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Objective: The importance of screening for diabetic retinopathy has been established, but the best method for screening has not yet been determined. We report on a trial of assessment of digital photographs by telemedicine compared with standard retinal photographs of the same fields and clinical examination by ophthalmologists., Research Design and Methods: A total of 129 diabetic inpatients were screened for diabetic retinopathy by slit-lamp biomicroscopy performed by an ophthalmologist and by two-field 50 degrees non-stereo digital fundus photographs assessed by six screening centers that received the images by electronic mail. Conventional 35-mm transparencies of the same fields as the digital photographs were assessed by a retinal specialist and served as the reference method for detection of diabetic retinopathy. Slit-lamp biomicroscopy was the reference method for the detection of macular edema., Results: The prevalence of any form of diabetic retinopathy was 30% (n = 35); of sight-threatening retinopathy including macular edema, the prevalence was 6% (n = 7). The assessment of digital images by the six screening centers resulted in a median sensitivity of 85% and a median specificity of 90% for the detection of moderate nonproliferative or sight-threatening diabetic retinopathy. Clinically significant macular edema (n = 4) was correctly identified in 15 of the 24 grading reports. An additional seven reports referred the patients for further investigation because of concurrent diabetic retinopathy., Conclusions: Telescreening for diabetic retinopathy by an assessment of two-field 50 degrees non-stereo digital images is a valid screening method. Although detection of clinically significant macular edema using biomicroscopy is superior to digital or standard non-stereo photographs, only few patients with sight-threatening diabetic retinopathy are missed.

After 2 wk of good control 9 type I diabetic patients were hospitalized and treated in a randomized fashion with different human insulin mixtures (regular: NPH), containing 10, 15, or 20% regular insulin. In the case of the 15:85% mixture, mean blood glucose was found to be in the range of 70-150 mg/dl. Significant differences occurred at certain time points between the curves obtained with the 10:90% and the 15:85% mixtures, and the 10:90% and the 20:80% preparations, respectively. Prolongation of the interval between hormone injection and start of breakfast from 30 to 45 min abolished the postprandial glucose excursion in the 15:85% and the 20:80% mixture, but not the 10:90% mixture.

A method of insulin therapy that appears to achieve better control of diabetes than present conventional methods is the use of insulin infusion devices--either glucose-controlled feedback (closed-loop) systems or the preprogrammed (open-loop) infusion pump. In view of the problems with implantable glucose sensors, we have worked to develop a miniaturized, programmable infusion system. Its use in insulin-dependent diabetic patients to provide either intravenous doses or a continuous subcutaneous insulin infusion resulted in significant reductions in blood glucose levels, glycemic excursions and 24-h glucose excretion.