Practice Pearls:

• Weight reduction has been linked to decreased risk of macrovascular complications in patients with type 2 diabetes and obesity.
• Study shows a correlation between reduced macrovascular risk and weight reduction achieved via bariatric surgery in patients with type 2 diabetes and obesity.
• Undergoing bariatric surgery may provide a macrovascular risk reduction if the patient has severe obesity and type 2 diabetes.

Reference:

Fisher, David P., et al. “Association Between Bariatric Surgery and Macrovascular Disease Outcomes in Patients With Type 2 Diabetes and Severe Obesity.” Jama, vol. 320, no. 15, 2018, p. 1570., doi:10.1001/jama.2018.14619.

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I just want to offer some encouragement to my friends that have chosen  weight loss surgery to help in their fight against diabetes

You have nothing at all to feel ashamed of. Many people have found great help, in taking this path, including Randy Jackson. It is just another tool in your  path to wellness

You still have a difficult fight ,to get the weight off ,and keep it off. If Randy Jackson can do it, so can you. He looks terrific, and has discovered things about himself, and food ,in the process

I use his airplane food diet, and it works for me, as well.I am not overweight, never have been, and haven't had weight loss surgery.  Call it anything  you like, moderation, portion control, or airplane diet, people have used it successfully, for years

Keep on keeping on ,my friends, and don't let other people discourage you. It is your life ,and your choice. Everyone doesn't have to do things ,the same way  other people do. Do what works for you.

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Felice Frankel / MIT News
New pill can deliver insulin
Capsule that releases insulin in the stomach could replace injections for patients with type 2 diabetes.
Written by Anne Trafton
MIT News

Daily needle injections may soon be a thing of the past for diabetes patients thanks to this latest breakthrough.

An MIT-led research team has developed a drug capsule that could be used to deliver oral doses of insulin as a means of potentially replacing the injections that people with type 2 diabetes have to give themselves every day.


 
About the size of a blueberry, the capsule contains a small needle made of compressed insulin, which is injected after the capsule reaches the stomach. In initial tests, the researchers showed that they could deliver enough insulin to lower blood sugar levels that are comparable to those produced by skin injections. They also demonstrated that the device can be adapted to deliver other protein drugs.

“We are really hopeful that this new type of capsule could someday help diabetic patients and perhaps anyone who requires therapies that can now only be given by injection or infusion,” says Robert Langer, a member of MIT’s Koch Institute for Integrative Cancer Research and one of the senior authors of the study, which was published in Science earlier this week.



Several years ago, a group of MIT colleagues developed a pill that was coated with tiny needles that could be used to inject drugs into the lining of the stomach or the small intestine. For the new capsule, the researchers changed the design to have just one needle, allowing them to avoid injecting drugs into the interior of the stomach, where they would be broken down by stomach acids before having any effect.

The tip of the needle is made of nearly 100 percent compressed, freeze-dried insulin, using the same process used to form tablets of medicine. The shaft of the needle, which does not enter the stomach wall, is made from another biodegradable material.

Within the capsule, the needle is attached to a compressed spring that is held in place by a disk made of sugar. When the capsule is swallowed, water in the stomach dissolves the sugar disk, releasing the spring and injecting the needle into the stomach wall.


The stomach wall has no pain receptors, so the researchers believe that patients would not be able to feel the injection. To ensure that the drug is injected into the stomach wall, the researchers designed their system so that no matter how the capsule lands in the stomach, it can orient itself so the needle is in contact with the lining of the stomach.

“As soon as you take it, you want the system to self-right so that you can ensure contact with the tissue,” says Giovanni Traverso, a visiting scientist in MIT’s Department of Mechanical Engineering and a senior author of the study.

The researchers drew their inspiration for the technology from the leopard tortoise. This tortoise, which is found in Africa, has a shell with a high, steep dome, allowing it to right itself if it rolls onto its back. The researchers used computer modeling to come up with a variant of this shape for their capsule, which allows it to reorient itself even in the dynamic environment of the stomach.



“What’s important is that we have the needle in contact with the tissue when it is injected,” says Alex Abramson, MIT grad student and first author of the paper. “Also, if a person were to move around or the stomach were to growl, the device would not move from its preferred orientation.”

Once the tip of the needle is injected into the stomach wall, the insulin dissolves at a rate that can be controlled by the researchers as the capsule is prepared. In this study, it took about an hour for all of the insulin to be fully released into the bloodstream.

In tests in pigs, the researchers showed that they could successfully deliver up to 300 micrograms of insulin. More recently, they have been able to increase the dose to 5 milligrams, which is comparable to the amount that a patient with type 2 diabetes would need to inject.

After the capsule releases its contents, it can pass harmlessly through the digestive system. The researchers found no adverse effects from the capsule, which is made from biodegradable polymer and stainless steel components.


Maria José Alonso, a professor of biopharmaceutics and pharmaceutical technology at the University of Santiago de Compostela in Spain, describes the new capsule as a “radically new technology” that could benefit many patients.

“We are not talking about incremental improvements in insulin absorption, which is what most researchers in the field have done so far. This is by far the most realistic and impactful breakthrough technology disclosed until now for oral peptide delivery,” says Alonso, who was not involved in the research.

The MIT team is now continuing to work on developing the technology and optimizing the manufacturing process for the capsules. They believe this type of drug delivery could be useful for any protein drug that normally has to be injected, such as immunosuppressants used to treat rheumatoid arthritis or inflammatory bowel disease. It may also work for nucleic acids such as DNA and RNA.

“Our motivation is to make it easier for patients to take medication, particularly medications that require an injection,” Traverso says. “The classic one is insulin, but there are many others.”

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A vitamin C tablet twice a day could help more than one million Australians with type 2 diabetes reduce their blood sugar levels a Victorian study has claimed.

The Deakin University study, published in the Diabetes, Obesity and Metabolism journal, found taking two 500mg doses daily can lower elevated blood sugar levels and reduce post-meal blood sugar spikes in type 2 diabetics.

"We found that participants had a significant 36 percent drop in the blood sugar spike after meals. This also meant that they spent almost three hours less per day living in a state of hyperglycaemia," lead researcher associate professor Glenn Wadley said.

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"This is extremely positive news as hyperglycaemia is a risk factor for cardiovascular disease in people living with type 2 diabetes."

More than 1.2 million Australians have been diagnosed with the disease.

The dose of vitamin C used in the randomised study was about 10 times the normal dietary intake and readily available at most health food stores.

"Vitamin C's antioxidant properties can help counteract the high levels of free radicals found in people with diabetes, and it's encouraging to see this benefits a number of the disease's common comorbidities, such as high blood pressure," Professor Wadley said.

Excess weight can lead to a number of health conditions, including cardiovascular disease, stroke, some cancers and Type 2 diabetes. (AAP) ()

"For people living with type 2 diabetes, vitamin C could be a potentially cheap, convenient and effective additional therapy, used in addition to their usual anti-diabetic treatments”.

Study participants with hypertension also had their blood pressure levels drop while taking the vitamin C tablets, he added.

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The results of a recent Texas A&M University-led study provide insights into the mechanism by which estrogen can decrease insulin resistance and the production of glucose, reducing incidence of Type 2 diabetes mellitus.

The study, "Estrogen Improves Insulin Sensitivity and Suppresses Gluconeogenesis via the Transcription Factor Foxo1," can be found online in the Diabetes journal of the American Diabetes Association.

"In this study, we investigated the role of estrogen in control of glucose homeostasis, which has profound impact on our understanding of obesity and diabetes as well as potential dietary interventions," said Dr. Shaodong Guo, primary study investigator and Texas A&M AgriLife Research scientist in the department of nutrition and food science in College Station.

Guo said recent research on the prevalence of Type 2 diabetes has shown gender-related differences, especially a reduced incidence of the disease in premenopausal women. Clinical and animal studies have shown a strong correlation between estrogen deficiency and metabolic dysfunction.

"In general, glucose homeostasis is maintained by glucose uptake in muscle and adipose tissue in addition to glucose production in the liver," he explained. "However, studies have shown the reduction of estrogen in postmenopausal women accelerates the development of insulin resistance and Type 2 diabetes.

"Conversely, clinical trials of estrogen replacement therapy in postmenopausal women have demonstrated a lowered insulin resistance as well as reductions in plasma glucose level."

Guo said estrogen deficiency or impaired estrogen signaling is associated with insulin resistance and faulty regulation of metabolic homeostasis, which contributes to the development of Type 2 diabetes and obesity in both human and animal models. But the exact contribution of the tissue-specific action of estrogen to metabolic changes and underlying mechanisms have not yet been elucidated through research.

"Premenopausal women exhibit enhanced insulin sensitivity and reduced incidence of Type 2 diabetes compared with age-equivalent men," he explained. "But this advantage disappears after menopause with disrupted glucose homeostasis, in part owing to a reduction in circulating estrogen."

Guo noted there is also a potential risk of breast cancer or stroke as a side effect of estrogen therapy, which is a significant roadblock to its use as a therapeutic agent.

"This is why it is so important to understand the tissue-specific action of estrogen and its molecular mechanism in metabolic regulation," he said. "Once that mechanism is understood, it will aid in the development of targeted estrogen mimics that can provide the therapeutic benefits without unwanted side effects."

In their study, Guo and other researchers investigated the action of estrogen on glucose homeostasis in male and ovariectomized female control and liver-specific Foxo1 knockout mice.

"We wanted to understand the mechanism by which estrogen regulates gluconeogenesis by means of interaction with hepatic Foxo1," he explained. "Foxo1 has an important role in the regulation of glucose production through insulin signaling. It is an important component of insulin-signaling cascades regulating cellular growth, differentiation and metabolism."

He said in both male and ovariectomized female control mice, a subcutaneous estrogen implant improved insulin sensitivity and suppressed gluconeogenesis. However, the estrogen had no effect on the liver-specific Foxo1 knockout mice of both sexes.

"This suggests Foxo1 is required for estrogen to be effective in suppressing gluconeogenesis," he said.

"We further demonstrated that estrogen suppresses hepatic glucose production through activation of estrogen receptor signaling, which can be independent of insulin receptor substrates Irs1 and Irs2. This reveals an important mechanism for estrogen in the regulation of glucose homeostasis."

Guo said study results support the hypothesis that improvement of glucose homeostasis by estrogen is regulated by hepatic Foxo1-mediated gluconeogenesis rather than by promoting muscle glucose uptake.

He said results may also help explain why premenopausal women have lower incidence of Type 2 diabetes than age-equivalent men and suggest that targeting the estrogen receptor ERa can be a potential approach to modulate glucose metabolism and prevent diabetes.

"The identification of tissue-specific actions of estrogen and direct targets of estrogen receptors will facilitate the development of novel selective ligands that prevent Type 2 diabetes, cardiovascular disease and obesity without promoting abnormal sex characteristics or breast cancer," he said.

Guo also noted some foods, such as soybeans, contain a certain amount of phytoestrogens, which can function in a similar way to that of estrogen, regulating bodily glucose metabolism and insulin sensitivity.

"This study provides some important insights into the molecular and physiological mechanism of metabolic diseases and provides a fundamental understanding that dietary intervention can play a crucial role in controlling obesity, diabetes and associated chronic diseases," he said.

Story Source:

Materials provided by Texas A&M AgriLife Communications. Original written by Paul Schattenberg. Note: Content may be edited for style and length.

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This is from Diabetes.Co.UK

I am going to ask my endo about this, today. I have to go for my 6 months checkup. If she feels it is worth trying, I will.

snip

Vitamin C supplementation is associated with improved blood glucose levels in people with type 2 diabetes, research suggests.

A small Australian study, published in the journal Diabetes, Obesity and Metabolism, reports that people with type 2 diabetes who took a vitamin C tablet two times a day reduced their blood glucose spikes after meals by 36%.

The Deakin University research revealed people who took the vitamin C supplements spent almost three hours less a day with high blood glucose levels.

A total of 31 participants took part in the study, comprising 26 men and five women, all of whom had type 2 diabetes.

They were spilt into two groups. One group was not given vitamin C, while the second group was given two 500mg doses daily, equivalent to approximately 10 times the intake considered to be normal. Both groups ate standardised meals and were monitored with continuous glucose monitors over a four-month period.

"We found that participants had a significant 36% drop in blood sugar spike after meals. This also meant that they spent almost three hours less per day living in a state of hyperglycemia. This is extremely positive news as hyperglycemia is a risk factor for cardiovascular disease in people living with type 2 diabetes," said associate professor Glenn Wadley, who led the study.

The participants who took vitamin C also had lower blood pressure, the results revealed.

Prof Wadley added: "Vitamin C's antioxidant properties can help counteract the high levels of free radicals found in people with diabetes, and it's encouraging to see this benefits a number of the disease's common comorbidities, such as high blood pressure.

"For people living with type 2 diabetes, vitamin C could be a potentially cheap, convenient and effective additional therapy, used in addition to their usual anti-diabetic treatments. Study participants with hypertension also had their blood pressure levels drop while taking the vitamin C tablets."

The findings indicate that vitamin C provides significant health benefit, but as the researchers say, the significance is that vitamin C is used as an "effective additional therapy", such as a healthy diet.

For many people, eating a real-food diet such as that recommended on our award-winning Low Carb Program can help people lose weight, reduce their blood glucose levels and even put type 2 diabetes into remission.

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Senate President Peter Courtney figures most of the bills coming out of his office originate from conversations with constituents or members of his staff.

This was the case with Senate Bill 9. A medical emergency experienced by a legislative staffer's type 1 diabetic daughter showed how precarious access to insulin can sometimes be in Oregon. The bill gets its first committee hearing Wednesday.

SB 9 would provide a road map for pharmacists to prescribe and dispense refills of insulin and diabetes supplies in emergency situations and require reimbursements to pharmacies for prescriptions.

Had this provision existed two years ago, a lack of insulin wouldn't have been as big a problem for the staffer's daughter. 

As it was, when the pump she used to inject insulin failed on a Thursday, it meant she wouldn't be able to get in contact with her doctor for a new prescription until Monday. This was despite calls from her mother to the doctor, pharmacy and insurance company.

Kolton Wangler, 6, who has Type 1 diabetes, eats his lunch as his mom, Jessica Wangler, monitors his insulin dosage in his kindergarten classroom at St. Joseph Catholic School in Salem on Tuesday, Feb. 12, 2019. Wangler works in Sen. Peter Courtney's office, and when he heard her story he introduced a bill to allow people to get emergency insulin from the pharmacy. (Photo: ANNA REED / Statesman Journal)

For type 2 diabetics, going without insulin is a manageable proposition — many type 2 diabetics don't take regular injections of insulin.

But for type 1 diabetics, insufficient insulin is risky.

To avoid a trip to the emergency room, she had to resort to borrowing insulin from another staffer in the building whose child also has type 1 diabetes.

Since then, a law and Board of Pharmacy rules were passed to allow pharmacies to dispense insulin on an emergency basis. But Courtney and his staff found out this wasn't happening because there weren't the necessarily guidelines in place.

So this session, and with the support of insurance agencies, they came back with SB 9.

'Kevin's Law' for emergency insulin

Dan Houdeshell of Avon Lake, Ohio, lost his type 1 diabetic son Kevin to diabetic ketoacidosis after he wasn't able to get insulin during the holidays in 2013. His prescription had expired and his pharmacy couldn't give him more until he contacted his doctor. 

In a letter Houdeshell submitted in support of SB 9, he described how Kevin tried calling his doctor for three straight days starting on New Years Eve, never getting through and getting progressively sicker.

On Jan. 8, 2014, Kevin was found dead in his apartment at age 36.

Kevin is now the namesake of laws across 15 states allowing for pharmacies to perform emergency refills of insulin, and Houdeshell said that Courtney's legislation takes his basic idea one step further.

"It doesn't have to be as difficult as it is for someone with a chronic disease to get their medication," Houdeshell said. "If this helps, then we're very happy and we know Kevin is, too."

The bill, sponsored by Courtney and Sen. Dennis Linthicum, R-Klamath Falls, expands on a "Kevin's Law" already on the books in Oregon.

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The frequency of eye exams among insured patients with type 1 and type 2 diabetes in the United States is "alarmingly low," new research indicates. 

Findings from an analysis of nationwide IBM Watson Health claims data were recently published online in Diabetes Care by Stephen R. Benoit, MD, of the Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues. 

Among nearly 300,000 insured individuals with type 2 diabetes and no diabetic retinopathy at baseline, almost half had no eye exam visits recorded over the past 5 years, and only about one in seven met the American Diabetes Association's (ADA's) recommendations for annual or biennial exams. Among nearly 3000 with type 1 diabetes, about a third had no eye exam visits in 5 years and just a quarter met the ADA recommendations.

"The frequency of eye exams was alarmingly low, adding to the abundant literature that systemic changes in healthcare may be needed to detect and prevent vision-threatening eye disease among people with diabetes," Benoit and colleagues write.

Eye Exam Rates Low for Both Types of Diabetes

The study involved insurance companies and employers that contributed data to IBM Watson Health during 2010-2014.

Among 298,383 patients with type 2 diabetes and no diabetic retinopathy, 48.1% had no eye exam visits over the study period, and just 15.3% met the ADA recommendations for yearly or 2-yearly eye exam visits.

Of 13,215 patients with type 2 diabetes who did have diabetic retinopathy at study onset, 11.2% had no eye exam visits and 50.9% met the ADA recommendations during the study period. In both cases, exam rates were lower among younger adults.

Among 2949 patients with type 1 diabetes for 5 years or more prior to the study and no diabetic retinopathy at baseline, 33.6% had no eye exams during the study period and only 26.3% met the ADA recommendations.

Of the 1429 patients with type 1 diabetes who did have diabetic retinopathy at the start of the study, 8.9% had no eye exams in 5 years and 63.5% met ADA recommendations. And again, exam rates were lower among younger patients with type 1 diabetes. 

Of Those Who Had Eye Exams, High Retinopathy Rates Found

Of the 146,151 patients with type 2 diabetes who did have an eye exam over the 5-year period, 24.4% were found to have diabetic retinopathy and 8.3% had vision-threatening diabetic retinopathy, defined as having severe nonproliferative diabetic retinopathy, proliferative diabetic retinopathy, or macular edema. 

Retinopathy prevalence was higher in older patients and in men compared with women (27.3% vs 21.7%; P < .0001).

Of the 13,882 patients with type 1 diabetes who had eye exams, 54.0% and 24.3% had diabetic retinopathy and vision-threatening diabetic retinopathy, respectively. And similar to type 2 diabetes, those who were older and men had a higher prevalence.

Of particular concern, Benoit and colleagues note, was that almost a third, 30.6%, of patients with type 1 diabetes aged 40-64 years had vision-threatening diabetic retinopathy.

"Systemic Changes in Healthcare May Be Needed"

Although access to care is often cited as a barrier to timely eye exams, all the patients in this study had health insurance so clearly there are other issues, the authors say.

"Due to the consistency in suboptimal eye care utilization among people with diabetes, systemic changes in healthcare may be needed," they urge.

Telemedicine may be one viable option, they suggest, but "other interventions could also simplify and improve the fractionated healthcare system so that eye care is a seamless part of diabetes care.”

"Until this happens, [diabetic retinopathy] will likely remain the leading cause of blindness among working-age adults."

The authors have reported no relevant financial relationships.

Diabetes Care. Published online January 24, 2019.