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There is an increasing prevalence of diabetes mellitus (DM) and diabetic peripheral neuropathy (DPN) in older people in many countries across the world. Older adults with type 2 DM have a significantly higher incidence of falls compared with their counterparts without DM. This review synthesize published findings on sensorimotor, cognitive, balance and mobility impairments, and their associations with falls in people with DM and DPN. Given the high incidence of falls and resulting serious consequences, systematically assessing fall risk in people with DM may optimize fall prevention strategies and reduce the associated morbidity, mortality and the rehabilitation costs for people with these conditions. These findings indicate balance, gait, sensorimotor and cognitive assessments should be administered to DM patients, especially in those with DPN, to document impairment levels and target interventions to reduce falls and associated morbidity, mortality and rehabilitation costs.

Introduction: Diabetes retinopathy (DR) is the fourth leading cause for blindness worldwide. Screening is vital for its early detection and prevention of blindness. However screening all diabetic patients by specialists is impossible, particularly in resource poor settings such as Sri Lanka. We aimed to compare the agreement between non-specialist doctors and specialist ophthalmologists in diagnosing DR and planning follow up. Methods: A descriptive study was conducted with a cohort of patients randomly recruited from the Sri Lanka Young Diabetes Study (SLYDS). They were examined by a group of non-specialist doctors by direct ophthalmoscopy after mydriasis, and specialists (by slit lamp biomicroscopy) who were blinded to non-specialist doctors’ finding. Agreement between DR grading according to International Clinical Diabetic Retinopathy Disease Severity Scale, and follow up decisions, by non-specialist and specialist doctors were assessed with kappa statistic, using SPSS-16. Results: Our study included 658 participants (males 36%, mean age 37.1 years, mean duration of diabetes 5.22 years (± 4.04), mean HbA1c 8.1% (±2.04)) and 123 (18.7%) had diabetes retinopathy and 54 (8.3%) required early referral. Exact agreement between ophthalmologists and non specialist doctors in determining absence or presence of diabetes retinopathy was 0.82 (Kappa 0.48, p < 0.001) while the agreement in diagnosing the grade of retinopathy was 0.76 (Kappa 0.347, p < 0.001). Junior doctors detected DR with a sensitivity and specificity of 0.68 and 0.86 respectively. Exact agreement on follow up decision was 0.92 (Kappa 0.48, p < 0.001), with 0.52 sensitivity and 0.96 specificity in decision for early referral. Conclusion: Non-specialist doctors can identify DR with reasonable sensitivity. This should be encouraged in primary care, particularly in resource poor settings. Referring patients with any form of DR to a specialist should be recommended to prevent those with severe degrees of retinopathy from being missed for appropriate specialist care. DOI: http://dx.doi.org/10.4038/sjdem.v3i2.6363 Sri Lanka Journal of Diabetes, Endocrinology and Metabolism 2013; 3: 63-67

The terms overweight and obesity are used to identifystates in which abnormal or excessive fat accumulationhas occurred in the body leading to adverse effects onhealth of an individual (1). According to the World HealthOrganization (WHO) estimates, nearly 2 billion adultsare suffering from overweight and 600 million from obesityin the world (1). Each year nearly 3 million adults die dueto being overweight and obese and it is estimated that35.8 million (2.3%) of global DALYs can be accounted tobe due to overweight or obesity (1). Obesity is stronglyassociated with diabetes, dyslipidaemia, hypertension,cardiovascular disease, non-alcoholic fatty liver diseaseand mechanical problems like obstructive sleep apnoea,osteoarthritis and even psychological issues such asdepression and anxiety (2).Sri Lanka is not an exception; obesity associatedmetabolic diseases have reached epidemic proportions.One-fifth Sri Lankan adults are suffering from dysglycemiaand 10% from diabetes (3). Moreover, 25% of adults havehypertension (4) and a similar percentage of adults arehaving metabolic syndrome (5). Deaths due to cardio-vascular diseases in Sri Lanka are more prevalent thanmany developed countries (6). However, according to theinternational BMI cut-offs, derived based on data fromWhite Caucasians obesity prevalence is very low. SriLanka Diabetes and Cardiovascular Study reported only4% of obesity in 2005-2006 (7). This level has not changedsignificantly in our second data collection carried out in2011 (8). Hence there seems to be a paradox between obesitydata according to the international cut-offs and obesityrelated co-morbidities based on prevalence data.