XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

Objectives: To evaluate factors related to the incidence of diabetic retinopathy (DR) in a population of African descent, after 9 years of follow-up. Design: Population-based cohort study; 81%participation after 9 years. Participants: Three hundred twenty-four participants of the Barbados Eye Studies, with diabetes mellitus (DM) at baseline and at risk for developing DR during follow-up. Methods: Diabetes-related changes were assessed by masked gradings of baseline and follow-up photographs using a standardized system. The 9-year cumulative incidence of DR was based on participants with DM and free of retinopathy at baseline; incidence rates were estimated by the product-limit approach. Cox regression models for discretetime data were used to evaluate risk factors associated with the 9-year incidence of DR. Results: Multivariate analyses revealed that older age at DM onset decreased the 9-year risk of DR development; for each 10 years of older age at onset, the risk of DR decreased by 30%(risk ratio [RR], 0.7; 95%confidence interval [CI], 0.56-0.96). The risk of DR doubled among persons with DM duration between 5 and 9 years (RR, 2.1; 95%CI, 1.2-3.6) versus those with shorter durations; it also doubled in those treated with oral medications or insulin at baseline versus those treated with diet only. Antihypertensive treatment halved the risk of DR versus no treatment (RR, 0.5; 95%CI, 0.3-0.9) and high systolic or diastolic blood pressure (BP) increased risk. Thus, DR risk increased by 30%for every 10 mmHg of higher systolic BPat baseline (RR, 1.3; 95%CI, 1.1-1.4) or of BPincrease from baseline to the 4-year follow-up (RR, 1.3; 95%CI, 1.1-1.4). Diabetic retinopathy risk similarly increased with each 1%of higher glycosylated hemoglobin level at baseline (RR, 1.3; 95%CI, 1.2-1.5). Conclusions: The long-term follow-up of persons with DM in this population of African origin, where disease prevalence is high, identified important potentially modifiable risk factors for DR. Findings suggest that efforts to achieve optimal glycemic and BPcontrol may reduce the vision-threatening complications of DM.

Hyperglycemia, blood pressure, and the 9-year incidence of diabetic retinopathy: The Barbados Eye Studies

The worldwide prevalence of diabetes mellitus (DM) continues to increase rapidly and is expected to reach over 592 million people by 2035.1,2 The most common microvascular complication of DM is diabetic retinopathy (DR), the leading cause of new cases of blindness in adults aged 17 to 34 in the world.3 According to a meta-analysis performed on 35 studies between 1998 and 2008, the prevalence of DR and vision-threatening diabetic retinopathy (VTDR) was 34.6% and 10.2% respectively.4 In this same study, the prevalence of proliferative diabetic retinopathy (PDR) was 7.0% and the presence of diabetic macular edema (DME) was 6.81%.4 Interventions exist to effectively halt or reverse retinopathy in many cases and thus the key to preventing vision loss is expedient recognition and treatment of retinopathy. However, given the high prevalence of DM worldwide, ensuring that all patients are screened and have effective follow-up adds a significant burden on health care systems. This paper will explore how artificial intelligence (AI) can minimize the burden of DR by addressing issues with detection, monitoring progression, and predicting treatment outcomes for DR and DME. In computer science, machine learning is the study of using machines to make intelligent decisions by extracting patterns and learning from data.

Applications of Artificial Intelligence for the Detection, Management, and Treatment of Diabetic Retinopathy.

Introduction: Diabetes is a pandemic disease that causes relevant ocular pathologies. Diabetic retinopathy, macular edema, cataracts, glaucoma, or keratopathy strongly impact the quality of life of the patients. In addition to glycemic control, intense research is devoted to finding more efficient ocular drugs and improved delivery systems that can overcome eye barriers. Areas covered: The aim of this review is to revisit first the role of diabetes in the development of chronic eye diseases. Then, commercially available drugs and new candidates in clinical trials are tackled together with the pros and cons of their administration routes. Subsequent sections deal with self-assembled drug carriers suitable for eye instillation combining patient-friendly administration with high ocular bioavailability. Performance of topically administered polymeric micelles, liposomes, and niosomes for the management of diabetic eye diseases is analyzed in the light of ex vivo and in vivo results and outcomes of clinical trials. Expert opinion: Self-assembled carriers are being shown useful for efficient delivery of not only a variety of small drugs but also macromolecules (e.g. antibodies) and genes. Successful design of drug carriers may offer alternatives to intraocular injections and improve the treatment of both anterior and posterior segments diabetic eye diseases.

https://www.tandfonline.com/doi/pdf/10.1080/17425247.2021.1953466

Diabetic eye: associated diseases, drugs in clinic, and role of self-assembled carriers in topical treatment.

Transplantation of gene transfected endothelial progenitor cells (EPCs) has provided novel methods for tumor neovascularization therapy but not for ocular disease therapy. This study aimed to investigate the efficacy of endostatin transfected EPCs in retinal neovascularization therapy. Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) showed the high expression of endostatin in endostatin-lentivirus-EPCs. The neovascularization leakage area and the number of preretinal neovascular cell nuclei were significantly decreased in the endostatin-lentivirus and endostatin-lentivirus-EPC groups, and the effects of these two treatments on inhibiting retinal neovascularization were almost the same. These two groups also showed the greater retinal distribution of endostatin. Intravitreal injections of endostatin-lentivirus-EPCs inhibited retinal neovascularization, vascular endothelial growth factor (VEGF) and CD31 expression, and increased endostatin expression in vivo. Endostatin-lentivirus-EPCs targeted and prevented pathologic retinal neovascularization. Gene-combined EPCs represent a potential new therapeutic agent for the treatment of neovascular eye diseases.

/pdf/an-endostatin-lentivirus-es-lv-epc-gene-therapy-agent-for-q5cvz4sz3j.pdf

An Endostatin-lentivirus (ES-LV)-EPC gene therapy agent for suppression of neovascularization in oxygen-induced retinopathy rat model.

Diabetes has been increasing in prevalence over the years, and nearly 30 million Americans (9.3%) now have diabetes (1). This disease burden on the population also translates to increased prevalence rates of diabetes complications. Diabetes is associated with several eye complications, including cataracts and glaucoma (2). However, the most common eye disorder associated with diabetes is diabetic retinopathy (DR), which is the leading cause of blindness among U.S. adults (2,3). During the 2005–2008 time period, >4 million adults ≥40 years of age with diabetes had retinopathy, including diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR), which can lead to vision loss (1).

The management of systemic disorders is vital to preventing diabetic eye complications (4). Specifically, the management of diabetes, hypertension, and hyperlipidemia has been associated with reduced or delayed onset and progression of DR (5–11). However, even with adequate control of these metabolic conditions, people with diabetes may still be at risk for developing retinopathy. Adequate eye screening is therefore important for the early detection and treatment of visual complications (4). Screening recommendations call for a dilated, comprehensive eye examination within 5 years after diabetes diagnosis for people with type 1 diabetes and immediately after diagnosis for those with type 2 diabetes (12).

Laser therapy has been the mainstay of treatment for DR and DME. Primarily, laser photocoagulation treatment has been used to prevent vision loss and to delay progression of retinopathy (13). The associated adverse effects of laser therapy, including night and peripheral vision loss, are generally preferred to eventual blindness. When laser treatment is not feasible, vitreous surgery becomes an option and has been shown to be beneficial for PDR and DME (4).

Research has supported the intravitreal administration of steroids, whose anti-inflammatory and antiangiogenic effects are beneficial in …

https://spectrum.diabetesjournals.org/content/diaspect/29/1/44.full.pdf

Overview of Ocular Anti-Vascular Endothelial Growth Factor Therapy in the Management of Diabetic Eye Complications

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

Christine Tran

Author Tools

Chat about Author

Papers

Overview of Ocular Anti-Vascular Endothelial Growth Factor Therapy in the Management of Diabetic Eye Complications