DVIDS – News – Army experts say diabetes is leading cause of preventable blindness in adults

By V. Hauschild, MPH, U.S. Army Public Health Center

ABERDEEN PROVING GROUND, Md. – Diabetes is a disease that disrupts the body’s ability to turn food into energy and can damage major organs such as the heart, kidneys and eyes. Diabetes is a leading cause of preventable blindness among adults.

According to the Centers for Disease Control and Prevention, many who develop diabetes do not realize it until organ damage has occurred – so maintaining healthy habits and having routine health and vision check-ups are key.

What is Diabetes?

Normally, your body breaks down most of the food you eat into sugar, known as glucose. And when your blood sugar goes up, your body releases insulin. Insulin lets the blood sugar into your body’s cells for use as energy.

With diabetes, your body either does not make enough insulin or cannot use it as well as it should to regulate the glucose in the blood. This damages the blood vessels, which are critical to organ functioning. Specifically for the eyes, the damage to the microvasculature can have severe consequences for your vision.

There are three main types of diabetes:

• Type 1, an autoimmune condition that causes the body to stop producing insulin, most frequently identified in children and young adults;

• Type 2, the most common and preventable form, where the body gradually becomes less able to use insulin properly, so it cannot keep blood sugar at normal levels; and

• Gestational diabetes, which occurs during pregnancy and generally resolves within 6 to 12 weeks after delivery.

The vast majority (90–95 percent) of people with diabetes have Type 2 diabetes. It develops over many years, so it is usually diagnosed in adults but is now being diagnosed more frequently in children, teens and young adults.

Symptoms of diabetes may include frequent urination, a sense of being thirstier and/or hungrier than usual, becoming fatigued easily, unexplained weight loss, numbness or tingling in the hands or feet, sores that heal more slowly than normal and blurry vision. You may not have symptoms early on, or if you do, they may not include visual symptoms, even if adverse changes are occurring in your eyes.

How serious is diabetes?

A Type 1 or 2 diabetes diagnosis may require termination of continued military service. As such, routine Army health surveillance data in the current Health of the Force report (page 67), shows diabetes is rarely diagnosed in active-duty Soldiers.

But the CDC has found that this gradually developing disease becomes much more common as we age – with risks increasing over age 40. According to the CDC:

• Diabetes in U.S. adults has doubled in the last 20 years.

• More than 37 million U.S. adults now have diabetes, and 1 in 5 do not know they have it.

• Diabetes is the seventh leading cause of death in the United States.

• Diabetes is the number one cause of kidney failure, lower-limb amputations, and adult blindness.

• More than 1 in 3 U.S. adults have prediabetes, where blood sugar levels are higher than normal but not yet high enough for a type 2 diabetes diagnosis. Though lifestyle changes have been proven to prevent the onset of type 2 diabetes, 8 in 10 adults do not know they have prediabetes.

• High blood pressure and cholesterol can increase the risk of developing diabetes.

• Pregnant women and people who smoke are also at higher risk.

Damage to the eye

The Tri-Service Vision Conservation and Readiness Branch of the U.S. Army Public Health Center is especially concerned that diabetes is the leading cause of preventable blindness among U.S. adults. To prevent blindness, the TSVCRB encourages everyone – especially those diagnosed with diabetes – to undergo routine periodic eye examinations.

Diabetic retinopathy, which is damage to the eye caused by diabetes, happens when high blood sugar causes the small blood vessels in the back of the eye to leak or close off. This causes the retina, the light-sensing posterior part of the eye, to swell and cause visual impairment.

The extra fluid not only changes the shape of the internal eye structures that focuses light for clear vision, but the blood can also cause retinal detachments and increased eye pressure, leading to glaucoma, a condition that causes deterioration of the optic nerve. Uncontrolled diabetes can also cause the lens in the front part of the eye to swell or become cloudy, developing into a cataract.

People diagnosed with type 2 diabetes should be evaluated by an ophthalmologist or optometrist as soon as possible to search for any changes such as diabetic retinopathy. People diagnosed with type 1 diabetes should be evaluated within 5 years of the diagnosis. After initial evaluation, regular eye exams are key for early diagnosis and treatment of diabetic retinopathy and other related complications.

When they occur, symptoms of diabetic retinopathy may include—

• Spots or floaters in your vision.

• Blurred vision.

• Fluctuations or changes in vision.

• Dark spots or missing areas of vision.

• Vision loss (acuity, clarity and/or field of vision).

However, diabetic retinopathy may not show early symptoms – so diagnosis may be made by an ophthalmologist or optometrist during a routine eye exam.

“Routine eye examinations are important even for those who have no symptoms,” says Navy Cmdr. Kyle Dohm, an optometrist working for the APHC’s TSVCRB. “Eye doctors are unique in that they are able to directly view the micro blood vessels inside your eyes during an eye exam. Often times we can see early signs of disease, to include diabetes, and then educate our patients on appropriate interventions, often working with other members of the patient’s healthcare team for the best results.”

Most of the eye and vision damage done by diabetes is preventable if detected early enough.

Dohm says the American Optometric Association recommends adults with no symptoms or high risk factors receive a routine eye examination at least once every 2 years. For those 65 and older, the frequency should be annually.

Of those with diabetes, African American, Hispanic, and indigenous populations are at higher risk of developing diabetic retinopathy. Other high risk factors include personal or family history of eye disease, high blood pressure, use of medications with ocular side effects, contact lens wear, and those who have permanently reduced vision in one eye.

Individuals with these high risk factors should seek examinations at least yearly, or more frequently as determined by their eye doctor.

To prevent diabetes or manage the severity of effects such as diabetic retinopathy, it is critically important to have regular health check-ups with your primary care manager for your overall health, as well as routine eye examinations by your eye doctor to maintain good vision and ocular health.

If you are diagnosed with diabetes, treatment consists of focusing on a healthy lifestyle that includes proper nutrition, exercise and weight control, as well as medication in some instances. The best course will be determined by your doctor or healthcare team in partnership with you.

Here are some useful resource links:

• CDC Diabetes Self-management Education and Support: https://www.cdc.gov/diabetes/dsmes/index.html

• CDC Diabetes information: https://www.cdc.gov/diabetes/library/spotlights.html

• National Eye Institute – Diabetic Retinopathy: https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/diabetic-retinopathy

The U.S. Army Public Health Center focuses on promoting healthy people, communities, animals, and workplaces through the prevention of disease, injury, and disability of Soldiers, retirees, family members, veterans, Army civilian employees, and animals through population-based monitoring, investigations, and technical consultations.

NOTE: The mention of any non-federal entity and/or its products is for informational purposes only, and not to be construed or interpreted, in any manner, as federal endorsement of that non-federal entity or its products.