A randomised control trial to determine if the review of non-mydriatic retinal images can contribute to a reduction in glycosylated hemoglobin in patients with poor control of their blood sugar diabetic retinopathy

INTERVENTION: The “intervention” group will have a nonmydriatic imaging of each retina (45 degrees one field centered between fovea and optic nerve head) following their endocrinologist exam, followed by a brief discussion by a retina specialist about the findings. The patients will be shown their images during this discussion and the following topics will be explicitly discussed with each patient: First, a series of images comprising a spectrum starting from a normal appearing fundus to images of mild and moderate nonproliferative diabetic retinopathy (DR), active proliferative DR and tractional retinal detachment. Second, ongoing blood glucose control will be stressed in order to delay or avoid worsening of their retinopathy and finally a brief summary of the results of the Diabetes Control and Complications Trial (DCCT) and United Kingdom Prospective Diabetes Study (UKPDS) regarding HbA1C control and DR. CONDITION: Diabetic Retinopathy PRIMARY OUTCOME: blood analysis of HbA1C at study entry and at 3 months follow up level SECONDARY OUTCOME: none INCLUSION CRITERIA: patients with type 1 or type 2 diabetes mellitus, as defined by the expert committee on the diagnosis and classification of Diabetes Mellitus, patients with documented poor glycemic control as reflected in a HbA1C> or = 8.0% within 1 month of baseline, patients with recently recognized clinical changes of DR in their medical record (Early Treatment Diabetic Retinopathy Study scores of 20 and above), and ability to obtain nonmydriatic retinal images