Search

Diabetic retinopathy (DR), a major complication of diabetes caused by vascular damage and pathological proliferation of retinal vessels, often progresses to vision loss. Vascular endothelial growth factor (VEGF) signaling plays a pivotal role in the development of DR, but the exact underlying molecular mechanisms remain ill-defined. Cellular prion protein (PrP c ) is a surface protein expressed by vascular endothelial cells, and the increased expression of PrP c is associated with physiological and pathological vascularization. Nevertheless, a role for PrP c in the development of DR has not been appreciated. Here, we addressed this question. We found that the development of streptozocin (STZ)-induced DR, but not the STZ-induced hyperglycemia/diabetes itself, was significantly attenuated in PrP c -KO mice, compared to control wildtype (WT) mice, evident by measurement of retinal vascular leakage, retinal neovascularization, a retinopathy score and visual acuity assessment. Moreover, the attenuation of DR severity seemingly resulted from attenuation of retinal neovascularization via VEGF/ras/rac signaling. Together, our study suggests a previously unappreciated role for PrP c in the development of DR.

Background: To implement an ultra-wide optical coherence tomography angiography imaging (UW-OCTA) modality in eyes with diabetic retinopathy (DR) with the aim of quantifying the burden of microvascular disease at baseline and subsequent clinic visits., Methods: UW-OCTA was implemented on a 1,060 nm swept source (SS) OCTA engine running at 100 kHz A-line rate with a motion tracking mechanism. A montage scanning protocol was used to capture a 100-degree field of view (FOV) using a 4×4 grid of sixteen total individual 6×6 mm 2 scans. Typical OCTA images with a FOV of 3×3, 6×6 and 12×12 mm 2 were obtained for comparison. DR patients were scanned at baseline and follow-up. They were treated at the clinician's discretion. Vessel density and non-perfusion area maps were calculated based on the UW-OCTA images., Results: Three proliferative DR patients were included in the study. UW-OCTA images provided more detailed visualization of vascular networks compared to 50-degree fluorescein angiography (FA) and showed higher burden of pathology in the retinal periphery that was not captured by typical OCTA. Neovascularization complexes were clearly detected in the two patients with active PDR. Vessel density and non-perfusion maps were used to measure progressive capillary non-perfusion and regression of neovascularization between visits., Conclusions: UW-OCTA provides approximately 100-degree OCTA images of the fundus comparable to that of wide-angle fundus photography, and may be more applicable in conditions such as DR which affect the peripheral retina in contrast to standard OCTA., Competing Interests: Conflicts of Interest: Dr. Wang disclosed intellectual property owned by the Oregon Health and Science University and the University of Washington related to OCT angiography, and licensed to commercial entities, which are related to the technology and analysis methods described in parts of this manuscript. Dr. Wang received an innovative research award from Research to Prevent Blindness. He is a consultant to Carl Zeiss Meditec, and Insight Photonic Solutions.

Diabetic retinopathy (DR) is the common cause of diabetic vascular complications. The NOD-like receptor (NLR) family, pyrin domain containing 1 (NLRP1), also known as NALP1, inflammasome is the first member of the NLR family to be discovered, playing an important role in inflammatory response. However, its effect on DR development has not been reported. In the study, the wild type (WT) and NLRP1 -/- mice were injected with streptozotocin (STZ) to induce DR. The results indicated that NLRP1 -/- significantly increased bodyweight reduction and decreased blood glucose levels induced by STZ. WT/DR mice exhibited higher levels of NLRP1 in retinas. NLRP1 -/- ameliorated retinal abnormalities in DR mice using H&E staining. In addition, attenuated avascular areas and neovascular tufts were also observed in NLRP1 -/- /DR mice. The levels of pro-inflammatory cytokines in serum and retinas were highly induced in WT/DR mice, whereas being markedly reduced by NLRP1 -/- . In addition, vascular endothelial growth factor (VEGF) and Iba1 expressions induced by STZ in serum or retinas were significantly down-regulated in NLRP1 -/- /DR mice. Consistently, NLRP1 -/- attenuated ASC and Caspase-1 expressions in retinas of DR mice. Compared to WT/DR group, NLRP1 -/- markedly decreased retina p-nuclear factor-κB (NF-κB), interleukin-1β (IL-1β) and IL-18 levels. And similar results were confirmed in vitro that suppressing NLRP1/ASC inflammasome ameliorated inflammatory response in fructose-treated retinal ganglion cells. The results above indicated that the modulation of NLRP1 inflammasome might be a promising strategy for DR therapy., (Copyright © 2018. Published by Elsevier Inc.)

Diabetic retinopathy (DR) presents a microvascular complication of diabetes, which may contribute to visual impairment. The treatment of DR is still controversial. Accumulating studies have reported the role of microRNAs (miRs) in DR. This study aims to explore the functions of microRNA-384-3p (miR-384-3p) in retinal neovascularization by targeting hexokinase 2 (HK2) in mice with DR. A total of 43 C57BL/6 male mice were selected and divided into normal ( n = 16) and DR ( n = 27) groups. Retinal microvascular endothelial cells (RMECs) were collected from the normal and DR mice and mainly treated with a miR-384-3p mimic, a miR-384-3p inhibitor, small interfering RNA (siRNA) against HK2 and HK2 overexpression plasmids to understand the underlying regulatory mechanisms of miR-384-3p. The relationship between miR-384-3p and HK2 was determined by dual-luciferase reporter assay. The miR-384-3p expression and the mRNA and the protein expressions of HK2 and CD31 in retinal tissues and cells were evaluated using reverse transcription quantitative polymerase chain reaction (RT-qPCR) and western blot assay. Cell proliferation was assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Tube formation was observed by conducting a tube formation experiment. HK2 is a target gene of miR-384-3p. The DR mice showed higher expression of HK2 and CD31 but lower expression of miR-384-3p. The miR-384-3p mimic and siRNA-HK2 reduced the expression of HK2, decreased cell proliferation and tube formation of RMECs, whereas the miR-384-3p inhibitor could reverse these trends. Our study demonstrates that overexpression of miR-384-3p inhibits retinal neovascularization in DR mice via inhibition of HK2., (© 2018 Wiley Periodicals, Inc.)

Diabetic retinopathy (DR), the most common cause of irreversible blindness in working-age adults, results in central vision loss that is caused by microvascular damage to the inner lining of the back of the eye, the retina. The aim of this work was to assess the temporal relationships between angiopoietin-like protein-4 (ANGPTL-4), a novel adipocytokine factor, and diabetic retinal inflammation and microvascular dysfunction. The downstream pathway(s) and upstream mediator(s) of ANGPTL-4 were then determined under high glucose (HG) conditions. Diabetic rats and control animals were randomly assigned to receive hypoxia inducible factor-1 alpha (HIF-1α) blockade (doxorubicin or shRNA) or vehicle for 8 weeks. Human retinal microvascular endothelial cells (HRMECs) were incubated with normal or high glucose, with or without blockade or recombinant proteins, for ANGPTL-4, HIF-1α, and vascular endothelial growth factor (VEGF). The levels of ANGPTL-4, profilin-1, HIF-1α, VEGF, interleukin 1 beta (IL-1β), IL-6, and intercellular adherent molecule 1 (ICAM-1) in the rat retinas and HRMEC extracts were examined by Western blotting and real-time RT-PCR. The levels of ANGPTL-4, profilin-1, HIF-1α, and VEGF protein and mRNA were significantly higher in the diabetic rats and HG-exposed HRMECs. ANGPTL-4 was a potent modulator of increased inflammation, permeability, and angiogenesis via activation of the profilin-1 signaling pathway. Our results showed that ANGPTL-4 upregulation was induced by HG, which was dependent on HIF-1α activation that was also triggered by HG, both in vivo and in vitro. Our results suggest that targeting ANGPTL-4, alone or in combination with profilin-1, may be an effective therapeutic strategy and diagnostic screening biomarker for proliferative diabetic retinopathy and other vitreous-retinal inflammatory diseases., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Diabetic retinopathy (DR) is a major complication of diabetes, and causes pathological changes in retina blood vessels, as the most common cause of vision loss. Extracellular-signal-regulated kinase 5 (ERK5) is the newest discovered member in the mitogen-activated protein kinases (MAPKs) family, and recent evidence demonstrates an essential role of ERK5 signaling in the angiogenesis. However, whether ERK5 signaling may regulate DR development is unknown. Here, we used a streptozocin (STZ)-induce mouse DR model to investigate this question. We detected significant increases in the phosphorylation of ERK5, a signature of ERK5 activation in the purified retinal endothelial cells in DR mice, compared to control mice. In vivo suppression of ERK5 phosphorylation through administration of a specific inhibitor of ERK5 activation, BIX02189, did not prevent the occurrence of STZ-induced diabetes in mice, but significantly alleviated the severity of DR, seemingly through attenuating the retina neovascularization. Thus, our study suggests a previously unappreciated role of ERK5 signaling in DR development., Competing Interests: CONFLICTS OF INTEREST The authors have declared that no competing interests exist.

Metformin is an AMP-activated protein kinase activator that is widely prescribed for treating type 2 diabetes. Recently, metformin was reported to slow down the development and alleviate the severity of diabetic retinopathy (DR). However, the underlying mechanisms remain unclear. Here, we used an alloxan-induced diabetes mouse model to study the effects of metformin on the development of DR as well as the mechanisms. We found that DR was induced in alloxan-treated mice 10 weeks after alloxan treatment, and treatment of metformin did not prevent the occurrence of alloxan-induced diabetes. However, metformin significantly alleviated the severity of DR, seemingly through attenuating the retina neovascularization. Moreover, the total vascular endothelial cell growth factor A (VEGF-A) mRNA in mouse eyes was not altered by metformin, but the protein levels was decreased. Further analysis showed that metformin may inhibit the VEGF-A protein translation through inducing a VEGF-A-targeting microRNA, microRNA-497a-5p, resulting in reduced retina neovascularization. Thus, our study suggests a previously unappreciated role of metformin in the prevention of development of DR., Competing Interests: None.

The retinal vascular network reflects the health of the retina, which is a useful diagnostic indicator of systemic vascular. Therefore, the segmentation of retinal blood vessels is a powerful method for diagnosing vascular diseases. This paper presents an automatic segmentation system for retinal blood vessels from Optical Coherence Tomography Angiography (OCTA) images. The system segments blood vessels from the superficial and deep retinal maps for normal and diabetic cases. Initially, we reduced the noise and improved the contrast of the OCTA images by using the Generalized Gauss-Markov random field (GGMRF) model. Secondly, we proposed a joint Markov-Gibbs random field (MGRF) model to segment the retinal blood vessels from other background tissues. It integrates both appearance and spatial models in addition to the prior probability model of OCTA images. The higher order MGRF (HO-MGRF) model in addition to the 1 st -order intensity model are used to consider the spatial information in order to overcome the low contrast between vessels and other tissues. Finally, we refined the segmentation by extracting connected regions using a 2D connectivity filter. The proposed segmentation system was trained and tested on 47 data sets, which are 23 normal data sets and 24 data sets for diabetic patients. To evaluate the accuracy and robustness of the proposed segmentation framework, we used three different metrics, which are Dice similarity coefficient (DSC), absolute vessels volume difference (VVD), and area under the curve (AUC). The results on OCTA data sets (DSC=95.04±3.75%, VVD=8.51±1.49%, and AUC=95.20±1.52%) show the promise of the proposed segmentation approach., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

G protein-coupled receptor 91 (GPR91) is a succinate-specific receptor and activation of GPR91 could initiate a complex signal transduction cascade and upregulate inflammatory and pro-angiogenic cytokines. In the retina, GPR91 is predominately expressed in ganglion cells, a major cellular entity involved in the pathogenesis of diabetic retinopathy (DR) and other hypoxic retinal diseases. During the development of DR and retinopathy of prematurity (ROP), chronic hypoxia causes an increase in the levels of local succinate. Succinate-mediated GPR91 activation upregulates vascular endothelial growth factor (VEGF) through ERK1/2-C/EBP β (c-Fos) and/or ERK1/2-COX-2/PGE2 signaling pathways, which in turn, leads to the breakdown of blood-retina barriers in these disorders. In this review, we will have a brief introduction of GPR91 and its biological functions and a more detailed discussion about the role and mechanisms of GPR91 in DR and ROP. A better understanding of GPR91 regulation may be of great significance in identifying new biomarkers and drug targets for the prediction and treatment of DR, ROP, and hypoxic retinal diseases., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Accurate detection of diabetic retinopathy (DR) mainly depends on identification of retinal landmarks such as optic disc and fovea. Present methods suffer from challenges like less accuracy and high computational complexity. To address this issue, this paper presents a novel approach for fast and accurate localization of optic disc (OD) and fovea using one-dimensional scanned intensity profile analysis. The proposed method utilizes both time and frequency domain information effectively for localization of OD. The final OD center is located using signal peak-valley detection in time domain and discontinuity detection in frequency domain analysis. However, with the help of detected OD location, the fovea center is located using signal valley analysis. Experiments were conducted on MESSIDOR dataset, where OD was successfully located in 1197 out of 1200 images (99.75%) and fovea in 1196 out of 1200 images (99.66%) with an average computation time of 0.52s. The large scale evaluation has been carried out extensively on nine publicly available databases. The proposed method is highly efficient in terms of quickly and accurately localizing OD and fovea structure together compared with the other state-of-the-art methods., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Purpose: Pericyte apoptosis is a predominant feature of early diabetic retinopathy. In diabetic retinopathy, activated microglia migrate and release proinflammatory cytokines that contribute to disruption of the blood-retinal barrier, neuronal loss, and enhanced ROS production. Reactive oxygen species (ROS) are implicated in pericyte death; however, the mechanism by which activated microglia affect retinal microvascular pericytes is unclear. We hypothesized that activated microglia may promote pericyte apoptosis by enhancing ROS production., Methods: Lipopolysaccharide (LPS)-activated microglia and pericytes were co-cultured in a cell culture system. Pericyte ROS production and the mitochondrial membrane potential (ΔΨm) were determined by flow cytometry. The pericyte protein expression levels of NADPH oxidase subunits, uncoupling protein 2, nuclear NF-κB-p65, and caspase-3 were determined by western blotting. One-way ANOVAs were used for statistical analysis., Results: LPS successfully activated the microglia, as demonstrated by their morphological and phenotype changes and the significant increase in tumor necrosis factor secretion (P < 0.01). Co-culture with activated microglia significantly up-regulated NADPH oxidase subunits (NOX4, NOX2, and NCF1; P < 0.01) and down-regulated uncoupling protein 2 expression (P < 0.01) in pericytes. Pericyte ROS production increased by 20% in the activated microglia co-cultured group, and was inhibited by pretreatment with diphenyleneiodonium, coenzyme Q 10 , and N-acetylcysteine. The proapoptotic pericyte changes induced by co-culture with activated microglia included a 9.50% decrease in pericyte ΔΨm and significant increases in NF-κB-p65 nuclear translocation (P < 0.01) and activated caspase-3 (P < 0.01). These proapoptotic effects of activated microglia were inhibited by diphenyleneiodonium., Conclusions: Our results are consistent with our hypothesis that activated microglia may promote pericyte apoptosis by enhancing ROS production. Further studies are needed to examine retinal microglia activation and the corresponding changes in pericytes in a rat model of diabetes mellitus.

Purpose: Detection (diagnosis) of diabetic retinopathy (DR) in optical coherence tomography (OCT) images for patients with type 2 diabetes, but almost clinically normal retina appearances., Methods: The proposed computer-aided diagnostic (CAD) system detects the DR in three steps: (a) localizing and segmenting 12 distinct retinal layers on the OCT image; (b) deriving features of the segmented layers, and (c) learning most discriminative features and classifying each subject as normal or diabetic. To localise and segment the retinal layers, signals (intensities) of the OCT image are described with a joint Markov-Gibbs random field (MGRF) model of intensities and shape descriptors. Each segmented layer is characterized with cumulative probability distribution functions (CDF) of its locally extracted features, such as reflectivity, curvature, and thickness. A multistage deep fusion classification network (DFCN) with a stack of non-negativity-constrained autoencoders (NCAE) is trained to select the most discriminative retinal layers' features and use their CDFs for detecting the DR. A training atlas was built using the OCT scans for 12 normal subjects and their maps of layers hand-drawn by retina experts., Results: Preliminary experiments on 52 clinical OCT scans (26 normal and 26 with early-stage DR, balanced between 40-79 yr old males and females; 40 training and 12 test subjects) gave the DR detection accuracy, sensitivity, and specificity of 92%; 83%, and 100%, respectively. The 100% accuracy, sensitivity, and specificity have been obtained in the leave-one-out cross-validation test for all the 52 subjects., Conclusion: Both the quantitative and visual assessments confirmed the high accuracy of the proposed computer-assisted diagnostic system for early DR detection using the OCT retinal images., (© 2016 American Association of Physicists in Medicine.)

Diabetic retinopathy (DR) is one of the leading causes of new cases of blindness. Early and accurate detection of microaneurysms (MAs) is important for diagnosis and grading of diabetic retinopathy. In this paper, a new method for the automatic detection of MAs in eye fundus images is proposed. The proposed method consists of four main steps: preprocessing, candidate extraction, feature extraction and classification. A total of 27 characteristic features which contain local features and profile features are extracted for KNN classifier to distinguish true MAs from spurious candidates. The proposed method has been evaluated on two public database: ROC and e-optha. The experimental result demonstrates the efficiency and effectiveness of the proposed method, and it has the potential to be used to diagnose DR clinically., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Literatures reported that poor sleep complaints were associated with a great deal of health outcomes. However, there are few studies on the association of poor sleep complaints with diabetic vascular complications., Methods: Aiming on the association, a cross-sectional survey was conducted among 1220 diabetic patients in this study. Poor sleep complaints were composed of difficulty falling asleep, early final awakening, short sleep and long sleep. The diabetic vascular complications involved in the study were diagnosed according to the Standards of Medical Care in Diabetes (ADA 2016)., Results: Our findings indicated that short sleep remained independently associated with diabetic kidney disease (DKD) (OR > 1, P < 0.05) after the adjustments; long sleep independently associated with diabetic retinopathy (DR) (OR > 1, P < 0.05); early final awakening and short sleep independently associated with cardiovascular disease (OR > 1, P < 0.05); short sleep independently associated with peripheral arterial disease (OR > 1, P < 0.05); there was no association between poor sleep complaints and neuropathy (P > 0.05)., Conclusions: The study suggests that the poor sleep complaints were distinguishably associated with diabetic vascular complications. Clinicians should take poor sleep complaints into account in diabetes treatment.

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease associated with multiple macro and microvascular complications, diabetic retinopathy (DR) being the commonest one. Recent literature has reported an increased risk of DR with insulin use., Methods: We carried out a cross-sectional study at the Ophthalmology Department of the Douala General Hospital (DGH) during a 2-year period to explore the association between insulin treatment and both DR and its severity as compared with oral hypoglycemic agents (OHAs) in Cameroonian T2DM patients aged ≥35 years, and who were all screened for DR through eye examination including exhaustive retinal evaluation., Results: In total, medical files of 134 T2DM patients were analyzed. The frequency of DR was 54.1% among patients on OHA and 73.9% among those on insulin treatment, giving an overall frequency of 57.5%. There were significantly more OHA treated patients than insulin treated patients (82.8% vs . 17.2%, P<0.001). As expected, both the OHA and insulin groups were comparable by age, sex, duration of diabetes, past history of hypertension, alcohol misuse, and current tobacco smoking. DR was almost significantly more frequent in T2DM patients under insulin regimen than in patients under OHA [73.9% vs . 54.1%; odds ratio (OR) 2.4; 95% confidence interval (CI), 0.9-6.6; P=0.06]. Proliferative diabetic retinopathy (PDR) was significantly more observed in insulin treated patients than in OHA treated patients (34.8% vs . 15.3%; OR 2.95; 95% CI, 1.1-8; P=0.035). Irrespective of staging, the frequency of diabetic macular edema (DME) was significantly higher in the insulin group than in the OHA group (43.5% vs . 19.8%; OR 3.1; 95% CI, 1.2-8; P=0.019)., Conclusions: Compared with OHA, insulin therapy may be associated with DR, DR severity and DME in these T2DM sub-Saharan African patients., Competing Interests: The authors have no conflicts of interest to declare.

Previous studies have shown that metformin, an AMP-activated protein kinase activator widely prescribed for type 2 diabetes, is especially beneficial in cases of diabetic retinopathy (DR) with undetermined mechanisms. Here, we used a streptozotocin-induced diabetes model in mice to study the effects of metformin on the development of DR. We found that 10 weeks after STZ treatment, DR was induced in STZ-treated mice, regardless treatment of metformin. However, metformin alleviated the DR, seemingly through attenuating the retina neovascularization. The total vascular endothelial cell growth factor A (VEGF-A) in eyes was not altered by metformin, but the phosphorylation of the VEGF receptor 2 (VEGFR2) was decreased, which inhibited VEGF signaling. Further analysis showed that metformin may induce VEGF-A mRNA splicing to VEGF120 isoform to reduce its activation of the VEGFR2. These findings are critical for generating novel medicine for DR treatment.

Background: The use of glycemic thresholds for diabetes diagnosis is controversial. However, no information is available regarding glycemic and glycated hemoglobin (HbA1c) thresholds for detecting diabetic retinopathy (DR) in the Iranian population., Objectives: The main purpose of the current investigation was to examine the association of fasting plasma glucose (FPG) and HbA1c levels with diabetic retinopathy (DR), and to determine the relevant cut-off levels in an Iranian population., Patients and Methods: This cross-sectional, population-based study was performed during 2012-2013 in Urmia, the capital of West Azerbaijan province, Iran. The subjects were 3,010 Iranians aged 40-81 years. The FPG levels were determined using the glucose oxidase method whereas, the HbA1c values were measured using a standardized assay by high performance liquid chromatography. DR was evaluated by an examination of the fundus photograph of each eye. The photographs were graded according to the international clinical diabetic retinopathy disease severity scale by photograph graders who were masked to the clinical information., Results: Of the subjects, 59 had DR. The prevalence of DR increased steeply between the ninth and the tenth deciles for both variables. The ROC curve analysis showed overall glycemic thresholds for DR of 6.5 mmol/L (117 mg/dL) for FPG and 6.2% (44 mmol/mol) for HbA1c. The sensitivities and specificities were 78.0% and 87.1% for FPG and 89.8% and 89.5% for HbA1c, respectively. The areas under the ROC curves indicated that HbA1c was a stronger discriminator of retinopathy: the area under curve was 0.880 for FPG and 0.946 for HbA1c P < 0.001). However, the thresholds for detecting DR for the two measures showed no significant differences after excluding individuals receiving anti-hyperglycemic medication., Conclusions: These findings suggest that the HbA1c and FPG thresholds for detecting diabetes in the Iranian population are lower than the current diagnostic criteria.

Aim: Main the goal of the research is to analyze the occurrence of glaucoma in patients with diabetes mellitus type 1 (DM type 1) and diabetes mellitus type 2 (DM type 2)., Patients and Methods: The study involved 140 patients, 34 with DM type 1 and 106 with DM type2. In relation to the type of glaucoma to the patients are divided into two groups: Primary and Secondary glaucoma. According to the stage of diabetic retinopathy (DR) patients were analyzed in three groups: non-proliferative, preproliferative and proliferative DR. Since ophthalmological parameters were analyzed: best corrected visual acuity (BCVA), intraocular pressure (IOP), visual field (VF) of computerized perimetry, excavatio optic nerve (E/D) by optic coherent tomography (OCT)., Results: Applying the test of quotient chance found that subjects with DM type 1 have a 5.94 times greater chance of developing secondary glaucoma, but is of primary (P <0.0001). In patients with DM type 2, where the chance of getting the subjects of secondary glaucoma 4.43 times larger than that of the primary (P = 0.0002)., Conclusion: Patients with DM type have great chance of developing secondary glaucoma of the primary. Primary glaucoma more common in NPDR but secondary glaucoma more common in PDR.

Objective: To assess the Knowledge, Attitude and Practices (KAP) towards diabetes and diabetic retinopathy in the general population of Bin Qasim Town (BQ), Karachi., Methods: An observational, cross-sectional study was approved by Research Ethical Committee of Al-Ibrahim Eye Hospital. It included every third household by stratified sampling in each Union Council of (BQ) Town, in the months of May to July 2013. The interview Questionnaire included 43 questions, of qualitative and quantitative aspects, which were awarded 56 scoring points. SPSS version 20.0 was used to analyze the data., Results: Six hundred ninety two adults one from each household were interviewed. Of the total respondents, 271 (39.2%) had diabetes. Lowest mean knowledge score (5.28 ± 6.09) was seen in illiterate respondents. Male's Mean Knowledge score (7.61 ± 6.600) was better than female's (5.46 ± 6.21) with P <0.001. Over all mean score of Attitudes towards diabetes was 5.43 ± 2.57. It was higher (6.62 ± 2.03) in diabetic respondents as compared with non-diabetic respondents (4.70 ± 2.59) with p < 0.000. In Practice module majority of the respondents (69.9%) did not exercise, 49% took high caloric snacks between meals and 87% ate outside home once a month, 56.8% diabetics visited ophthalmologist for routine eye examination; but only 9.2% asked for retinal examination., Conclusion: Lack of knowledge of diabetes was found in the surveyed community, more marked in females, illiterate and the individuals not having diabetes.

Background: Over the past few decades diabetes has emerged as an important non-communicable disease in Sub-Saharan Africa (SSA). Sight loss from Diabetic Retinopathy (DR) can be prevented with screening and early treatment. The objective of this paper is to outline the required actions and considerations in the planning and development of DR screening services., Methods: A multiple-case study approach was used to analyse five DR screening services in Botswana, Ghana, Tanzania and Zambia. Cases included: two regional screening programmes, two hospital-based screening services and one nationwide screening service. Data was collected using qualitative methodologies including: document analysis, in-depth interviews and observation. The World Health Organization (WHO) Health Systems Framework was adopted as the conceptual framework for analysis., Results: Planning for a sustainable and integrated DR screening programme demanded a health systems approach. Collaboration with representatives from a variety of ministerial departments and professional bodies was required. Evolution of DR screening services may occur in a variety of ways including: increasing geographical coverage, integration into the general healthcare system, and stepwise progression from a passive, opportunistic service to one that systematically and proactively seeks to prevent DR. Lessons learned from the implementation of cervical cancer prevention programmes in resource-poor settings may assist the development of DR programmes in similar settings., Conclusion: To promote good planning of DR screening services and ensure limited resources are used effectively, there is a need to learn from screening programmes in other medical specialities and a need to share experiences between newly-developing DR programmes in resource-poor countries. The WHO Health Systems Framework presents an invaluable tool to ensure a systematic approach to planning DR screening services.

Aims: Few representative population-based data are available regarding glycaemic and HbA1c thresholds for detecting diabetic retinopathy (DR) in Asia. We investigated the association between DR and fasting plasma glucose (FPG) and HbA1c levels among Korean adults., Methods: Using data from the Korea National Health and Nutrition Examination Survey (2011), a total of 5212 adults (≥19 years old) were analysed. When participants had diabetes mellitus and/or a suspicion of DR in two-field nonmydriatic fundus photography, seven standard photographs were obtained after pupil dilatation (75.9% of men, 75.0% of women among the subjects). DR was defined as the presence of ≥1 retinal microaneurysms or blot haemorrhages with or without more severe lesions. Receiver operating characteristic (ROC) curves were used to determine the optimal cut-off value for HbA1c or FPG., Results: The overall glycaemic thresholds for DR were 6.3mmol/l for FPG and 6.2% (44mmol/mol) for HbA1c. The optimal thresholds did not differ by age group. The sensitivities and specificities were 82.6% and 91.2% for FPG and 93.9% and 89.7% for HbA1c, respectively. The diagnostic discrimination was better for HbA1c than FPG for DR-area under curve: 0.908 for FPG and 0.953 for HbA1c (p=0.007). After being controlled for other covariates, the odds ratio for the risk of DR increased significantly in a consistent way from 6.2% (44mmol/mol) for HbA1c and 6.3mmol/l for FPG., Conclusions: According to these nationally representative data, the current diabetes diagnostic values for FPG and HbA1c based on DR may be lower for the Korean population., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Diabetic Retinopathy (DR) is one of the attenuating complications of diabetes mellitus. The key gene responsible for causing diabetic retinopathy is protein kinase C beta (PKCβ). Protein kinase C is a family of protein kinase enzymes which are involved in controlling the function of other proteins through phosphorylation mechanism and plays a crucial role in signal transduction mechanisms. Among all the PKC isoenzymes, PKCβ could be a significant isoenzyme involved in vascular dysfunction during hyperglycemia. Studies show that oral administration of PKCβ inhibitor Ruboxistaurin (LY333531), decreases vessel permeability and improves retinal condition. Thus compounds that decrease the PKCβ activation would be helpful in the treatment of diabetic retinopathy. The compounds similar to Ruboxistaurin are taken from Super Target database and docking analysis was performed. Maleimide derivative 3 showed highest binding affinities compared to Ruboxistaurin and so we advise that compound may be utilized in the treatment of diabetic retinopathy.

The number of Diabetes patients has risen in both the developing and the developed nations. It is associated with lot complications retinopathy, nephropathy, neuropathy etc. Diabetic retinopathy is one of the leading causes of preventable blindness. Diabetic patients have to be monitored at regular intervals to detect any signs of retinopathy and deterioration of vision and timely intervention. This requires lot of time and cost both on the part of the patient and the specialist. Therefore there is a need to differentiate the ' high risk ' patients from the ' low risk ' patients, so that the high risk ones can be managed more rigorously while the low risk patients can be referred for less frequent screenings and checkups. Data of around 100 patients with Grade 1 retinopathy was collected. Their physiological parameters with their DR grading after 3 years was recorded. Physiological parameters which were having a higher impact on the course of Retinopathy were taken (e.g. Mild blood urea, Hypertension and Smoking in this case). Transition probabilities of going from one stage to other were calculated. Probability of having a single physiological parameter in a given stage of DR at a given point of time was calculated. Probability of various combinations of these physiological parameters in a given stage of disease was calculated. Then by knowing the present stage of that disease future stage (3 years later in this case) of the disease can be predicted. Based on these predictions, the ' high risk ' patients are differentiated from the ' low risk ' patients and are accordingly referred for screenings and interventions.