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Educational literature and a list of support agencies and other resources should be made available to these individuals. (Consensus Statement) 15 aoa.org I. INTRODUCTION AND GUIDELINE OBJECTIVES Diabetes mellitus is a metabolic disease characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels.2 The major categories of diabetes are type 1 and type 2. Type 2 diabetes is the most prevalent form of the disease and often goes undiagnosed for many years because high blood glucose levels develop gradually and initially are often not severe enough for a person to notice any of the symptoms of diabetes. During this time, individuals are at risk of developing microvascular and macrovascular complications of diabetes, including visual impairment and blindness, hypertension, renal failure, heart disease, and stroke. Diabetic retinopathy, the most common microvascular complication of diabetes, is a leading cause of new cases of vision impairment among people 20 to 74 years of age in the United States and many developed countries.3-6 Intensive treatment to maintain blood glucose concentrations close to the normal range has been shown to reduce the risk of development of diabetic retinopathy and decrease the risk of its progression in persons with type 1 or type 2 diabetes.7-9 In addition, early intensive glycemic control appears to have a lasting protective effect on diabetic retinopathy progression and severity due to “metabolic memory.”10,11 Unfortunately, an estimated 10 to 25 percent of people with diabetes don’t know they have the disease.12-14 For some, signs of diabetes found during an eye examination may be the initial indication of the presence of the disease.15 About 20 to 40 percent of individuals with type 2 diabetes already have retinopathy at the time of first diagnosis of diabetes.16,17 Doctors of optometry may be the first health care practitioners to examine persons with undiagnosed diabetes mellitus or ocular manifestations of diabetes.
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