Diabetic complications/Retinopathy II

POS-004-107 A CLINICAL STUDY OF DIABETES MELLITUS ADVANCING TO RETINOPATHY.

H DOGEN, T AOKI, H MIYATA, H OSADA, K MINEKAWA, T MURAKAMI, Y HAYASHI, Y MATSUO, T OKANO* Department of 3rd Internal Medicine and Department of Ist Pathology*, Nihon University School of Medicine, Tokyo, Japan.

Objective and Method 387 outpatients of our hospital (196 males and 191 females) who were negative for retinopathy by ophthalmoscopic examination at first visit but later advanced simple retinopathy during follow-up were studied for sex, type of disease, age of onset, duration, therapy, HbAl and diabetic nephropathy. Results Female patients outnumbered males, the former accounting for 35.5% of the sample and the latter 28.7%; IDDM and NIDDM represented 46.7% and 30.4% respectively; about 50% had a duration of 9 years or more and 20% less than 9 years; onset was under age 20 in 37.5% and the incidence gradually decreased with increasing age; HbAl was 9.5%or higher in 30% or more; and by therapy the disease was similarly advanced in patients on dietary therapy(9.8%)

those on an oral hypoglycemic agent(35.1%), and those on insulin(4~.8%); and the sequence of advancing nephropathy was proteinuria negative patients(27.3%), intermittently positive patients(34.0%) and chronically positive patients(55.2%). Conclusion IDDM, female sex, lower age of onset, duration of 9 years or more, HbA~ values of 9.5% or more, insulin therapy and chronic proteinuria were considered factors predisposing to simple retinopathy in diabetes mellitus.

POS-004-I08 ROLE OF VITREOUS TRACTION IN DIABETIC RETINOPATHY

Tadashi OKANO, M.D. Department of Ophthalmology, Gunma University School of Medicine, 3-39-15, Showa-machi, Maebashi, 371, JAPAN

We evaluated 88 diabetic eyes, 81 patients, who developed vitreous hemorrhaEe or tractional retinal detachment during the 2-year-period after the initial examination. In all the 88 eyes, these complications due to vitreoretinal traction were absent at the start of clinical observation.

As a unique finding, posterior vitreous detachment was initially absent in 77 eyes, while the remaining II eyes manifested incomplete vitreous detachment. The retinopathy further progressed in 77 eyes, due mainly to vitreoretinal traction secondary to posterior vitreous detachment.

In another series of 149 eyes, 97 patients, vitreous hemorrhaKe or tractional retinal detachment was already present when initially seen by us. Spontaneous resorption of vitreous hemorrhaEe resulted in 59 eyes secondary to complete vitreous detachment.

The finding indicates that initiation or progression of posterior vitreous detachment often triggers exacerbation of diabetic retinopathy. Whenever complete vitreous detachment developes, or is initially present, diabetic retinopathy improves or follows a benign course.

$560

POS-004-109 SIGNIFICANCE OF DISTRIBUTION OF VASCULAR CHANGES IN THE PROGRESSION OF PREPROLIFERATIVE DIABETIC RETINOPATHY

N. ANDO Department of Ophthalmology, Niigata University School of Medicine, Niigata, Japan.

Analysis of the clinical of 43 eyes of 31 patients with progressive preproliferative retinopathy revealed that retinopathy should be classified into three types concering its prognosis : central, mid-peripheral, and peripheral.

The central type was characterized by angiographic hyperpermeability, and showed active course, finally resulted in neovascularization on the disc. The mid-peripheral type was typical preproliferative retinopathy characterized by cotton wool spots, IRMA and venous abnormalities, resulted in neovascularization on the disc and elsewhere. The peripheral type was localized on the peripheral fundus, and was usually silent, resulted in neovascularization elsewhere.

These results lead to the conclusion that the distribution of vascular changes is the one of the most important factors to dicide the prognosis of the diabetic retinopathy.

POS-O04-110 EVALUATION OF DIABETIC RETINOPATHY WITH AUTOMATED STATIC PERIMETRY

SACHIKO HAMADA Hamada's Clinic, Nara City, Japan.

We estimated decibel threshold depression of the retina in 62 diabetics with the Humphrey automated static perimeter. Patients were classified into two groups: group I consisting of patients with no retinopathy or with stages 1 and 2 of simple diabetic retinopathy, and group II of patients with stage 3 of simple retinopathy or preproliferative retinopathy. As controls, 13 normal subjects were examined, l)The mean values for threshold sensitivity in group I and II were,respectively, 1804.0 i 258.0 and 1712.2 ± 158.5 , in the central retina within 30 degrees from the fovea. The mean value in group II tended to be depressed as compared with group I. II) The mean value for threshold sensitivity was 990.1 ± 161.5 in group I and 817.3 ± 155.9 in group II in the midperipheral retina 30 to 60 degrees from the fovea. Comparing with controls which averaged 1153.9 ± 170.6 , the mean values in group I and especially group II were significantly depressed. III) Rate(T) of threshold sensitivity depression of the central retina to that of the midperipheral retina was calculated, as follows: T = P/C x I00 %, P:values for threshold sensitivity in the midperipheral retina. C: values for threshold sensitivity in the central retina. The mean T was 55.7 ± 6.3 % in group I and 51.1 ± 6.5 % in group II. The mean T in group II tended to be decreased as compared with group I. IV) Results indicated that threshold sensitivity of the retina was depressed in diabetic retinopathy. This method is useful in evaluating diabetic retinopathy in patients to whom fluorescein angiogram is prohibited.

$561

POS-O04-111 RISK FACTORS DETERMINING DIABETIC RETINOPATHY IN JAPANESE SUBJECTS

PROSPECTIVE FOLLOW-UP STUDY OF OVER 7,000 DIABETICS ---

H OOHASHI, T MIHARA, T YOSHIHIRA, Y HIRATA Diabetes Center, Tokyo Women's Medical College, Tokyo, Japan.

The pathogenesis of diabetic complication still remains unresolved, though glycemic control, genetic and environmental factors are thought to be involved to varying degrees. We have commenced a series of studies examining diabetic complications and their risk factors in cohorts of patients who attended the outpatient clinic of Diabetes Center, Tokyo Women's Medical College during the 10 year period from 1976 to 1985. Annual clinical data up to 1986 were accumulated and analyzed by the SAS program. According to the diagnostic criteria advocated by the WHO, subjects were divided into three groups; IDDM 319, NIDDM 6287, Unclassified 79 and IGT 531. By cross-sectional analysis, retinopathy was observed in 30% of newly diagnosed NIDDM and prevalence was increased gradually as a function of known duration. IDDM had no retinopathy at first, but developed retinopathy immediately according to duration. The incidence and risk factor of retinopathy were examined by the life table method. At the 5 year point, retinopathy free rate was 81% in IGT, 69% in NIDDM and 54% in IDDM. The median risk of developing retinopathy in IDDM was 9.5 years of duration. More than 10 parameters were analyzed in order to determine the risk factor of retinopathy. In the case of NIDDM, FPG, systolic blood pressure and decrease in body mass index were, in this order, closely associated with the development of retinopathy. Duration of diabetes in IDDM and FPG in IGT significantly influenced the development of retinopathy.

POS-004-112 SIGNIFICANCE OF COLOR VISION DEFECT IN PATIENTS WITH NON-INSULIN-DEPENDENT DIABETES (NIDDM).

H MATSUO, K SAKAMOTO, Y TORATANI, Y UEDA, E MIKUNI, M KONDO*, T SANKE*, K NANJO*, K M~YAMURA*. Department of Medicine, Wakayama Rosai Hospital, *The First Dept. of Medicine, Wakayama University of Medical Science, Wakayama JAPAN

Few study about color vision defect in diabetics has been reported. In this study we investigated color vision defect quantitatively by Lanthony's New Color Test (NCT) which is appropriate for the examination of acquired color vision defect and discussed its clinical significance in patients with NIDDM. Fifty-six patients with NIDDM and 40 normal controls without congenital color vision defect were subjected for this study. The separation test of Lanthony's NCT according to Munsell was performed under daylight. The score of NCT in normal controls was increased with aging, however all scores were less than 4. The score of NCT was positively correlated with the duration of diabetes and HbAIc levels in patients with NIDDM. On the other hand, the score was negatively correlated with coefficient variation of R-R interval in ECG as an index for autonomic neuropathy. The score (Mean±SE) in 20 diabetics with retinopatby (9.4±1.9) was significantly (p<O.O5) higher than that in 30 diabetics without retinopathy (2.5±0.5). No correlation was observed between the score and diabetic macroangiopathy. The neutral zone was restricted to the region purple-blue, blue-purple, and yellow in almost diabetics. In conclusion, NCT is one of the useful method for quantitative evaluation of visual color defect in patients with NIDDM and the score showed significant correlations with diabetic retinopathy and neuropathy, respectively.

$562

POS-004-113 DIABETIC RETINOPATHY - - INITIAL FINDINGS AND PROGRESSION OF SYMPTOMS --.

Y OOHAGI, C KINOSHITA, K KAWAHARA, M MATOBA, Y ENOMOTO, S KURABUCHI, K UENOYAMA Department of Ophthalmology, Wakayama University of Medical Science, Wakayama, Japan.

Retinopathy is a serious complication associated with diabetes mellitus and is a common cause of blindness in adults. We reviewed the charts of 973 diabetics who presented to ophthalmic clinic between January 1982 and July 1985. The patients were aged from 0 to 87 years, consisting of 535 males and 438 females. Hypertension (systolic ~ 160 and/or diastolic ~ 95) was noted in 238 cases (24%). Retinal findings were classified opthalmoscopically according to Scott's definition (1951). Furthermore, 77 patients were subjected for a follow up study for one to two year period. The incidences of retinopaty were 43% less than 40 years old, 46% in 40's, 48% in 50's, 60% in 60's, 59% in 70's, 50% in 80's, and 49.5 % as a whole. No significant difference was found between males and females. Duration of diabetes had a positive correlation wit~ the incidence of retinopathy (p<0.01). In diabetics with hypertension, the incidence of retinopathy (58%) was significantly (p<0.01) higher than that in those without hypertension (43%), and the incidence of vitrous hemorrage was almost twofold (5.9%). In 77 follow up cases, diabetic retinopathy worsened in 13 (19.6%) patients during one to two year period. It was noteworthy that out of 29 patients who had no findings on the initial visit, six (17.1%) had developement of diabetic retinopathy. Our result suggests that regular ophthalmic examination is essential in the observation of diabetics, especially for the initial one to two year period.

POS-004-114 CHRONIC TREATMENT WITH PIRENZEPINE BLUNTS THE NOCTURNAL GH SECRETION IN IDDM

V. MARTINA, M. MACCARIO, M. TAGLIABUE and F. CAMANNI

Department of Biomedicine, Division of Endocrinology. University of Turin, Turin, I ta ly .

A blunted nocturnal growth hormone (GH) secretion in insulin-dependent diabetes mellltus (IDDM) induced by acute administration of a cholinergic muscarinic blockade using pirenzepine, either intravenously or ora l ly , was previously shown in our studies. The poss ib i l i ty of an inhib i tory effect on GH during a chronic treatment with oral pirenzepine was ruled out in this study. The nocturnal GH secretion of 5 patients (group A), in which euglycemia was obtained by Biostator and thereafter overnight infused with 0.15 mU/kg/min insulin and of 8 patients receiving their usual insulin treatment (group B) were studied from II p.m. to 8 a.m. before and after a month of treatment with pirenzepine, lO0 mg p.d. ora l ly , administered at II p.m.. Blood samples were collected every 30 min for plasma GH and glucose determinations. Glycosilated haemoglobin (HbAlc) was measured before and after pirenzepine treatment. GH secretion (GH AUC, area under curve, ng/ml/hr) was blunted after pirenzepine treatment in both groups (group A, mean ± SEM: 187.0 ± 38.3 vs 299.7 ± 66.6, p< 0.05; group B: 62.4 ± 31.8 vs 103.7 ± 32.8, p<0.0025). HbAlc showed a sl ight but signif icant decrease after pirenzepine treatment (mean ± SEM: 6.5 ± 0.4 vs 6.8 ± 0.2%, p<O.02). A reduction in the dai ly insulin requirement was observed in 4 out of 13 patients (reduction of 5-23 U/day). The present data clearly show that the previously documented inhib i tory effect of pirenzepine on GH secretion is persistently present during chronic treatment. Moreover, this treatment seems to improve the metabolic control of the patients. As the altered GH hypersecretion observed in IDDM may play a permissive role in the pathogenesis of dlabetlc mlcrovascular compllcatlonj pirenzeplne, a wel l- tolerated drug, lO0 mg p.d. ora l ly , could be a usefull tool in the prevention and treatment of diabetic retinopathy.

$563

POS-004-115 DIABETIC MACULOPATHY. A CORRELATION OF FINDINGS IN FLUORESCEIN

ANGIOGRAPHY TO VISUAL ACUITY.

SADAO HORI, SHIGEHIKO KITANO, KAZUHISA HAYAKAWA, HIDEHARU FUNATSU. Department of Ophthalmology, Tokyo University School of Medicine, Tokyo, Japan.

We analyzed a relationship between the findings of fluorescein angiography (FAG) and visual acuity in 327 eyes (184 patients) with diabetic retinopathy. FAG was performed on the patients who had blot hemorrhage with/without exsudates or more advanced retinopathy in either eye. The eyes with serious vitreous bleeding and with other associated macular diseases than diabetic retinopathy were excluded. FAG findings in the macula were devided into four groups: Group 1 (97 eyes); no leakage in the macula with/without capillary aneurysms (AN), group 2 (118 eyes); focal macular leakage from AN, retinal capillaries or relatively large vessels, group 3 (78 eyes); diffuse macular leakage from AN, retinal capillaries or rela- tively large vessels, and group 4 (34 eyes); macular atrophy with/without capillary non-perfusion and waxy deposits. We classified the degree of visual acuity disturbance into four grades: Grade 1 (133 eyes); visual acuity of 1.0 (20/20) or better, grade 2 (87 eyes); 0.6 (20/30) or better and worse than 1.0, grade 3 (54 eyes); 0.2 (20/100) or better and worse than 0.6, and grade 4 (53 eyes); worse than 0.2. Statistical analysis revealed signifficant relationship of visual acuity disturbance to macular findings in FAG. The visual acuity in group 3 showed wide variation from normal to severely disturbed. When we exa- mined these eyes by fundus ophthalmoscope, we found that the eyes in poor vision associated appearent macular edema involving the foveola whereas the eyes in good vision showed no macular edema but only distorted reflex of the inner limiting membrane in the macula. The results suggested that the findings of the macula in FAG in addition to the fundus ophthalmoscopy well correlated to the visual acuity disturbance.

POS-004-116 ONSET AND DEVELOPMENT OF SOFT EXUDATES IN DIABETIC RETINOPATHY.

HIDEHARU FUNATSU, SADAO HORI, SHIGEHIKO KITANO, KAZUHISA HAYAKAWA.

Department of Ophthalmology, Tokyo University School of Medicine, Tokyo, Japan

We analyzed the clinical risk factors ±nfluentlng on ~he onset and development of soft exsudates

(SE) in diabetic retinopathy. Non-insulin dependant diabetic patients with simple or preproliferative diabetic retinopathy and with followup periods for more than one year at the diabetes service in our department, were derided into three groups: group I (41 patients); patients who had no SE at the time of first visit to our clinic and developed SE during the followup period, group 2 (48 patients); patients who had SE already at the time of first visit, group 3 (35 patients); patients who were recog- nized no SE during the followup period. We performed comparative analyses in these 3 groups on clinical factors including fasting blood glucose (FBS) levels, values of HbAlc, and other sys- temic complications. The values of vitreous fluorophtometry in patients from group I and in patients who developed SE during the followup period from group 2 were compared to those in patients from group 3. FBS levels and HhAIc values were higher in groups 1 and 2 than in group 3. In group I, FBS levels and HbAlc values were high before SE was recognized comparing to those after SE appeared. Among the systemic complications, diabetic nephropathy was only disclosed as the relating factor to the onset of SE. The values of vitreous fluorophotometry in patients who developed SE in groups 1 and 2 increased, whereas those in group 3 were unchanged during the followup period. A correlation in onset of SE to improvement of blood glucose control, and that in development of SE to increase of vitreous fluorophotometry value were statistically signifficant. Our data suggested that the rapid control of blood glucose for the patients who had been under poor control might influence the onset of SE, and that breakdown of the blood-retinal barrier correlated to the development of SE.

$564

POS-004-117 D I A B E T I C OEDEMATOUS MACULOPATHY MUST BE TREATED BEFORE A DECREASE OF VISUAL ACUITY : RESULTS IN 69 YEYES TREATED IN #0 PATIENTS,

B . V I L L A T T E CATHELINEAU*, G. CA THELINEAU**. * S e r v i c e d ' O p h t a l m o l o g i e - H 6 p i t a l de la P i l l 6 - PARIS, FRANCE * * S e r v i c e de D i a b ~ t o l o g i e - H 6 p i t a l S a i n t L o u i s - PARIS, FRANCE

Oedematous m a c u l o p a t h y a re a f r e q u e n t c a u s e o f b l i n d n e s s in d i a b e t i c s . The l a s e r p h o t o c o a g u l a t i o n i n t h i s f o r m o f r e t i n o p a t h y is in d i s p u t e . The r e s u l t s o f l a s e r p h o t o c o a g u l a t i o n t r e a t m e n t in 69 eyes in #0 p a t i e n t s a re r e p o r t e d he re : ( t y p e I : n=17) ( t y p e I1 : n = l l ) ( i n s u l i n r e q u i r i n g s u b j e c t s : n = 1 2 ) . A f t e r a c l i n i c a l and a n g i o g r a p h i c o p h t a l m o l o g i c e x a m i n a t i o n f o l l o w e d by an o b s e r v a t i o n a l p e r i o d o f 3 to 6 months i n o r d e r to o b t a i n the b e s t d i a b e t i c c o n t r o l , p a t i e n t s were r e e x a m i n e d . A p u n c t i f o r m p h o t o c o a g u l a t i o n (by h e m i c i r c l e o r c i r c l e ) was done on the m a e u l a r l e s i o n s a c c o r d i n g to w e t h e r or no t t hey had imp roved or d e g e n e r a t e d at 6 m o n t h s . The c r i t e r i a o f j udgemen t w e r e the v i s u a l a c u i t y , a n g i o g r a p h i e d e c r e a s e o f m a c u l a r oedema, a f t e r one y e a r . R e s u l t s : The absence o f o e d e m a was o b t a i n e d i n 77% o f the sample . V i s u a l a c u i t y r e m a i n e d s t a b l e o r i m p r o v e d in 93% o f the samp le . The v i s u a l a c u i t y was b e t t e r than 5 / 1 0 in 65% o f c a s e s . These r e s u l t s j u s t i f i e the e a r l y i n t e r v e n t i o n in d i a b e t i c m a c u l a r o e d e m a where the s p o n t a n e o u s c o u r s e o f the d i s e a s e is s e r i o u s .

POS-004-118 CHANGE OF B-CELL FUNCTION AND DEVELOPMENT OF INCIPIENT RETINOPATHY AFTER 5 YEARS OF DIABETES

IN 46 PATIENTS WITH JUVENILE ONSET NIDDM.

OWADA M., AKATSUKA A., HANAOKA Y., JOGO Y., TANIMOTO M., KITAGAWA T.

Dept of Pediatrics, Nihon University School of Medicine, Tokyo, Japan.

This paper presents the clinical findings, glucose tolerance, insulin secretory activity as well as the ophthalmologic finding~ in patients with NIDDM whose onset was at less than 15 years of age, also the prognosis of these cases will be discussed. 46 patients with NIDDM who diagnosed by urine glucose testing in school and we have followed for more than 5 years at our outpatient office were examined. The diagnosis of type II diabetes was made according to the classification of the WHO Expert Committee on Diabetes decided upon, namely, a disease that responds to dietary management and physical exercise with an improvement of glucose tolerance. IRI and CPR response to glucose, arginine or glucagon loading as well as daily urine CPR excretion were examined in order to estimate the retained pancreatic B-cell function. Ophthalmoscopic examinations and fluolescence angiography were carried out at least once a year. Obesity was noted to be present in 82.6% of the cases in this series. Cases with slight glucose intolerance (major cases) ex- hibited delayed hypersecretion of insulin in response to glucose, whereas those with severely decreased glucose tolerance (2 cases in this series) showed a marked decrease in insulin secretory response. These findings indicate that diministed responsiveness to insulin rather than insulin insufficiency plays a predominant role in impaired glucose tolerance, at least during initial stage after onset. Ophthalmoscopic examination revealed no abnormality within one year from onset, however, after 7 years of diabetes, the frequency of abnormality increased steadily with the duration of diabetes reaching 62.5% at 9 years of diabetes. Fluorescein angiographic exami- nation revealed abnormality in 30 to 40% of cases within 5 years of diabetes. Early dietary and exercise therapies were so effective to prevent the deterioration of glucose tolerance and development of diabetic complication in juvenile NIDDM, that the glucose screening in school children has become an important examination.

$565

POS-004-119

ABSTRACT WITHDRAWN

POS-004-120 COMPUTERIZED ANALYSIS OF AVASCULAR AREAS ON RETINAL FLUORESCEIN ANGIOGRAPHY.

M KIKUCHI, T MATSUMOTO, R MINAMIKAWA ~ Department of Endocrinology & Metabolism, Mitsui Memorial Hospital, Tokyo. *Tokyo Mertopolitan Institute of Medical Science.

Topographic distribution of avascular areas on retinal fluorescein angiography was studied using a computerized densitometry (pixel unit 50x5Oum) on 324 photographies of 91 eyes in 69 mild non-insulin-dependent diabetics (NIDDM) treated with diet alone or oral hypoglycemic agents. Discernible areas of avascular lesions in synthesized fundus photographs were traced on transparent films superimposed. Avascular areas on the films were input by television camera into a computer (POP-11/17). The mean FBG was 133.1±17.8, relative body weight +13.2±17.8% at the first study. Relevant clinical data did not change during the study of 2-5 years. Of total avascular areas expressed as pixels 8, 15, 29 and 48% were present in temporal superior, temporal inferior, nasal superior and nasal inferior quadrants respectively. The most accumulated areas were found in nasal inferior quadrant, 2 to 3 D.D. away from the disc margin. Comparable topographic distribution were observed in 19 eyes with newly formed lesions, 31 eyes with a single, in 64 eyes with a few and 12 eyes with many ones, whereas their averaged avascular areas were 196, 72, 334 and 2,635 pixels respectively. There was a similar tendency in fractional distributions of total pixels in every quadrant at the start, one year after and two years after in 69 eyes, while mean areas of avascular lesions were 407,632 and 1,665 pixels respectively. Annual rates of the incremental areas were accelerated from 225 pixels for the first year to 439 for the second. 75% of 594 avascular lesions were present in the middle part of the first to the third branches of perfusing arterioles, with 40% being associated with the second branches. In summary, I) Early avascular areas in mild NIDDM were mostly initiated with multiple lesions in every quadrant of ocular fundi. 2) They progressed with the same rates anywhere. 3) Their annual rates were accelerated with time. 4) The most vulnerable portions were 2 to 3 away nasal and inferior from the optic disc. 5) They were mostly associated with the middle part of perfusing arterioles except for the bifurcation.

$566

POS-004-121 PLASMA LEVELS OF PROTEIN C AND ANTITHROMBIN-III IN PATIENTS WITH NON-INSULIN- DEPENDENT DIABETES MELLITUS, WITH REFERENCE TO RETINOPATHY.

M OHTA, TMANABE, Y TOMITA, H HORIKAWA, H HASHIMOTO, J SHIMIZU, ~ OHTAKE, H OKUMURA First Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.

Protein C (PC) and antithrombin-III (AT-III) are both known to play an impor- tant role in the regulation of blood coagulation. Although decreased level of PC has been reported in patients with insulin-dependent diabetes mellitus (IDDM), levels of these two factors in patients with non-insulin-dependent diabetes mellitus (NIDDM) have not been investigated as of yet.

To study the clinical significance of these factors in relation to microvas- cular complications represented by retinopathy, we measured their activities and certain related coagulation factors in a total of 44 patients with NIDDM, and the findings were compared with those in 9 sex- and age-matched healthy control subjects. Protein C was quantitated by enzyme immunoassay (EIA) and AT-III by turbid dimetric immunoassay (TIA).

Protein C in the total group of NIDDM patients was significantly less than in the control subjects (114.7±24.6% vs 135.9±23.6%, P<0.05). However, PC levels did not show any significant correlation neither with the blood glucose levels nor with hemoglobin A1c. Eighteen patients with retinopathy had significantly lower PC levels (110.5±14.9%) than the control subjects (P<0.01), whereas 19 patients without retinopathy did not show any significant differences (119.1±34.0%) from the controls. On the contrary, there was no statistically significant difference in AT-III levels between the NIDDM and control groups nor between the NIDDM pa- tients with and without retinopathy.

These results strongly suggest that decreased PC in NIDDM, as well as in IDDM, may indicate an abnormal hemostatic condition, which may be related to the devel- opment of microvascular complications such as represented by retinopathy.

$567