Sleeping Difficulties Increase Risk of Eye Disease in People with Diabetes

People with Type 2 diabetes who have obstructive sleep apnea (OSA) are more at risk of losing their sight due to severe retinopathy, as well as foot problems and possible amputation because of neuropathy....

Researchers from the University of Birmingham looked at 231 people with Type 2 diabetes of whom 149 had OSA, a sleep disorder caused by disturbed breathing. They found there were twice as many people with severe retinopathy (48 percent) in the group with OSA compared to the group without OSA (20 percent).

In a separate study, the researchers found that OSA was also linked to neuropathy. They looked at 230 people with Type 2 diabetes of whom 148 had OSA. They found that 60 percent of the group with OSA had neuropathy compared to 22 percent in the group without OSA.

According to Dr. Iain Frame, Director of Research at Diabetes UK, said, "We already know that there is a high prevalence of OSA in people with Type 2 diabetes. However, this is the first time that the link between OSA and retinopathy, and neuropathy in people with Type 2 diabetes has been examined. This research suggests that if someone with Type 2 diabetes also has this sleeping disorder they are more at risk of developing these serious complications compared to someone with the condition who does not have OSA."

"As being overweight is a risk factor for both OSA and Type 2 diabetes, this is yet another reason to highlight the importance of good weight management through a healthy diet and regular physical activity. In people with Type 2 diabetes, the increasing severity of OSA is associated with poorer blood glucose control and the treatment of sleep disorders (in this case by losing weight) has the potential to improve diabetes control and energy levels."

In both studies, the association between OSA and the two diabetes complications in people with Type 2 diabetes was independent of age, gender, ethnicity, blood pressure, blood glucose levels, smoking and cholesterol.

"Our work highlights several important issues," stated Dr. Abd Tahrani, who led the research. "Our results emphasized what is already known -- that OSA is very common in patients with Type 2 diabetes, much higher than OSA prevalence in the general population. Furthermore, our results suggest that OSA is not an innocent bystander in patients with Type 2 diabetes and might contribute to morbidities associated with this condition. Whether OSA treatment has any impact on these complications will need to be determined."

Diabetes is the 6th leading cause of death in the United States

LANGLEY AIR FORCE BASE, Va. - Diabetes is the sixth leading cause of death in the United States, claiming more than 180,000 victims annually. Part of the debilitation of diabetes is the effect the disease has on feet, resulting in painful sores, immobility and potential amputation. However, with attention and preventative measures, some effects may possibly be avoided.

According to Maj. Hjalmar Contreras, 633d Medical Group podiatrist, diabetic foot infections are the most common reason for hospital admissions among diabetic patients, accounting for 25 percent of all diabetic admissions.

“Without proper care, diabetic patients may develop ulcers on their feet, which occur in 15 percent of diabetic patients,” said Contreras.

Diabetes affects the feet in two ways: contributing to vascular disease and damaging nerves. Vascular disease impairs circulation, creating an oxygen deficiency in tissues. This deficiency could result in poor healing, infections and even gangrene. Symptoms of vascular disease include changes in the skin of the feet, such as lack of hair or thinning of skin, absent peripheral pulses and arterial Doppler abnormalities.

“Diabetes and smoking pose the greatest risk of peripheral vascular disease,” said Contreras, noting that PVD is 30 times more prevalent in diabetic patients.

Diabetes also damages the three nerve systems -- autonomic, sensory and motor -- resulting in a loss of feeling in the feet. This condition is known as diabetic neuropathy. Symptoms of neuropathy include a loss of protective sensation, dry flaky skin and foot deformities.

Most of the aforementioned conditions can be avoided or limited by prevention, said Contreras. To help prevent complications from diabetes, follow these 10 guidelines:

1. Inspect your feet daily. Check for cuts, scrapes, bruises or blisters.
2. Never soak your feet. There’s little way of knowing what may be in the water, and contaminants may irritate or cause infections. Wash your feet in lukewarm water, and carefully dry between toes.
3. Moisturize your feet. Use lotions and creams. Do not use petroleum jelly, and do not apply any topical solution between toes.
4. Cut toenails straight across, leaving the front edge. Don’t pull or rip off nail edges.
5. Never use chemical corn removers on your feet. These may cause blisters, burning holes in the skin. Never cut calluses with razors -- use a pumice stone instead.
6. Change your socks daily. Keep socks clean and dry, and avoid tight socks and stockings.
7. Never walk barefoot. Check the insides of your shoes daily.
8. Avoid smoking.
9. Wear shoes that fit. Tip: leather shoes easily adapt to feet and may provide more comfort.
10. Get annual check-ups.

“Controlling your glucose levels decreases chances of foot problems by 50 percent,” added Contreras.”While developing complications from diabetes may not be completely avoidable, practicing sound prevention measures will greatly diminish the chances of problems occurring.”