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Objective: To examine the association of physical activities (PA) with diabetic retinopathy (DR) progression based on a 10-year follow-up of a large cohort of working-aged diabetic populations in Australia., Methods: Nine thousand and eighteen working-aged diabetic patients were enrolled from the baseline of the 45 and Up Study from New South Wales, Australia. Self-reported PA collected by questionnaire at baseline in 2006 was graded into low (<5 sessions/week), medium (≥5-14), and high (≥14) levels. Retinal photocoagulation (RPC) treatment during the follow-up period was used as a surrogate for DR progression and was tracked through the Medicare Benefits Schedule, which was available from 2004 to 2016. Cox regression was used to estimate the association between PA and RPC incidence., Results: In the fully adjusted model, higher PA level was significantly associated with a lower risk of RPC incident (Cox-regression, p-value for trend = 0.002; medium vs. low, hazard ratio (HR) = 0.78, 95% Confidence Interval (CI): 0.61-0.98; high vs. low, HR = 0.61, 95%CI: 0.36-0.84. In addition, gender, body mass index, insulin treatment, family history of diabetes, history of cardiovascular disease were significant effect modifiers for the association between PA and RPC., Conclusions: Higher PA level was independently associated with a lower risk of DR progression among working-aged diabetic populations in this large cohort study., Competing Interests: The authors have declared that no competing interests exist.

Objective: To test whether the rate of diabetic retinopathy development in a population calculated from the prevalence of retinopathy and duration of diabetes can be used to assess their prior glycemic control., Research Design and Methods: 9281 patients with type 2 diabetes (T2DM) were grouped by duration of diabetes and plotted against the % of retinopathy in each band. The slope was used to calculate retinopathy development/year (RD/y). We correlated the RD/y with updated HbA1c within groups of different ethnicity, age of diabetes onset, year of the eye examination, socio-economic status and fluency in English., Results: Differences in ethnicity, age of diabetes onset and year of the eye examination affect RD/y to a degree predictable from their respective updated HbA1c. No such relationship with updated HbA1c was evident when a factor has no apparent effect on RD/y., Conclusions: This relationship between prevalence of retinopathy and duration of diabetes can be used to assess future retinopathy burden. Perhaps more intriguing, the camera can be reversed to allow an estimate of prior glycemic control of a population from its retinopathy prevalence. Health care organizations can use this method to project future needs and to assess adequacy of prior glycemic control., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: The aim of the present study was to determine temporal changes in characteristics and management of Asians with type 2 diabetes (T2D) compared with those of the majority Anglo-Celt (AC) patients in an urban Australian community., Methods: Cross-sectional data from the observational Fremantle Diabetes Study (FDS) collected in 1993-96 (Phase I; FDS1) and 2008-11 (Phase II; FDS2) were analyzed for patients classified as Asian (n = 44 and 65 in FDS1 and FDS2, respectively) or AC (n = 796 and 793, respectively). Between-group differences in changes in key variables between FDS phases were analyzed by generalized linear modeling with adjustment for age and gender., Results: Asians patients were significantly younger at diagnosis and recruitment and had a lower body mass index and smaller waist circumference than the AC participants in both FDS phases. They were also less likely to be treated for hypertension. Cardiovascular risk factors and their management and macrovascular complications were similar in the two groups over time. A greater propensity to retinopathy with Asian ethnicity in FDS1 (27.3% vs 13.5%; P = 0.23) was attenuated in FDS2 (23.7% vs 19.0%; P = 0.39). Asians had a significantly lower prevalence of peripheral sensory neuropathy in FDS2 (33.8% vs 63.3%; P < 0.001; adjusted P = 0.011 for between-group temporal change)., Conclusions: There were persistent differences between the phenotypic features of Asian migrants with T2D versus AC patients in an Australian urban community over 15 years of follow-up, but management of diabetes and non-glycemic risk factors remained comparable. Ethnicity-specific differences in susceptibility to microvascular complications should be considered in clinical management., (© 2015 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.)

Aim: To describe current diabetic retinopathy (DR) screening and management practices among Australian general practitioners., Methods: A self administered questionnaire on DR management was mailed to 2000 rural and urban GPs across Australia in 2007-2008., Results: Only 29% of the GP respondents had read the National Health and Research Council guidelines at least once and 41% had a 'moderate' to 'strong' desire to screen for DR. A majority of GPs (74%) reported not routinely examining their diabetic patients for DR. Lack of confidence in detecting DR changes (86.4%) and time constraints (73.4%) were the two major barriers to GPs performing dilated fundoscopy on diabetic patients., Discussion: Given that access to optometry is not evenly distributed across the country, and that ophthalmology is underresourced, GPs are the healthcare providers most able to manage and screen for DR in the community.

Objective: The aim of this work was to study the frequency of examining for diabetic eye and foot complications in an Australian population and to study factors associated with regular screening., Research Design and Methods: The Australian Diabetes, Obesity, and Lifestyle Study (AusDiab) was a population-based study of 11,247 people from randomly selected areas of Australia. Participants identified as having previously diagnosed diabetes (n=475) were invited to participate in the complications study. Measures included foot examination, retinopathy photography, and self-report use of health care services., Results: Seventy-seven percent of participants reported having an eye examination within the previous 2 years, and 50% reported having their feet examined by a health professional in the previous year. Type of diabetes treatment (odds ratio 1.46, 95% CI 0.85-2.50 for tablets versus diet alone and 4.17, 1.71-10.17 for insulin or insulin and tablets versus diet alone) and visiting a diabetes nurse educator in the previous 12 months (2.14, 1.18-3.87) were independent predictors of having had an eye examination. Duration of diabetes (1.33, 1.06-1.67 per year) and visiting a diabetes nurse educator in the previous 12 months (1.89, 1.20-2.95) were independent predictors of a foot examination., Conclusions: This study has shown that retinopathy screening is performed more frequently than foot screening in Australia. This may be due to the implementation of eye screening programs and awareness campaigns. Foot screening appears to be poor, with less than one-half of the population reporting a regular examination for foot complications. In Australia, diabetes nurse educators play a key role in promoting screening for diabetes complications.

Diabetic retinopathy is a common complication in people with diabetes. General practitioners can arrange annual screening for diabetic eye disease to detect early changes and prevent severe damage. Due to an ageing population the number of people with type II diabetes will increased dramatically during the next 20 years. This article outlines how general practitioners can prevent progressive loss of vision in their patients.

A prevalence study of diabetic eye disease was conducted in Newcastle during 1977-1978. Ophthalmoscopic retinopathy was found in 49% of 1210 clinic diabetics, while vision-threatening retinopathy (VTR) (proliferative signs of maculopathy) occurred in 13%. Maculopathy was the commonest cause of visual loss, occurring frequently in subjects with non-insulin-dependent diabetes. This group has now been followed for up to seven years (including 70% at four years); incidence rates for the development of retinopathy and for progression to a vision-threatening stage can now be estimated. The study found that diabetics with no retinopathy developed this at a rate of 8% per year, while only 0.4% per year progressed to VTR. However, once any retinopathy was present, progression to VTR occurred in 6% per year (2% proliferative and 4% maculopathy); and if any retinal signs indicating the presence of capillary closure were noted the rate was 13% per year. These rates are for the group overall: however, certain parameters were found to influence the progression in individual patients. Included were the age at onset and the duration of diabetes, the presence of poor control (particularly in older diabetics on oral agents) or associated nephropathy. An analysis of these data and their implications for routine eye screening of diabetics is presented.