الفهرس 
DEFINITIONOnly 14 pages are availabe for public view
 |  | from | 267 |  |  |
| | | from | 267 | | |
Abstract
This work aimed at studying the most probable medical risk
factors that may affect development of diabetic retinopathy (DR) in
the main classes of diabetic patients; the insulin - dependent diabetes
mellitus (IDDM) and the non-insulin dependent diabetes mellitus
(NIDDM) patients.
The study included 90 patients who were divided into 3 groups:
!fJrnJ7¥Jjp D; of 30 IDDM patients will DR, either of background
(BDR) type or proliferative (PDR) type.
!fJrnJ7¥Jjp !lD; of 40 NIDDM patients with DR; also either of BDR,
preproliferative (PPDR); or PDR types.
((;~I1Jau-1/I)1J eNlIJjp of 10 IDDM patients and 10 NIDDM patients
without DR, or with minimal changes in the
retina, as almost always all diabetics would show
some changes after 10 years of diabetic state.
By analysing the history, clinical examination data, and
biochemical immunologic & genetic investigations for all these
patients, the following observations were found:
(l) Sex of the patient was found to be importance as a risk
factor for DR being male predominance in IDDM group
and female predominance in NIDDM group.
(2) Age at examination of the patients was found to be of high
significance in both groups; IDDM and NIDDM. But this
significance was due to comparing IDDM group with
Summary and Conclusion
NIDDM group or control group both types.
(3) Duration of diabetes was an important risk factor for IDDM
patients developing retinopathy, but it was not a risk for
NIDDM patients.
(4) Age at onset of diabetes was shown to affect development of
DR whether in IDDM or NIDDM group.
(5) Systolic blood pressure was very important factor for the
PDR type of IDDM group. for NIDDM group; it was of
importance in both types (BDR & PDR).
Diastolic blood pressure was not found to be of importance
except for the PDR type of IDDM group; where it was very
important.
So, hypertension could be considered as an effective risk factor
for the PDR type of IDDM patients, but for NIDDM
patients, only systolic hypertension could be considered
effective.
(6) Proteinuria as a factor for determining associated
nephropathy was significant in this study, on the contrary to
creatinine measurement. As a risk for developing
retinopathy, fallow-up proteinuria is supposed to be much
informative, a measure that was not offered in this work.
(7) Regards glycemic control, poor control was clearly
associated with development of retinopathy in this study, but
it was not a factor determining severity. Also, treatment
Summary and Conclusion
was found to be important factor inducing retinopathy.
(8) Total cholesterol and triglycerides could be considered as
risk factors affecting development of POR, but
HOL -&LOL - cholesterol were not considered to be the
same. Also, total lipids were found to add some risk for
developing retinopathy.
(9) Circulating immune complexes (CICs) were found to be
higher in diabetic patients with retinopathy than without it.
lt was also found higher in 100M group than NIOOM
group. CICs were thus suggested to be of importance as risk
factor for retinopathy in this study.
(10) HLA typing showed that for 100M group; increased
frequencies of A28, B8 & DR3 was found with decreased
frequencies of AI’ A2, B7, B15 & DR4. For NIDDM group;
AI’ B12, BW21 & BW6 were found to exist in increasing
frequencies.
All these findings could have been suggest the factors which
when found in diabetic patient would induce retinopathy. Still, many
diabetics when analysed could show no retinopathy inspite of
existance of many of these factors in the patient. Hence, further
studies regards hormonal factors that may affect developing
retinopathy are suggested. Growth hormone and glucagon hormone
are suggested. Also, prospective controlled trials with meticulous
glycemic control and follow-up for the diabetic patient since staring
are supposed to give accurate results concerning the most reliable
factors that may induce or help progression of retinopathy.