In diabetic retinopathy, high blood glucose levels cause damage to the blood vessels in the retina, resulting in leakage and vision loss. — Handout
According to the 2023 National Health and Morbidity Survey (NHMS), one in six adults (15.6%) in Malaysia, reported having diabetes.
This marks a significant increase from 9.4% in the 2019 NHMS.
Alarmingly, the condition also affects those in the 18-29 age group, with 84% unaware that they have the disease.
Diabetes is a chronic illness that affects how the body converts food into energy.
The food we consume is broken down into glucose (sugar) and then released into the bloodstream.
The pancreas releases insulin – a hormone that acts as a key to transport glucose into the body’s cells – when blood glucose levels rise.
Glucose is then converted into energy for bodily functions.
Insulin also helps to maintain blood glucose levels within a normal range.
In diabetic patients, however, the body either does not produce enough insulin or cannot use it effectively.
The symptoms of diabetes include:
- Frequent urination, especially at night
- Feeling very hungry or thirsty
- Unintentional weight loss
- Blurred vision
- Numbness or tingling in hands or feet
- Extreme fatigue
- Very dry skin
- Sores that heal slowly
- More frequent infections than usual.
Diabetes and its complications
Generally, diabetes can be categorised into two main types.
Type 1 diabetes is often detected at a young age, but can also develop at a later age.
The exact cause of Type 1 diabetes remains unclear, but one contributing factor is when the body’s immune system attacks pancreatic cells, impairing natural insulin production.
Type 2 diabetes is typically diagnosed later in life.
However, the number of Type 2 diabetes in children is increasing, influenced by various factors such as an unhealthy lifestyle, excess body weight and a family history of diabetes.
In addition to these two main types, diabetes can also occur during pregnancy.
This is known as gestational diabetes mellitus (GDM).
Typically, GDM resolves after the mother gives birth.
However, mothers who have experienced GDM are at a higher risk of developing Type 2 diabetes in the future.
The persistently high levels of glucose in the bloodstream in uncontrolled diabetes can lead to serious complications that can affect nearly every organ in the body.
Diabetic complications can be divided into two main groups: macrovascular (involving large blood vessels), such as stroke and heart attack, and microvascular (involving small blood vessels), such as renal failure, retinopathy and neuropathy.
Cause of blindness
Among the complications diabetic patients should be aware of is retinopathy.
Diabetic retinopathy, or damage to the retina, is the leading cause of blindness in diabetic patients.
This vision loss results from damage to the blood vessels in the retina, a layer of tissue at the back of the eye that senses light and sends images to the brain.
The risk of diabetic retinopathy increases with the duration of diabetes and patients often do not notice any changes to their vision until the condition has developed.
According to the Clinical Practice Guidelines of Diabetes Mellitus by the Health Ministry, less than 5% of patients show signs of retinopathy at the time of diabetes diagnosis, but this number rises to 40-50% after a decade.
In the early stages of diabetic retinopathy, symptoms are often absent.
Some patients may experience intermittent vision changes, such as difficulty reading or seeing distant objects.
Other symptoms include trouble seeing at night, colours appearing faded or washed out, and fluctuating vision that alternates between blurry and clear.
These symptoms typically affect both eyes, underscoring the need for prompt attention as the disease advances.
As the condition progresses, blood vessels in the retina may begin to leak into the vitreous – the gel-like fluid within the eye.
When this happens, patients may notice dark, floating spots or streaks resembling cobwebs.
Although these spots may sometimes clear on their own, it is crucial for patients to seek treatment promptly.
Without intervention, scar tissue can develop at the back of the eye, and the bleeding may recur or worsen, increasing the risk of severe vision impairment.
Consistent compliance needed
Controlling their diabetes well is the most effective way for a patient to reduce the risk of developing diabetic retinopathy.
This involves maintaining blood glucose levels within a normal range.
This can be achieved through compliance with the prescribed anti-diabetic medicines, regular physical activity and a balanced diet.
The prescribed treatment will not be effective if a diabetic patient does not adhere to it consistently.
Patients should take their medication at the same time every day.
They can use aids, such as medicine charts or alarms, to help remind them to take their medicines.
Additionally, they may ask family members or relatives to help them remain compliant with their medicines.
Patients should discuss any issues or difficulties they encounter with anti-diabetic medication with a doctor or pharmacist.
This is especially so when experiencing side effects that affect their quality of life.
Adjusting the timing of medication intake to align with daily activities can help improve the patient’s adherence to treatment.
Additionally, regular eye examinations are essential for diabetic patients.
If diabetic retinopathy develops, early intervention can slow its progression and may ultimately prevent blindness.
Therefore, patients should discuss the necessity of regular eye check-ups with their doctor.
Diabetic patients are advised to quit smoking and limit alcohol intake.
Those who are overweight or obese may need to start reducing their body weight.
A balanced diet is essential for diabetic patients to control their blood glucose levels.
They should consume more fruits, vegetables, lean proteins and whole grains, while reducing saturated fats, refined carbohydrates and processed foods.
Furthermore, regular exercise is recommended, as it can help lower blood glucose levels and increase cell sensitivity to insulin.
These healthy lifestyle practices are also strongly encouraged for individuals at risk of developing diabetes.
In conclusion, managing diabetes effectively is essential for reducing the risk of serious complications, including diabetic retinopathy, which can lead to blindness.
The key takeaway for diabetic patients is to maintain blood glucose levels within a normal range through adherence to prescribed medications and healthy lifestyle choices.
Any further enquiries regarding medicines can be submitted to the National Pharmacy Call Centre (NPCC) through 1-800-88-6722 on Monday to Friday, from 8am to 5pm, except on public holidays.
Thamron Keowmani Eh Sau is a pharmacist at Klinik Kesihatan Aring, Gua Musang, Kelantan. This article is courtesy of the Health Ministry’s Pharmacy Practice and Development Division. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
