[acb-diabetics] many articles

[Patricia LaFrance-Wolf]

1.%% Heartwire  NAVIGATOR Off Course to Diabetes Prevention With Valsartan,
Nateglinide 3/13/10 - Daily therapy with an angiotensin receptor blocker
(ARB)

had a significant but weak dampening effect on the risk of incident DM in a
population with impaired glucose tolerance and either CV
[cardio-vascular]disease

or CV risk factors, but no such effect was seen in the same group with a
different drug, a short-acting promoter of insulin secretion. Neither
valsartan

(Diovan) nor nateglinide (Starlix), had any significant effect on CV risk in
the trial, which compared them with placeboes and followed participants for

a median of 5 years. Everyone in the study, also followed a
lifestyle-intervention program aimed at reducing the risk of DM. We don't
know if the drug

was effective at all. .

 

2.%% Ask the Experts -3/08/10  Question Can insulin be considered an early,
second-line therapy straight after metformin? If so, when should we initiate

it and should we then intensify sooner in the treatment paradigm?  Response
from Eugene E. Wright Jr., MD

Current guidance does indicate that insulin can be added to metformin as the
second step in therapy for a patient with T2 after initiation of treatment

with lifestyle changes and metformin. Insulin should be considered for
patients with an A1C >8.5% or with symptoms secondary to hyperglycemia after
2-3

months of treatment

with metformin and lifestyle changes. Treatment can be initiated with a
basal (intermediate-or long-acting) insulin and the initial dose should be
10 U

/ 0.2 U/kg.C 2010 Primary Care Education Consortium

 

3.%% NYTimes 3/15/10  Drug Helps Diabetics, [Joslin DM Center]Trial Finds An
inexpensive, generic anti-inflammatory drug from the aspirin family helped

patients manage their T2DM and lower their blood sugar, adding to evidence
that inflammation plays a role in DM. The drug, salsalate, which is related

to aspirin but is not as hard on the stomach, has been used for years to
treat arthritis and joint pain.  after 3months, those in this study on the
highest

dose lowered their hemoglobinA1C scores by 0.5% average and lowered their
triglycerides.  "We may have a new class of therapeutic agents to treat
patients

with T2.. the work may help unravel the root causes of diabetes, said  the
senior author (Harvard Medical School.) "If we can figure out how this is
working,

we can figure out some of the root causes of DM and how obesity  promotes
inflammation, and how inflammation promotes diabetes and other chronic
health

problems," [100 patients] negative side effects - one was increase in LDL,
The most common side effect was experienced by patients on sulfonylureas -
episodes

of mild hypoglycemia , a drop in blood sugar that can be dangerous.

 

4.%% MW Thiazolidinediones Don't Cause Macular Edema: Study

(Reuters Health) Mar 09 - TZDs ( pioglitazone and rosiglitazone)[actos and
avandia] don't seem to cause macular edema in T2, TZDs can cause fluid
retention,

and a small number of case reports have suggested they might worsen DM
macular edema. [3473 subjects] TZD use was not associated with clinically
significant

macular edema or any DM macular edema. In ACCORD thiazolidinedione use was
associated with marginally better visual acuity - 0.79 letters on a zero to

100 scale..

 

5.%%Infected Foot Ulcers in Male and Female Diabetic Patients:.. 3/08/10;
Ann Clin Microbiol Antimicrob. 2010;9:2 Conclusions:  Male diabetic patients

with MDRGNB-infected foot ulcers have poor glycemic control and hence they
might have higher mortality rates compared to their female counterparts..
Researchers

are expected to  utilize this information to design more potent and
versatile CTX-- inhibitors. . Studies have reported 'male sex' as a
significant risk

factor for non-healing foot ulcers.  hypertension was found to be
significantly associated with poor glycemic control .. the prevalence of
hypertension

was found to be significantly higher among men than women. Hence, an absence
of glycemic control with the presence of hypertension appears to be a strong

indicator of MDRGNB-infections in male diabetic patients.

 

6.%%Treatment of Gestational Diabetes Does Not Affect Childhood BMI
(Reuters Health) Mar 09 - While treatment of GDM markedly

reduces macrosomia [very large body]at birth, it does not reduce the
infant's risk of a high body mass index (BMI) in early childhood.

[199 children born to mothers who had participated in a randomized trial of
treatment for mild GDM] The intervention group received dietary advice,
blood

glucose monitoring, and insulin if needed. The 105 women in the control
group received routine care. The prevalence of macrosomia was 5.3% in the
intervention

group newborns and 21.9% in the control babies. But at 4-5 years of age, the
mean age- and sex-specific BMI z-score was 0.49 in the intervention children

and 0.41 in the controls. The estimate was only minimally changed after
adjustment for maternal race, parity, age, and socioeconomic index.  It is
possible

that postnatal factors that determine a child's height and weight, such as
diet and physical activity, overwhelm any effects of treating GDM during
pregnancy."

Diabetes Care 2010.

 

7.%% Insulin Glargine QD Equivalent to Insulin Detemir BID for T2DM (Reuters
Health) Mar 08 - Once-daily insulin glargine and twice-daily insulin detemir

provided similar glycemic control for insulin-naive T2 diabetics.. however,
the glargine patients gained more weight but required significantly lower
doses

of insulin.  [973 patients whose disease could not be controlled with only
oral agents] Mean improvements in HbA1c and proportions of patients
achieving

HbA1c < 7% were similar for the 2groups. However, significantly fewer
glargine patients reached HbA1c levels below 6.5% compared to detemir
patients. "Considering

the similar control and hypoglycemia frequency, the type of insulin that
patients start with should depend on the experience of the physician and the
preference

of the patient,"

 

8.%% MW Long-Acting Insulin Analogs May up Risk of Diabetic Ketoacidosis in
Children (Reuters Health) Mar 10 - Use of insulin glargine or detemir rather

than NPH insulin does not reduce the risk of ketoacidosis in children and
adolescents with T1DM, and in fact may increase the risk. [10,682 T1
diabetics;mean

age, 14 .]".. The possibility of increased diabetic ketoacidosis risk in
pediatric patients injecting insulin glargine or detemir warrants further
attention,"

the authors conclude. Diabetes Care 2010.

 

9.%% Could Germs Be Making People Fat?  (Reuters) Mar 04 - Germs that make
their home in the gut may help cause obesity and a range of
health-threatening

symptoms that go along with it, researchers

report..It could be that certain bacteria cause inflammation that can affect
appetite as well as inflammatory bowel conditions like Crohn's and colitis. 

"Previous research has suggested that bacteria can influence how well energy
is absorbed from food, but these findings demonstrate that intestinal
bacteria

can actually influence appetite,"  "We were studying mice that had colitis,"
They suspected some kind of germ was responsible, so they transferred mouse

embryos into surrogate mothers to prevent them from being infected by their
own mothers. The colitis was better but the baby mice became obese and
developed

metabolic syndrome - including insulin resistance."What we think is that the
mice are prone to intestinal inflammation, If you have a lot of inflammatory

signals about, insulin won't work properly." The team is now working to can
identify the micro- organisms involved and  to see if obese people have
unique

patterns of gut bacteria. Scientists know that hundreds of species of
bacteria live in the gut and an average person carries about 5 pounds (2 kg)
worth.

, Chinese scientists reported that they found 1,000 different species in
human intestines. Science 2010.

 

10.%% MW FDA Approves Combined Diabetes Management System

3/18/10  FDA yesterday approved Medtronic's MiniMed Paradigm REAL-Time Revel
System, a DM management system that combines an insulin pump with a glucose

monitoring system. The system may represent the next step toward an
artificial pancreas.  The system includes "smart" insulin pump therapy and
continuous

glucose monitoring with predictive alerts that can give early warning of
impending hypoglycemia or hyperglycemia. These alerts allow people with DM
to

intervene with appropriate action to prevent dangerous high or low glucose
events. In addition, the system includes online therapy management software

that helps patients with DM and their healthcare providers evaluate and
manage treatment and make needed adjustments based on easy-to-read reports,
charts,

and graphs. Trend alerts detected by the system's glucose sensors can notify
patients of rapid changes in glucose levels, which they need to confirm with

a fingerstick glucose measurement and then take immediate corrective or
preventative action, if needed..Predictive and rate-of-change alerts, as
well as

other new features, help achieve optimal glucose target range by giving
earlier warnings of potential glycemic excursions. These alerts can be
tailored

as appropriate for a specific patient's lifestyle; for example, by creating
different settings for exercise or for management of nocturnal hypoglycemia.

Similarly, insulin delivery can be customized to specific needs because of
new features in the insulin pump. Children or other patients who are
sensitive

to insulin can now receive insulin in smaller increments (0.025 units per
hour), and insulin-resistant patients with T2 can more tightly control their

glucose levels using the new 1:1 carbohydrate ratio. The system also allows
for missed meal bolus reminders. Nearly all US private and government
insurance

programs cover the costs of insulin pumps, and nearly 90% of T1patients with
private insurance are covered for continuous glucose monitoring costs,
provided

they meet medical criteria. In the US, personal continuous glucose
monitoring is approved for use by people at least 7 years of age. The system
is immediately

available, Medtronic said.

 

11.%%JHA Are Your Feet at Risk? 3/18/10  If you have diabetes, it's
critically important to pay attention to your feet. Shoes that rub or pinch
can cause

foot ulcers, a major DM complication. In fact, one study says that
ill-fitting shoes are the most common precipitator of foot ulcers. And if
not detected

and treated early, foot ulcers can become infected and even lead to
amputation.. Properly fitting, comfortable shoes are essential to prevent
foot ulcers

and protect the health of your feet. Of course, not everyone with diabetes
is at high risk for foot ulcers. The main problem that determines foot ulcer

risk is DM  neuropathy (nerve damage). One indication that you may have
neuropathy is numbness, tingling, or burning in your feet and toes,
especially

if you have had DM for a decade or more. The reason numbness puts you at
such risk is that the nerves have a purpose: to warn you of danger. If those
nerves

aren't functioning properly, you will not know when you are developing a
foot ulcer, have shoes that don't fit, or have even stepped on a tack!
Peripheral

arterial disease (PAD) is another problem that can put our feet at high
risk. The poor blood flow to the legs and feet in this condition slows the
healing

of any foot wound and increases the chance of infections. One symptom of PAD
is a cramping pain in one or both calves when you walk (called claudication)

that goes away within minutes when you stop walking. The highest risk is
suffering from both neuropathy and PAD, so find out from your healthcare
provider

whether you have one or both. But even if you do, all is not lost. With
careful foot care, you can successfully prevent problems by following some
important

healthcare behaviors. The key is to prevent that first break in the

skin and to treat it quickly if it happens. 

 

12.%% MNTD New Alterations Found In Young Adults With T2DM 3/12/10  Diet and
aerobic exercise are highly effective for the treatment of T2 but not for

obese subjects that have developed the disease when very young.   obese
subjects between 18 &25 years of age carry mitochondrial proteins and genes
that

work abnormally and that these anomalies contribute to generating insulin
resistance and a reduced response to physical exercise. The team leader says


"We are starting to observe that there are special forms of T2 that behave
in a different way to the classical form, and these differences require
specific

treatments for each kind of patient." another study showed  that morbidly
obese DM subjects [BMI +40]  also suffer from specific mitochondrial
alterations

that are different than classical DM patients.

 

13.%% MW Guidelines Issued for Diagnosis and Classification of Hyperglycemia
in Pregnancy 3/9/10 - Internatl Assoc of Diabetes and Pregnancy Study Groups

(IADPSG) has issued recommendations on the diagnosis and classification of
hyperglycemia in pregnancy. The new guidelines for (GDM) are published in
the

March issue of Diabetes Care. Specific recommendations for identifying and
diagnosing hyperglycemic disorders in pregnancy include the following: At
the

first prenatal visit, all or only high-risk women should undergo testing of
fasting plasma glucose (FPG), hemoglobin A1c, or random plasma glucose,
based

on the background frequency of abnormal glucose metabolism in the population
and on local circumstances. Thresholds for diagnosis of overt diabetes
during

pregnancy are FPG of at least 7.0 mmol/L (126 mg/dL); hemoglobin A1c level
of at least 6.5% or random plasma glucose at least 11.1 mmol/L plus
confirmation.

If this testing result indicates overt DM, treatment and follow-up should be
the same as for preexisting DM. If testing is not diagnostic of overt
diabetes

and FPG is at least 5.1 mmol/L but less than 7.0 mmol/L, GDM should be
diagnosed. If FPG is less than 5.1 mmo l/L the patient should be tested for
GDM

from 24 to 28 weeks of gestation with a 75-g oral glucose tolerance test ..
All women diagnosed with GDM or overt diabetes during pregnancy should
undergo

postpartum glucose testing.

 

14.%% MW  3/19/10 - Basal insulin requirements may be less on the day after
maintenance hemodialysis in T2DM with end-stage renal disease [10 T2
patients]

Basal insulin requirements decreased from 0.4/hour before hemodialysis to
0.3/hour after hemodialysis "The present study has demonstrated a
significant

25% reduction in basal insulin requirements the day after dialysis compared
to the day before," the study authors write. "No significant change in
boluses

was observed, and overall the reduction of total insulin requirements was
15% equivalent to -4IU/day post hemodialysis of marginal statistical
significance."

 

15.%% Metformin More Effective if Initiated Soon After Diabetes Diagnosis
3/22/10 - Starting patients with metformin within 3 months of their diabetes

diagnosis increases the drug's efficacy. [1799 T2 patients who received
metformin as their first antihyperglycemic medication]  Results also showed
that

A1C levels at the time of metformin initiation are significant."Our study
suggests that initiating metformin soon after diabetes diagnosis and while
A1C

is low may improve the durability of metformin; thereby delaying the need
for therapeutic adjustments and reducing the glycemic burden associated with

its failure," the  authors write. R. Bergenstal, MD,ADA  applauded the study
findings "This was the first study that said, 'Maybe we shouldn't wait until

diabetes gets out of control to add the first medication.' Diabetes Care.
2010;33:

 

16.%%  Nature Reviews Neurology  The Optic Nerve Head in Acquired Optic
Neuropathies 3/09/2010  Abstract -  Acquired optic neuropathies are a common
cause

of blindness in adults. Optic neuropathies [ON] involve degeneration of the
optic nerve, and can be hereditary or acquired.. these neuropathies result

in characteristic changes to the optic nerve head (the visible portion of
the optic nerve, also known as the optic disc) and the surrounding retinal
nerve

fiber layer (RNFL) as a result of direct and indirect damage to the retinal
ganglion cells and their axons.   Diabetic Papillopathy - is a diagnosis of

exclusion in DM patients with, transient disc swelling minimally decreased
visual acuity; normal systemic BP; no signs of raised intracranial pressure

(ICP); and a normal brain CT scan. At presentation, most patients have mild
nonproliferative diabetic retinopathy. Diabetic papillopathy was initially

described in young patients withT1DM  and later reports described a similar
entity in patients with T2DM.   In general, eyes with diabetic papillopathy

have a crowded disc, In the acute phase, the involved disc in diabetic
papillopathy often shows nonspecific,

edema & surface telangiectasia [small dilated vessels] which has  been
mistaken for neovascularization of the optic disc. Optic disc edema
gradually resolves

over 2-10 months. The long-term visual prognosis is usually limited by the
associated diabetic retinopathy

and not the diabetic papillopathy; however, persistent visual loss can occur
secondarily to the optic neuropathy.

 

17.%%

<acb-hsp at acb.org>

 3/23/10  Prodigy Count-A-Dose is now available!  Count-a-dose is a medical
device that allows a  blind or vision impaired person with diabetes,  to
fill

an insulin syringe independently without assistance. Insulin therapy will
cost a lot less with  Count-A-DoseR versus using insulin pens and prefilled
reservoirs!

In addition to the release of the count-a-dose,  we are pleased to announce
a new Low Vision  Center on our website, this center contains  information

about the ProdigyR Count-a-doseT,  Prodigy VoiceT Meter, and soon to be
Prodigy IQ Pump information.

For additional information 866-908-9201.

 

18.%% MW  Motor Vehicle Accidents in Patients With Diabetes 3/12/10 Motor
Vehicle Crashes in DM Patients With Tight Glycemic Control: A
Population-Based

Case Control Analysis PLoS Med. 2009;6:   Summary - The aim of this study
was to explore the effect of tight glycemic control on the frequency of
motor

vehicle crashes. [795 DM patients]. The mean HbA1c of crash victims was 7.4%
vs 7.9% for non-crash patients. The team calculated that lowering the HBA1c

level by 1% increased the risk for a vehicular accident by 25% Other risk
factors for sustaining a crash were severe hypoglycemia and increased age at

onset of DM. Viewpoint -  Uncontrolled diabetes can impair the ability to
drive, and lead to serious complications such as blindness and
cardiovascular

disease. Careful DM control is a standard of good practice, but in this
study, patients with the tightest control of glucose levels as measured with
HbA1c

levels had an increased risk for motor vehicle accidents. The authors
emphasized the difficulty in assessing the driving fitness of patients with
DM, and

that HbA1c levels may be an inappropriate measure.

 

19.%% MW Acute Metabolic Responses to a High-carbohydrate Meal in
Outpatients with Type 2 Diabetes Treated with a Low-carbohydrate
Diet:.3/12/10; Nutr

Metab. 2009;6:52 -  A low-carbohydrate diet (LCD) achieves good glycemic
control in (T2DM) compared with a high-carbohydrate diet. acute metabolic
responses

to high- carbohydrate meals (HCMs) have not been determined

in LCD patients with T2. [31 subjects] Conclusion  -  HCMs rapidly decreased
postprandial ketone body concentrations in T2patients  treated with a LCD.

The decreases were more remarkable in strict than in moderate LCD subjects.
HCMs slightly decreased postprandial triglyceride levels in strict LCD
subjects.

 

20.%%  Medscape DM & Endo   Is the Association Between Glucose Control and
Cardiovascular Outcomes in Diabetes Affected by Comorbidity? 3/18/10  Study

Summary This 5-year observational study of a community-based sample of older
patients with T2 was designed to determine whether attaining glycated
hemoglobin

(A1c) targets of < 6.5% or < 7.0% provided differential benefits for
patients with comorbidity.[another illness/condition] [2613 patients] within
the high

comorbidity group, there was no significant difference in CV risk between
those who did and did not attain A1c = 6.5%. Similar results were found when

using an A1c of 7.0% .It is now widely known that 3 recent clinical trials
were unable to demonstrate a CV benefit of tight glycemic control (A1c =
6.5%). 

There were indications from other studies however, that younger patients or
those without previous heart disease might benefit, suggesting that
healthier

patients may in fact experience fewer CVD events with tight control.  The
current study is consistent with those suggestions.. As other research has
shown,

multifactorial intervention is the key to overall risk reduction.

 

21.%% MW  Amitriptyline vs Pregabalin for Painful Diabetic Neuropathy
[DMN]-- A Rare Head-to-Head Comparison 3/17/10  Best Evidence Reference  DMN
results

in significant morbidity and can be confusing to both patients and
physicians. Several effective treatments are available. The current study
provides important

insight into treatment choice by comparing 2 effective medications. The
estimated prevalence of painful neuropathy in the US is 11% to 21% among
patients

with DM. The pain and comorbidity associated with diabetic neuropathy are
significant. In a study of 140 patients with painful DMN, 57% reported
moderate

levels of pain, and one quarter of subjects had severe pain.  Neuropathy was
linked to worse functional status, and 35% of respondents described work
disruption

resulting from neuropathy symptoms. In addition, 43% of the cohort

reported the use of prescription medication to treat concomitant anxiety,
depression, or sleep disturbance. Clinical trials confirm the efficacy of
both

antidepressants and anticonvulsants for the treatment of painful diabetic
neuropathy.   In indirect comparisons of 11 studies (none of which tested
amitriptyline),

the authors found that pregabalin, duloxetine, and gabapentin were all
effective in improving pain. Duloxetine was associated with less dizziness
compared

with pregabalin, but not compared with gabapentin.  he clinician can thus
conclude that multiple treatments are effective for the management of DMN
and

therefore individual patient factors and preferences are critical in the
decision of which treatment to choose. A major factor in this decision for
many

patients and insurance companies is the profound difference in price between
medications such as pregabalin and amitriptyline.. treatment with pregabalin

could cost greater than 20 times more than treatment with amitriptyline.
However, the lower cost of amitriptyline must be weighed against its more
significant

profile of adverse events.  Tricyclic antidepressants are associated with
potentially disastrous adverse events, particularly among older adults. Such

events include a higher risk of falling as well as life-threatening
arrhythmias.  These risks must be balanced against the potential benefits of
tricyclic

antidepressant therapy as well as the known side effect profiles of other
medications used to treat painful DMN. Newer therapeutics are not
necessarily

more effective than established treatments. Because all medications used to
treat painful diabetic neuropathy have their limitations, it is better to
have

a variety of medications from which to choose.

 

22.%% MNTD Diabetes Patients' Lives May Be Shorter If They Have Difficulty
Trusting And Reaching Out To Others 3/19/10  Mistrust can exact a high toll.

Being overly cautious or dismissive in relating to people, researchers are
learning, may shorten the lives of people with diabetes. DM patients who
have

a lower propensity to reach out to others have a higher mortality rate than
those who feel comfortable seeking support. These are the findings of a
5-year

study  This is the first known study.. to examine the association between
relationship styles and mortality. [3,535 adults with T1&2] Because
depression

has been linked to premature death from DM, patients with depression were
not included to avoid confounding results. . Individuals with an interactive

style find it easy to get close to others and rely on them, and in turn are
dependable for others. Those with an independent style tend to be either
dismissive

or fearful of close relationships. Some people with this style would like
emotional closeness, but find it hard to trust or depend on others. Others
can

be indifferent to close relationships, preferring instead to be free and
self-reliant. "These ways of relating often extend to their relationships
with

health-care providers," the team said., diabetes patients who were
mistrustful of people, including health-care providers, had a 33%  higher
mortality

rate than those who interacted easily with others and sought comfort and
support. The team found the significantly higher risk of death among DM
patients

who were less likely to seek support still held after controlling for other
potential risk factors for mortality such as age, marital status, other
medical

conditions, and DM complications. "Prior studies have shown that lower
support seeking is associated with poorer adherence to treatment," "Many
self-management

behaviors related to DM are optimally carried out in collaboration with
others -- family, peers and health-care providers,"  Planning and cooking
diabetic-friendly

meals, exercising, and quitting smoking are best undertaken with
motivational support. Also, as diabetes gets more severe or complications
arise, a self-reliant

attitude that worked in the past may become a liability.

 

23.%% MNTD Study Finds Selenium Protects Men Against Diabetes

19 Mar 2010  The role of selenium in DM has been controversial..Now,
research shows that, for men, high plasma selenium concentrations are
associated with

a lower occurrence of  dysglycemia. [abnormal glucose regulation] [1162
subjects 9 years] ".. for French elderly males, having plasma selenium
concentrations

in the top tertile [3rd]of the population distribution was significantly
associated with a lower risk of developing dysglycemia over the following 9
years".

"The reason we observed a protective effect of selenium in men but not in
women is not completely clear, but might be attributed to women being
healthier

at baseline, having better antioxidant status in general and possible
differences in how men and women process selenium".

 

24.%% Nature Reviews Endocrinology 6, 179 [NRE] (April 2010) |

HbA1c -based diagnosis of diabetes: ethnic disparities in prevalence effects
- The proposed shift from the use of the oral glucose tolerance test (OGTT)

to HbA1c  level to diagnose DM will have differential effects on the
prevalence of this disease across ethnic groups.. different ethnic groups
produce

different HbA1c levels at similar blood glucose levels. [23,094
participants]The shift to HbA1c -based criteria will result in increased
prevalence of

DM in some populations but decreased prevalence in others, according to the
findings.. prevalence was 63% increased by use of the HbA1c  definition in

the Danish study but 82% decreased in the Australian study."What is needed
is a more rigorous evaluation of the relationship between HbA 1c and recent

antecedent glycemic burden over the preceding 2-3 months among a large cross
-section of individuals from the major ethnic/racial groups of the world.

Until then, it will be advisable to confirm the diagnosis of  with actual
blood glucose values, especially in persons from African, Asian and other
non-European

ancestry."

 

25.%% MW Aspirin Use in Newly Diagnosed Diabetics May Be Cost- Effective,
but the Practice Remains Controversial 3/25/10- Patients with newly
diagnosed

T2DM who take aspirin can gain an average of nearly 4 months of life for an
cost of less than $2000. The risk of developing cardiovascular disease (CVD)

is 2 to 4 times greater for those with DM. "..  studies concluded that
aspirin use was  cost -effective," write researchers "It is not known if the
same

conclusion holds for persons with diabetes." They used a validated model to
simulate T2 progression its complications: nephropathy, neuropathy,
retinopathy,

coronary heart disease, and stroke. Patients on aspirin lowered their
cumulative incidence of coronary heart disease events by 3.91%, However,
their cumulative

incidence of stroke increased by 0.51%, Although the team concluded that
ongoing aspirin therapy is cost-effective, they did not find it to be
cost-saving.

"First, aspirin's effect on gastrointestinal bleeding increased the total
medical costs of the group taking aspirin. Second, the aspirin treatment
group

lived longer and required additional resources for treatment of DM and
hypertension, Third, aspirin treatment affects diabetes macrovascular
complications

but not microvascular ones." [such as retinopathy] The use of aspirin to
ward off CVD is still controversial and merits further study."Future
clinical

trials are needed to better understand if aspirin is efficacious for people
with T2. Centers for Disease Control and Prevention supported the study. 

 

26.%% Ophthalmology vol117,4 April 2010 Impact of Diabetic Retinopathy [DR]
on Vision-Specific Function  [ 3280 Asians]  Conclusions People with vision-

threatening  and proliferative diab retinopathy have substantial difficulty
undertaking vision-specific daily activities. These findings reinforce the

importance of preventative efforts targeted at the earliest DR stages to
prevent progression to later stages of DR.

 

27.%% Ophth 117,4 Apr 2010   Effect of Retinal Photocoagulation on
Intraretinal Lipid Exudates in Diabetic Macular Edema Documented by OCT [13
patients

with clinically significant macular edema in T2] Conclusions  Retinal
photocoagulation has a major impact on retinal edema and subsequently on the
distribution

of intraretinal lipid deposits.

 

NRE - Nature Reviews Endocrinology 

- Abbreviations:  DM - diabetes Mellitus;T1DM - type 1 diabetes mellitus
T2DM - type 2; DME - diabetic macular edema; GDM gestational diabetes;PDR -
proliferative

diabetic retinopathy;   FPG - fasting plasma glucose BP - blood pressure;
CVD - cardio-vascular disease; MI -myocardial infarction or heart attack
;HTN

- hypertension or high BP; OCT - optical coherence tomography; VA - visual
acuity  -ADA - Amer Diabetes Ass & ADA Professional Resource Online; FDA
Federal

Drug Adm. JHA - Johns Hopkins Alerts ; MW Medscape Web MD; NIH - National
Institutes of Health;  MNTD- Medical News Today  Definitions via online
Medical

dictionaries.  Disclaimer, I am a BSN RN but not a diabetic or diabetic
educator. Reports are excerpted unless otherwise noted. This project is done
as

a courtesy to the blind/visually impaired and diabetic communities. Dawn
Wilcox BSN RN Coordinator The Health Library at Vista Center; an affiliate
of

the Stanford Hospital Health Library.   contact above e-mail or 

thl at vistacenter.org     

            

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