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Importance: Knowledge of the incidence and progression of diabetic retinopathy (DR) after gastric bypass surgery (GBP) in patients with obesity and diabetes could guide the management of these patients., Objective: To investigate the incidence of diabetic ocular complications in patients with type 2 diabetes after GBP compared with the incidence of diabetic ocular complications in a matched cohort of patients with obesity and diabetes who have not undergone GBP., Design, Setting, and Participants: Data from 2 nationwide registers in Sweden, the Scandinavian Obesity Surgery Registry and the National Diabetes Register, were used for this cohort study. A total of 5321 patients with diabetes from the Scandinavian Obesity Surgery Registry who had undergone GBP from January 1, 2007, to December 31, 2013, were matched with 5321 patients with diabetes from the National Diabetes Register who had not undergone GBP, based on sex, age, body mass index (BMI), and calendar time (2007-2013). Follow-up data were obtained until December 31, 2015. Statistical analysis was performed from October 5, 2018, to September 30, 2019., Exposure: Gastric bypass surgery., Main Outcomes and Measures: Incidence of new DR and other diabetic ocular complications., Results: The study population consisted of 5321 patients who had undergone GBP (3223 women [60.6%]; mean [SD] age, 49.0 [9.5] years) and 5321 matched controls (3395 women [63.8%]; mean [SD] age, 47.1 [11.5] years). Mean (SD) follow-up was 4.5 (1.6) years. The mean (SD) BMI and hemoglobin A1c concentration at baseline were 42.0 (5.7) and 7.6% (1.5%), respectively, in the GBP group and 40.9 (7.3) and 7.5% (1.5%), respectively, in the control group. The mean (SD) duration of diabetes was 6.8 (6.3) years in the GBP group and 6.4 (6.4) years in the control group. The risk for new DR was reduced in the patients who underwent GBP (hazard ratio, 0.62 [95% CI, 0.49-0.78]; P < .001). The dominant risk factors for development of DR at baseline were diabetes duration, hemoglobin A1c concentration, use of insulin, glomerular filtration rate, and BMI., Conclusions and Relevance: This nationwide matched cohort study suggests that there is a reduced risk of developing new DR associated with GBP, and no evidence of an increased risk of developing DR that threatened sight or required treatment.

Aim: To study the prognosis of patients with newly diagnosed Type 2 diabetes in primary care in relation to their baseline C-peptide concentration., Methods: C-peptide concentrations were determined in 399 patients aged < 65 years with newly diagnosed Type 2 diabetes using the Skaraborg Diabetes Register, Sweden. Data on cardiovascular complications and death were extracted from national registers and a local study of retinopathy. Statistical analyses were performed using Cox regression., Results: An analysis of C-peptide concentrations in quartiles, after adjusting for confounders, showed that patients in the highest quartile had a 2.75-fold higher risk of death from all causes compared with those in the lowest quartile (CI 1.17-6.47). By contrast, C-peptide concentration was not associated with the incidence of cardiovascular events or the development of retinopathy., Conclusions: Measurement of C-peptide concentration at diagnosis could help identify patients who are at high risk and who presumably would benefit from more intensive treatment., (© 2014 The Authors. Diabetic Medicine © 2014 Diabetes UK.)

Diabetes mellitus is a health concern of the first order, given the high level of associated morbidity and mortality. The objective, in order to slow down the advance of its complications before they become irreversible, is based on correct metabolic control. The high rate of morbidity associated with the surgery of the vascularized pancreas transplant and the high index of rejection have for three decades formed an obstacle to this being considered a valid alternative in the treatment of these patients. Nowadays the pancreas transplant has come to occupy a key position, thanks to the new regimes of immunosuppression and to the perfection of surgical techniques. In this article we review the evolution of the pancreas transplant from its beginnings to its present state.

Aims/hypothesis: In a previous study conducted over the last decades we found a decreased incidence of nephropathy but unchanged incidence of severe retinopathy among patients with Type 1 diabetes diagnosed in childhood and with 20 years duration of diabetes. The aim of our current study was to investigate the incidence 5 to 10 years later in the same population., Methods: We studied all 269 patients in whom Type 1 diabetes was diagnosed in childhood between 1961 and 1985 in a district in southeastern Sweden. Ninety-one percent were monitored for retinopathy until at least 1997 and 95% were monitored for nephropathy. Severe retinopathy was defined as laser-treated retinopathy and nephropathy as persistent proteinuria. Survival analysis was used and the patients divided into five cohorts according to the time of onset of diabetes., Results: The cumulative proportion of severe retinopathy had declined ( p=0.006). After 25 years it was 47% (95% CI 34-61), 28% (15-40) and 24% (12-36) in the cohorts 1961 to 1965, 1966 to 1970 and 1971 to 1975 respectively. After 30 years it was 53% (40-66) and 44% (28-59) in the oldest cohorts. The cumulative proportion of nephropathy after 25 years duration was 30% (18-42), 8% (1-16) and 13% (4-23) in the cohorts 1961 to 1965, 1966 to 1970 and 1971 to 1975 respectively. After 30 years, it was 32% (20-44) and 11% (2-20) for the oldest cohorts ( p<0.0001)., Conclusions/interpretation: In an unselected population with Type 1 diabetes diagnosed in childhood, modern diabetes care markedly reduced the incidence of severe retinopathy and nephropathy.

Objective: To evaluate the importance of risk factors for microvascular and macrovascular complications, separated by sex, in type 2 diabetes., Design: Cross-sectional surveys of diabetic patients registered with primary health services in 1995., Setting: Three community health centres in Stockholm County., Subjects: 407 subjects with type 2 diabetes in 1995. For 78 of these, data were also registered in 1992., Main Outcome Measures: Odds ratio (OR) by logistic regression for risk factors predicting microvascular and macrovascular complications, for age and duration in years., Results: For microvascular complications, the most important factors were in men the duration of diabetes (OR 1.13, p < 0.001) and in women the duration of diabetes (OR 1.08, p < 0.001) and age (OR 1.04, p < 0.05). For macrovascular complications, the most important factors were in men, age (OR 1.09, p < 0.001) and hypertension (OR 4.85, p < 0.001) and in women, age (OR 1.08, p < 0.001) and duration of diabetes (OR 1.08, p < 0.01)., Conclusions: Hypertension is more important among men and the duration of diabetes among women as risk factor for macrovascular complications in type 2 diabetes.

To monitor changes over time in the incidence of blindness among people with diabetes, referrals (mentioning diabetes) to all vision rehabilitation centres in Stockholm County (1995 population 1 725 756) during 1981-1995 were registered. A mass mailing to people with diabetes in 1989 urged them to have their eyes examined. Mobile fundus photography teams initiated early diagnosis of diabetic retinopathy in primary health care in 1990. Referrals with diabetes and blindness, defined (WHO, ICD 10) as best-corrected visual acuity (VA) of the better eye less than 3/60 (0.05), occurred for 172 persons (7.6% of those referred with diabetes). During 1981-1985, 93 were referred (95% confidence interval 75 to 114); 1986-1990, 51 (38 to 67); 1991-1995, 28 (19 to 41). Five-year average annual incidence rate of referrals with blindness was reduced by 47% from 1.2 to 0.63 to 0.33 per 100,000 population. Mean yearly reduction during 1981-1995 was 11% (8 to 15%), 11.5% (8 to 15%) if blindness was defined as in the UK (VA 3/60 or less), and 7% (4 to 9%) for legal blindness (VA 6/60 or less); test for trend p < 0.001 (Poisson regression analysis). This is the first report of reduction in a geographical region of a proxy measure for new blindness in diabetes by one-third or more, attaining one of the main targets of the St Vincent Declaration.

Objective: Diabetic retinopathy, which leads to macular oedema and retinal neovascularisation, is the leading cause of blindness among working age Americans. Research has demonstrated significant cost savings associated with detection of eye disease in Americans and Europeans with insulin-dependent diabetes mellitus (IDDM, type I diabetes) and non-insulin-dependent diabetes mellitus (NIDDM, type II diabetes). In this report, we estimate the current and potential savings in both the United States and in a European country resulting from the screening and treatment of retinopathy in persons with diabetes., Design: Computer modelling, incorporating data from population-based epidemiological studies and multicentre clinical trials. Monte Carlo simulation was used, combined with sensitivity analysis and present value analysis of cost savings., Results: Detection and treatment of diabetic eye disease in both the United States and Scandinavia is not only cost effective, but is actually cost saving from the governmental perspective. Potential savings in the United States exceed $US600 million annually, while, in Sweden, potential savings of 36 million SEK might be realised. These findings are comparable given the differences in population between the 2 countries., Conclusions: Our analysis indicates that prevention programmes aimed at improving eye care for persons with diabetes not only reduce needless vision loss, but also provide a financial return on the investment of public funds.

The spectrum of diabetic retinopathy, the need for fundus screening and the evaluation of two presumptive screening methods, was investigated in a population based study among patients with type II diabetes. Retinal evaluation was performed in 86.9% of the known diabetic population. Background diabetic retinopathy was detected in 37.8%, pre-proliferative in 1.1% and proliferative retinopathy in 3.8%. Diabetic maculopathy was found in 24.3% of the patients. Laser therapy was considered in 11.4% of the patients due to diabetic retinopathy, and in 14.6% when venous occlusive diseases were included. Two methods, a slit-lamp observation enhanced by a 60D lens and reading from two non-stereo photographs of the posterior pole, were evaluated among 154 patients willing and mentally capable of being examined by either method. The sensitivity of the photographic method was 87/97% (right eye/left eye) when detecting background retinopathy and 81/80% for maculopathy versus 69/61% and 79/63%, respectively, with the slit-lamp method. The photographic method could be applied in 93% of the patients mentally capable of cooperation. Only 5 or 6 patients could be examined per hour with the 60D slit-lamp compared with 30-35 examined by reading retinal photographs. The photographic method is recommended as an easy and reliable screening device for diabetic retinopathy among patients with type II diabetes.