many articles

March 29, 2012

1.%% M 2/28 FDA Adds Warnings to Statin Label - Taking a statin can raise BS

& glycosylated hemoglobin HbA1c levels, according to a new labeling change

approved by the FDA for the entire drug class.Recent studies of popular

statins showed a significant increase in the risk of DM associated with

high-dose statin therapy[sT] An Trial of [crestor] Rosuvastatin showed a 27%

increase in DM in pts taking the drug vs placebo. Also, a substudy showed

that high-dose atorvastatin [lipitor] can worsen glycemic control. The

labeling changes also include new info on the potential for usually minor &

reversible cognitive side effects. The label for lovastatin [mevacor] now

provides info on contraindications & dose limitations for the drug in pts

taking other meds that may increase the risk for muscle injury. FDA says it

is also eliminating the recommendation that pts on ST undergo routine

periodic monitoring of liver enzymes because this approach is ineffective in

detecting & preventing the " rare & unpredictable " serious liver injuries

related to statins. ST should be interrupted if the pt shows signs of

serious liver injury, hyperbilirubin -emia, or jaundice. [see #2 & 12]

2.%% MNT 3/08 Statin Medications & Increased Risk for DM There have been

recent studies regarding the link between cholesterol- lowering statin

medications & an increased risk for new-onset DM. These studies of more than

153,000 women, ages 50-79 involved more than 10,000 cases of DM being

diagnosed. The studies found that statin therapy was associated with an

increased risk for DM, of about 48%. The analyses suggested that there could

be a medication class effect matched to all forms of statins. Also it was

found an increased risk for DM with both low & high-potency statins, but no

clear relationship with dose or duration of therapy. The implication of

these findings states that for the vast majority of pts on statins, the

benefits are expected to outweigh the risks. Statins are very effective at

lowering risk for heart disease & stroke. Overall there are some clinical

implications that the use of statins among DM pts is a risk yet not a huge

risk. The studies done do not indicate that an abrupt stopping of statin

medication is indicated among pts with DM. Instead more testing for DM pts

on statins is important. ca [see#1 & 12]

3.%% MA 2/29 Exercise duration - not total work completed has a greater

influence on glucose control in T2. Hypoxia & muscle contrac-tion stimulate

glucose transport. We previously showed that EX & hypoxia have an additive

effect on insulin sensitivity in T2. Results [8 male pts] suggest that EX

duration & not total work completed has a greater influence on acute &

moderate term glucose control in T2DM.

4.%% JH 3/1 The Promise of the Artificial Pancreas - Over the past several

years, experts have been working on a device called the artificial pancreas

[AP] which automatically senses changes in glucose levels & delivers an

appropriate amount of insulin into the bloodstream, as would a healthy

pancreas. Pts with T1 or advanced T2 must use insulin several times a day to

regulate glucose levels & prevent complications. 2 technologies have made

this easier: the continuous glucose monitor, which measures glucose levels

around the clock via a sensor implanted under your skin, & the insulin pump

-- an external device that delivers insulin through a catheter. The idea

behind the APis to create a system in which continuous monitoring & insulin

delivery are integrated. A computer algorithm would calculate the proper

dosage & timing of the insulin & deliver it when your body needs it. One way

the AP might be particularly useful is for managing night-time

hypoglycemia-dangerously low glucose. Extreme hypo can be a medical

emergency, & long-term exposure to low BS can lead to permanent neurological

damage. Before an AP becomes available, numerous technical problems must be

addressed.

5.%% MPD 3/1 Duration of Diabetes Raises Stroke Risk Action Points Having

diabetes for 10 years or more tripled the risk of an ischemic stroke in this

longitudinal diverse population. The risk of ischemic stroke increased by 3%

for each additional year a pt had DM,[3298pts] The growing stroke risk with

-includes- Greater carotid plaque thick-ness, Increasing vascular

complications from long-term hypertension Abnormalities in clotting

mechanisms The finding " warrants steps to institute long-standing &

sustainable lifestyle changes for primary prevention & appropriate long-term

management after diagnosis, "

authors wrote. source: Stroke: J Amer Heart Association

6.%% MA 3/2 Panretinal photocoagulation (PRP) for proliferative DM

retinopathy (PDR): pattern scan laser (Pascal) vs argon laser.Am J

Oph2012;[82eyes] Retrospective comparative case series. Conclu-sions: When

using traditional laser settings, PRP performed with Pascal is less

effective than that performed with traditional argon laser in pts with

previously untreated high-risk PDR. Physicians may need to change Rx

parameters when using Pascal pattern laser therapy for high-risk PDR.

7.%% M 2/29 Understanding the Diabetic Heart - It is important to try to

understand the differences between what causes heart disease in diabetics vs

non-diabetics. The main drivers of heart failure [HF] are high blood

pressure & /or heart disease. The majority of treatment is aimed at what is

called " after- load reduction, " to reduce the pressure against the failing

heart beating. In contrast, DM, is a metabolic disease, & it not only

affects the ability of insulin to allow the tissues to take up glucose to

use as a fuel, but it also effects lipid & fat met-abolism. New studies are

looking at whether the metabolic derange-ments of DM also lead to HF. Many

studies show that tight glucose control does not have a major impact on

long-term [CV] events. It is known that the diabetic heart accumulates fat &

when it uses fat as the main fuel, it develops a condition known as

" lipotoxicity. " If the excess fat in the heart cell is reduced, there is

reduction of both diastolic & systolic heart dysfunction. The best testing

for DM heart failure pts, is biochemical/imaging tests that determine if a

pt has early HF due to lipotoxicity, high BP, or both. In the diabetic,

there is constant bombardment of the heart by increased free fatty acids &

triglycerides due to a combination of lipolysis & fat tissues working

overtime to deal with the excess calories coming into the heart muscle. One

possibility would be to burn the fat right within the heart, with

cell-surface transporters, such as CD36 that would shut down the import of

excess fat. Most of the anti-diabetic meds, work in the liver & not the

heart. There is a real interest in developing agents that would increase the

ability of the heart to use glucose again which would then reduce the amount

of fat going in & would provide a healthy balance of fuel for the heart.

Medscape.com S ,MD; D., MD; ca

8.%% [MedEd excerpts] Diabetic Macular Edema- DME Exploring Recent Research

26 mill Americans have T1, T2 or impaired glucose tolerance - about half of

these have some diabetic retinopathy [DR]. One of the main causes of vision

loss from DR is DME. Several recent trials, looked at the effect of

anti-VEGF therapies compared with focal /grid laser. One study looked at

whether the addition of ranibizumab [lucentis] to laser would yield a better

effect than laser alone. A 2nd arm involved ranibizumab + deferred laser. A

3rd combined a steroid, triamcinolone & laser. In pts treated with laser

alone, we saw about 30% of the eyes improve 2 or more lines. With

ranibizumab strategies, about 50% improved by 2 or more lines. 5% lost

vision when they were treated with the ranibizumab strategies, as opposed to

10%-15% who received laser alone or laser combined with steroids. A UK study

showed that when [avastin] is compared with laser, the drug shows 6 letters

of improvement on average .. One risk associated with the eye injections is

endophthalmitis [major eye infection] - a small risk, although not zero. In

the trials, we see no increased risk for cataract when using lucentis vs

laser alone. Corticosteroids do, however, increase the need for cataract

surgery. 12/22/2011 indepen-dent ed grant Genentech.

9.%% M 2/21 Dapagliflozin Reduces Body Fat in Diabetics-T2 A new study

confirms [dap] helps pts with T2 lose a few pounds in addition to improving

their BS levels. The drug leads to loss of fat mass, both abdominal visceral

& subcutaneous tissue. Dapagliflozin,a highly selective inhibitor of

sodium-glucose cotransporter 2(SGLT2),belongs to a new class of anti-DM

drugs designed to allow more sugar to be excreted with urine. [182pts;24wks]

The team, some AstraZeneca employees, say longer-term data are needed to

establish whether the wt loss observed with dap is sustained. 6.6% of the

pts on dap had a serious adverse event vs 1.1% on placebo. events suggestive

of genital infections & lower urinary tract infections were seen more often

in the dapagliflozin arm. J Clin Endocrin Metab 2012.

10.%% ADA 3/26 New heart risk found for men with T2 T2 is a known risk

factor for heart disease. The new study investigated the impact of DM on

heart health & stroke risk among men & women, separating variables that

included age, ethnicity, & other CV risk factors. Men with T2 taking insulin

were 40% more likely than women to develop cardiovascular disease (CVD) &

70% more likely to have a first heart attack or die from CVD than men who

have already had a cardiac event. The finding is important for men dealing

with DM who should be especially vigilant about exercise, cholesterol

lowering & managing BP, all of which can lower the chances of heart attack

in the future. Brigham & Women's Hospital presented at the American College

of Cardiology 2012 Annual Scientific Session

11.%% ADA 3/7 Regulators consider waiving prescription for DM, cholesterol

...drugs FDA said Wed they are considering waiving Rx requirements for

certain drugs used to treat ailments like DM & asthma. Driving the move is a

wave of computer technology,including touch-screen kiosks found in

pharmacies, designed to help pts self- diagnose common diseases. The

regulators said that easing access to obtain certain medications could help

address undertreated epidemics like DM. Of the more than 25 mil Amer with

diabetes, an estimated 7 mil are not diagnosed & therefore do not receive

treatment. Diabetes is a leading cause of heart disease & stroke. FDA Dr. M

Hamburg said " We're not talking about abandoning standards for safety &

efficacy...Under the industry backed proposal, drug-makers could use

electronic questionnaires, BP monitors & other computer-assisted technology

to guide pts. In some cases, pts would still need to see a doctor to get an

initial Rx before getting over-the- counter refills. In other cases,

patients would need to speak with a pharmacist but would not need a

prescription to receive medication. " We're not talking about very specific

drugs right now, we're talking about the concept, " C The Washington Post

Company

12.%% 2/24 Statin Therapy [sT] & Risk for Diabetes: Deconstructing a Flawed

Study In a recent observational study by Culver..statin use was reported to

be associated with increased risk of 48% for hyper-glycemia/ " diabetes "

[153,840 pts] this report generated a frenzy of sensational

misinterpretation of the data by news media & concern & doubt about the

safety of statins among healthcare providers & public alike. A closer look

reveals numerous flaws in the design & data acquisition that render the

conclusions highly questionable. Further, none of the trials n the

meta-analyses nor the current study was designed to test the hypothesis of

statin-assoc DM; hence they do not establish cause & effect - only

association. For now, healthcare providers should feel comfortable in

assuring their pts that the well established benefits of ST far outweigh the

slight risk ..Just as important is the need for placing much greater

emphasis on dietary & lifestyle modifications than reliance on statin

therapy alone. Medscape Internal Medicine [see #1 & 2 ]

13.%% M 3/5 Risk of New-Onset Diabetes With Niacin Less Than Previously

Thought: - High BS levels that occur with niacin may normalize on their own,

even when hyperglycemia has started to look like new-onset DM. Data from

additional analysis of a large random-ized controlled trial suggest that

glucose elevation with niacin is largely a transient phenomenon lasting

several months, " just as the well-known skin flushing with niacin is

transient over a similar time period, " said Dr. J.Guyton, Duke. [942pt]..

niacin is a reasonable option to treat dyslipidemia in pts with or at risk

for DM, but risk/ benefit should be weighed, & glucose should be checked

periodically, " the investigators conclude .

14.%% ADA 3/12 Gut cells transformed into insulin factories T1 Though

insulin-producing [iP] cells can be made in a lab from embryonic stem cells

(SC), these are not yet ready for transplant because they do not release

insulin appropriately in response to glucose levels. When the team turned

off a gene (Foxo1) the progenitor cells [=an early descendant of a SC] also

generated IP cells. More cells were made when the gene was turned off early

in development, but IP cells were also made when the gene was turned off in

adult mice.. it could be possible to regrow IP cells in the GI tracts of our

pts, " Accili said. the new intestinal cells did release insulin in response

to blood glucose levels.. The key to turning the finding into a viable Rx

will be to find a drug that has the same effect on the GI progenitor cells

in people as knocking out the gene does in mice. " ..a new treatment for T1

needs to be just as safe as, & more effective than, insulin. Columbia U Med;

journal Nature Genetics.

15.%% M 3/6 T1DM Associated With Enterovirus [=a virus that lives in GI

tract] in Gut Mucosa Small-bowel mucosal biopsy [120pts] Enterovirus was

found in DM pts more frequently than in controls & was assoc with a clear

inflammation response in the gut mucosa.This finding opens new opportunities

for studying the viral etiology of T1. .In conclusion, we propose that

persistent enterovirus infection in gut mucosa may play a role in the

pathogenesis of T1. Gut mucosa may be an important virus reservoir from

which the virus can spread to the pancreas, which is very close & has common

lymphatic & vascu-lature networks. Also, the viral persistence in gut mucosa

may maintain chronic inflammation, which can promote islet autoreactivity

16.%% M 3/5 Risk Factors and Management of Paediatric Diabetic Retinopathy

Conclusions - Although clinical DR remains rare among paediatric pts with T1

& T2, regular monitoring for the appearance of complications is essential

given the progressive nature of the disease & chronic nature of the

underlying hyperglycaemia. The Internat Soc for Paediatric & Adolescent

Diabetes, suggests that annual screening for DR be conducted in pts aged 11

years after DM of 2 yrs duration & from age 9 with DM of 5 yrs' duration.

The single most important intervention remains prevention through adherence

to strict glycemic control achieved without inducing hypoglycaemic

complications. study was supported by Pfizer Inc. Br J Oph 2012;96(3):

17.%% MPD 3/14 H. Pylori Linked to Diabetes Marker Action Points : H. pylori

presence.. was associated with higher mean HbA1c levels. The results raise

the possibility that anti-H. pylori therapy may be used to help control or

prevent DM in pts with chronic H. Pylori infection. The bug that causes

ulcers may also play a role in the development of T2.. cross- sectional

analysis of two cohorts [7,417 pts] 2,403 who were Hpylori-positive had a

mean HbA1c level of 5.49%, vs with 5.40% among those who were not

colonized.The team cautioned that the study is cross-sectional & therefore

can't say anything about causality. findings need to be confirmed & more

study is needed - especially in the form of randomized trials.. Source: Chen

Y, Blaser MJ J Inf Dis 2012; 205:

18.%% 3/7 MNT Dark Chocolate Good For Those With Advanced Heart Failure [HF]

...a flavonoid - epicatechin, found in dark chocolate, enhanced mitochondria

structure in pts with advanced HF & T2. The team examined 5 extremely sick

pts with major damage to skeletal muscle mitochondria. Mitochondria are

structures that provide the energy a cell requires in order to move, divide,

& contract. Both HF & T2 impair these power cells, resulting in

abnormalities which cause decreased capacity such as difficulty walking even

short distances & shortness of breath. Each day for 3months, ptps ate dark

chocolate bars & a drink with a epicatechin content of abt 100 mg. The team

did biopsies of skeletal muscle before & after the Rx..The team will next

conduct a larger, placebo-controlled human trial in order to evaluate

whether [these subjects] improve their exercise capacity when given

epicatechin-rich cocoa. journal Clinical and Translational Science.

19.%% %%J AmBoard Fam Med.2012;25(1): Dietary fiber for the treatment of T2

: a meta-analysis. Purpose -to determine if an increase in dietary fiber

affects glycosylated hemoglobin (HbA1c) & fasting blood glucose in patients

with T2DM 15 randomized studies. Conclusion: Overall, an intervention

involving fiber supple-mentation for T2 can reduce fasting blood glucose &

HbA1c. This suggests that increasing dietary fiber in the diet of pts with

T2 is beneficial & should be encouraged as a disease management strategy.

20.%% MNT 3/15 Eye Disease As Marker Of Brain Health A new study at UCSF

suggests that screening for retinopathy, a disease of blood vessels in the

retina at the back of the eye, could serve as a marker for brain health,

after researchers found that women aged 65 & over with even a mild form of

the disease were more likely to have cognitive decline & related vascular

changes in the brain. Findings

suggest that a simple eye test could look for early signs of retinopathy, &

serve as a marker for cognitive changes linked to vascular disease. This

would allow for earlier diagnosis & treatments that potentially reduce the

progression of cognitive impairment to dementia. Retinopathy usually results

from T2 or high blood pressure (hypertension). Lead author Dr Haan,

said: " Early intervention might reduce the progression to full onset DM or

hypertension. " [511women;av age 69;10yr fup] during the follow-up, 7.6% of

the pts developed retinopathy, and on average, their scores on the cognition

tests were worse than the women who did not develop the eye disease. Brain

scans of the group showed that the women with retinopathy had more damage in

their brain blood vessels. they had 47% more ischemic lesions or holes in

the overall blood vessel structure, & 68% in the parietal lobe. Such lesions

are thought to be caused by high BP. Another feature that was more prominent

in the brain scans of the retinopathy group was more thickening of the white

matter tracks that transmit signals in the brain. However, retinopathy was

not linked to more brain atrophy, which is a hallmark of Alzheimer's

disease. Pub Mar/4 issue of Neurology

21.%%MP 3/22 Fraud Alert for People with Diabetes Office of Inspect Gen US

Depart Health & Human Services Criminals who plot to defraud the Government

and steal money from the American people have a new target: people with

diabetes. Although the precise method may vary, the scheme generally

involves someone pretending to be from the Gov, a DM association, or even

Medicare, calling you. The caller offers " free " diabetic supplies, such as

glucose meters, or DM test strips. The caller may also offer other supplies

such as heating pads etc in exchange for the beneficiaries' Medicare or

financial information, or confirmation of this type of personal info. You

may also receive items in the mail that you did not order. The call is a

scam. If you receive such a call, OIG recommends the following actions: 1.

Protect Your Medicare & Other Personal Information - Do not provide your

Medicare number or other personal information. Be suspicious of anyone who

offers free items or services & then asks for your Medicare or financial

information. These calls are not coming from Medicare or other similar

organizations. While the caller says the items are " free, " the items are

still billed to Medicare. Once your Medicare information is in the hands of

a dishonest person or supplier, you are susceptible to further scams. Alert

others about this scheme, and remind them not to provide strangers Medicare

numbers or other personal information. 2. Report the call to the OIG Hotline

at 1-800-HHS-TIPS or online at www.OIG.HHS.gov/fraud/hotline ..

22.%% Intern Med.2012;51(2) Gender differences in the control of

cardiovascular risk factors in patients with T2DM [8775pts] cross- sectional

analysis Conclusion: Women with DM have poorer control of main potentially

modifiable cardiovascular risk factors than men. This could contribute to

disparities in trends in CV mortality and it demands clinicians' and public

health awareness.

23.%%MPD 3/22 Medicare Turns Gimlet Eye on DME Drugs Vascular endothelial

growth factor (VEGF) inhibitors, such as ranibizumab (Lucentis) or

bevacizumab (Avastin), may improve vision in pts with diabetic macular edema

(DME), but more research on specific risks & benefits is needed, according

to a Medicare advisory panel. Nor is there enough evidence to support use of

one of these agents over any other in DME. Centers for Medicare & Medicaid

Services (CMS) called the meeting to help them decide whether to undertake a

formal Nat- ional Coverage Determination for anti-VEGF therapies in

DME. " It's not enough to say that these agents seem to work, " said committee

chair. Although laser of the retina has long been the standard of care for

treating DME, clinicians have been using VEGF inhibitors off-label for the

condition. At last year's ADA meeting, trials showed that Lucentis improved

vision in DME patients vs placebo. However, clinicians there said that

Avastin, was equally effective at a much lower price tag. Though both drugs

are made by Genentech, Lucentis injections can run $1,950 each while Avastin

costs $50 per shot. .The reports concluded that there appears to be a class

effect for VEGF inhibitors in DME. Macugen & aflibercept (Eylea)- are

FDA-approved for other indications & have been used off-label in DME..

24.%% M 3/26 Bariatric Surgery May Outrank Standard Diabetes Treatment ..up

to 23% of patients with morbid obesity also have T2 & Rx is particularly

challenging in these pts because insulin/other hypo- glycemic agents often

cause additional weight gain. [60pts] randomly assigned to Roux-en-Ygastric

bypass(RYGB), bilopancreatic diver-sion(BPD), or conventional Rx -

individualized meds, monitored diet & lifestyle interventions. Since trial

began, none of the patients in the medical group has entered remission,

whereas 95% in the BPD grp & 75% in the RYGB grp have entered & maintained

remission for the 2-year study period & were able to discontinue all DM

meds. Age, sex, preop BMI, duration of DM, & wt loss after surgery did not

predict DM remission. " These findings confirm that the effects of

bar-surgery on T2 may be attributed to the mechanisms of surgery rather than

the consequences of weight loss, " N Engl J Med. Pubonline Mar 26, 2012.

25.%% M 3/16 Statin Nonadherence High Among Patients With T2 .. Patients

with T2 who begin taking statins after they have started oral antidiabetic

drugs are more likely to discontinue statin treatment than those who start

receiving statins before their anti-DM drugs. [2072pts] authors say the

findings are " intriguing, " given that the 2 treatment types have " at least

comparable risks of bothersome side effects.. It is plausible that pts who

already used statins before starting oral anti- diabetics more often have

additional indications for initiating statins, such as [family history] &

this may " result in higher awareness of severity, " [see #1]

26.%% M 3/20 Diabetic retinopathy - A Team Approach DR affects about one

half of all people with DM & is the leading cause of vision loss & new-

onset blindness in Americans age 20-64. Fortunately, several prospective

clinical trials provide excellent data on the natural course of DR &

treatment strategies that are 90% effective in preventing severe vision

loss. In its earliest clinical stage, diabetic retinopathy is called

'nonproliferative' DR & is characterized by retinal vascular abnormalities,

such as microaneurysms & intraretinal hemorrhages. As diabetic retinopathy

progresses, the closure of retinal vessels results in ischemia (impaired

perfusion of retinal tissue). This ischemia is believed to stimulate the

production of vascular endothelial growth factor (VEGF) & other cytokine

mediators that can result in a transition to proliferative diabetic

retinopathy (PDR). PDR develops when new & abnormal blood vessels grow on

the inner surface of the retina. With sufficient duration of diabetes,

approximately 60% of pts will develop PDR; without intervention, nearly one

half of eyes with PDR will progress to profound vision loss. Increased

retinal vascular permeability [leaking] may result in retinal thickening

(edema) & lipid deposits (hard exudates). Known as " diabetic macular edema "

(DME), this can occur at any stage of DR.

%%Who Is at Risk for DR? Duration of DM & severity of hypergly-cemia are the

2 major risk factors. After 5 yrs, about 25% of patients with T1 have DR

increasing to 80% after 15yrs. Of pts with T2 with a known duration of

disease less than 5 yrs, 24-40% have DR. The prevalence increases to 53-84%

after 19 years of diabetes.

Severity of hyperglycemia is the key modifiable risk factor associated with

the development/progression of diabetic retinopathy, as shown in the

prospective landmark studies Diabetes Control & Complications Trial (DCCT) &

United Kingdom Prospective Diabetes Study (UKPDS).

Intensive management of elevated blood sugar & hypertension can

significantly slow the progression of diabetic retinopathy. Elevated serum

lipid levels also have been associated with the development of DR. The

effects of many other clinical factors (type of DM, renal disease, physical

inactivity etc..on the development & progression of DR have been studied,

with less definitive findings.

Treatments and Prognosis - The management of diabetic retinopathy requires

an understanding of the importance of general medical management & when to

consider laser therapies, intravitreal injection of medications,

& vitrectomy.

Medical Management - Control of CV risk factors is central to slowing the

progression of diabetic retinopathy. Maintaining near- normal glucose levels

& BP reduces the risk for & progression. The DCCT showed that

develop/progression of DR in pts with T1 can be delayed by maintaining

glucose concentrations in the near-normal range.After 3 yrs of intensive Rx

to reduce glucose levels in patients without retinopathy, the development of

any DR was reduced by 75% over the 9year study. Similar data indicating a

reduction in risk for progression of DR in T2 was demonstrated in the UKPDS

which also showed improved control of hypertension reduced progression of DR

by 34%.

%%Laser-Based Therapies

Laser photocoagulation has been a standard technique for treating diabetic

retinopathy since 2 landmark trials: the DR Study & Early Treatment of DR

Study (ETDRS). Panretinal laser is used to treat PDR, & it treats

neovascularization[development of new/abnormal vessels] of the [back of the

eye] by placing burns throughout the peripheral area. Appropriate panretinal

[laser] reduces the risk for severe vision loss by 50%. Focal

photocoagulation is used to treat DME & involves applying light, small-sized

burns to areas of leaking microaneurysms in the macula. The ETDRS

demonstrated that moderate vision loss can be reduced by more than 50% by

performing appropriate focal laser. The primary goal of Rx is to stabilize

visual acuity, because vision improves for only a minority of pts ..Some

medications may contribute to DME. In particular, glitazone [actos &

avandia] have been associated with DME.

Intravitreal Injections - More recent research has identified VEGF as a key

player in the pathogenesis of DME which is the major cause of visual

impairment in pts with DM. Multiple anti-VEGF drugs, including [lucentis,

avastin & aflibercept, are currently available for routine clinical use. 2

recent phase 3 randomized controlled trials demonstrated good efficacy of

ranibizumab in the treatment of DME.

Vitrectomy plays an important role in the management of patients with DR &

has been shown to increase vision-related quality of life in specific pts.

In PDR, the neovascular vessels are fragile & often accompanied by damaging

scar tissue. These vessels can bleed into the vitreous cavity of the eye,

causing vitreous hemorrhage obscuring vision; or scar tissues can distort &

detach the retina, causing tractional retinal detachment. These are the

primary indications for surgical intervention. - Management of diabetic

retinopathy requires a team approach. Primary care physicians play a

critical role in patients' eye health in the setting of diabetes mellitus.

Development & progression of diabetic retinopathy can be slowed by

optimizing pts' CV risk factors. Pts with DM should obtain yearly

comprehensive eye exams including detailed macula & peripheral evaluations.

Timely diagnosis & appropriate management can be 90% effective in preventing

severe vision loss from diabetic retinopathy. Medscape Ophthalmology C 2012

WebMD, LLC

27.%% 3/26 ADA New heart risk found for men with T2 T2 is a known risk