many articles

August 31, 2012

1.%% 7/30 New Gov Commission Could Streamline DM Care An act has been

introduced in the Senate that would ensure a thorough review of the US gov's

approach to DM care, an effort experts hope will ..slow the pace of this

epidemic. If approved, the Nat Diabetes Clinical Care Com Act will create a

public–private sector commission to recommend improvements to care. [it]

will include healthcare professionals as well as pt advocates & reps of fed

agencies involved with DM care. The group is to make recommendations to US

Sec Health & Human Services & Congress. The act is endorsed by [includes]

Pediatric Endocrine Society, AmerAcad Oph, & the ADA.

2.%% M 7/30 Improvement in Outcomes of Clinical Islet Transplanta-tion:..

Conclusions: The CITR shows improvement in primary efficacy & safety

outcomes of islet transplantation in recipients who received transplants in

2007–2010 vs those in 1999–2006, with fewer islet infusions & adverse events

per recipient. Diabetes Care. 2012;35(7):

3.%% M 7/30 Does Insulin Therapy Prevent Adverse Cardiovascular Events in

Early Diabetes? Abstract - Insulin glargine conferred no benefit in large

trial. [12,500pts;6yrs] Pts were randomized to either nightly insulin or

standard care. Results provide strong evidence that early addition of basal

insulin confers no CV benefit in pts with pre-DM or pts whose T2 is well

controlled on no meds or a single oral agent.

4.%% NatureNews 7/30 Digital pills make their way to market

The sensors made by (Proteus Digital Health in Redwood City) are the first

ingestible devices approved by the FDA. To some, they signify the beginning

of an era in digital medicine. The sand-particle sized sensor consists of a

minute silicon chip containing trace amounts of magnesium & copper. When

swallowed, it generates a slight voltage in response to digestive juices,

which conveys a signal to the surface of a person’s skin where a patch then

relays the info to a mobile phone belonging to a healthcare-provider.

Medicines that must be taken for years, such as those for [includes] DM, are

top candidates, says company co-founder. “This way doctors can prescribe a

different dose or a different medicine if they learn that it’s not being

taken appropriately.” Proponents of digital medical devices predict that

they will provide alternatives to doctor visits, blood tests, MRIs & CAT

scans...

5.%% M 7/31 ?-3 Fatty Acids for Cardiovascular Disease Prevention in

Patients With Diabetes Many pts take ?-3 fatty acid supplements for primary

or secondary prevention of adverse CV events. However, recent trials have

cast doubt on the effectiveness of [these] [12500pts;T2;6yrs] death from CV

causes -was 9% in both groups.

6.%%DiabMed2012;29(7)Fasting plasma glucose [FPG]6-12 wks after starting

insulin glargine predicts likelihood of treatment success. [1036pts T2]

Conclusions - FPG remaining greater than 10 mmol/l after 6-12 wks of

glargine Rx indicates that reaching target HbA1c 7% is unlikely & calls for

individualized attention to consider further therapeutic options.

7.%% M 8/2 T2DM in Lean Individuals: A Different Disease? Summary

Genome-wide association studies have identified approx 50 genetic loci assoc

with T2 in lean & obese pts [17818pts; 73369controls] Data from these 2

studies showed a new association in the lean cases between a genetic variant

and T2 & also that 29 of 36 other known T2 risk loci were more strongly

assoc with lean than with obese cases. This difference in direct genetic

susceptibility vs environmental inter-actions may inform the strategies for

intervention. ..in lean cases of DM, accurate knowledge of the genetic

underpinnings may indicate specific medications that correct the physiologic

imbalance driving disease. PLoS Genet. 2012;8:

8.%% M 8/10 FDA Approves Ranibizumab for Diabetic Macular Edema

" DM is a major public health issue in our country, & all pts with diabetes

are at risk of developing DME " FDA said. Ranibizumab was previously approved

for Rx of neovascular (wet) AMD & macular edema after retinal vein

occlusion. The advisory com. reviewed data from 2 phase 3, double- masked,

RCT [759 pts;36m] there was an average increase in BCVA of 12.4 letters in

the 0.3-mg grp, 11.2 ltrs in 0.5-mg grp, & 4.5 ltrs in the sham group.

Common adverse effects of ranibizumab include sub-conjunctival hemorrhage,

eye pain, increased intraocular pressure, and floaters.

9.%%ADA Obese T2 patients had a lower risk of heart attack after bariatric

surgery Both obesity & T2 increase the risk of heart disease [607pts;13yrs]

S Romeo & team found that weight loss surgery was assoc with a reduced risk

of heart attack. (hazard ratio of 0.56). But this surgery appeared to have

little impact on stroke risk. Surgery lowered the risk of heart attack most

in pts with higher levels of cholesterol & triglycerides (blood fats) at the

beginning of the study. BMI (measure of body fat using ht & wt), was not

related to the outcome of surgery. Pub- Aug 2012 Diabetes Care

10.%% M 8/6 Race-Based Differences in Retinopathy Risk & HbA1c Levels " A

growing body of evidence shows that HbA1c levels are consistently higher

among black than white persons” write authors. [3812 non-Hispanic wh & blk

Amer pts age 40 yrs + ] cross-sectional study. After adjustment for age,

sex, hypertension, BMI, & family history of DM, they found, the prevalence

of retinopathy significantly increased among black pts at an HbA1c level of

5.5- 5.9% vs an HbA1c of 6.0-6.4% for whites. Black pts had higher fasting

glucose levels, a higher BMI, & were more commonly diagnosed with DM.

" Longitudinal studies with larger samples are warranted to determine whether

a lower threshold of HbA1c should be considered for the diagnosis of DM in

this population. " Ann Intern Med. 8/6/2012

11.%% M 8/6 More Evidence That Exercise Helps Fight DM Two new studies have

found that staying active will cut death risk in T2DM. The first

study[6,000pts] found that those who were moderately physically active had

the lowest risk of death. Leisure- time physical activity, i.e: biking,

gardening, housework & walking were also assoc with lower risk of death. The

second study of 32,000 men, found that wt training increased muscle mass &

improved insulin sensitivity. Previous studies have reported that aerobic EX

is of major importance ..that men who weight train, on a regular basis,

could reduce their risk for T2 by up to 34%. Men who lifted weights for just

up to 59 min/wk reduced their risk for DM by 12%. Men who did more than

150min of aerobics plus at least 150 min of weight training/wk had a 59%

lower risk for T2. Source Harvard School PubHealth, release, 8-06-12

12.%% M 7/27 ..Combination Treatment With Sitagliptin and Metformin in T2DM

[150pts;52wk] Analysis was done with baseline tests of [includes] fasting

glucose, insulin, C-peptide,?-cell function & insulinogenic index (IGI)

[ratio of insulin to glucose]. Results- mean HbA1c significantly decreased

from 8·7 to 7·2, IGI increased signifi-cantly Conclusion These results

suggest that drug-naïve [not taking DM meds yet] T2 pts with low ?-cell

function would benefit the most from early initial combo Rx sitagliptin &

met. Clin Endo 2012;77(2)

13.%% M 7/30 Reduced Insulin Exocytosis* in Human Pancreatic ?-Cells With

Gene Variants Linked to T2 * exocytosis [=cell excretes/ discharges

material] The team studied human islets from DM & non-DM donors. They

identified 4 risk alleles that associate with impaired ?-cell exocytosis.

These findings give new insights on the physiology of T2 that may open up

ways of finding subgroups of pts who would benefit from Rx specifically

14.%% ADA 8/7 Neutrophils- A type of immune system cell plays a key role in

the development of T2 Neutrophils, normally attack bacteria & other foreign

invaders, but they also secrete a protein (neutrophil elastase) that

promotes insulin resistance. The team at UCSD found this protein impairs

insulin signalling. Removing [it] from obese mice fed a high- fat diet

improved their insulin sensitivity, the study showed.

15.%% MP 8/7 Normal-Weight People With T2 Have Higher Death Risk: People who

were normal-wt when diagnosed, have more than twice the risk of dying from

heart disease & other causes than their over -wt peers with DM. " Overweight

& obesity confers certain protective effects in end-stage renal disease &

heart failure. It's called the obesity paradox, author said but she added

that being overwt/obese is far more harmful than protective overall. Extra

weight is assoc with the development of many diseases, such as T2, heart

disease & some cancers. [5 long-term studies-2600pts] data adjusted for

[includes] waist circumference, smoking, BP, & cholesterol levels... it may

be that the genetic profile in thinner pts who develop T2 may be different-

also may be that some doctors don't treat T2 in thinner pts as aggressively

as they do in heavier ones. 5-15% of people w T2 are normal-wt - She

recommended EX -- particularly resistance training -- as a good way for

[this group] to lower their BS.J AmMed Ass 8/8/12

16.%% MPD 8/8 Vaccine May Help in T1DM An immunotherapy that stimulates

tumor necrosis factor (TNF) is promising as a therapy for T1. In a small

study Bacillus Calmette-Guerin (BCG) vaccine killed disease-causing

autoimmune cells & improved insulin sensitivity. The findings suggest that

BCG or other stimulators of host innate immunity may have value in the Rx of

long-term DM. BCG causes production of TNF, that kills the autoimmune T

lymphocytes that destroy insulin- secreting pancreatic beta cells. TNF, at

high doses, causes systemic toxicity.So the team used an FDA- approved

vaccine that can induce TNF by triggering the immune response. The study

included pts with long-standing T1. [57pts;16 controls;20wks] 6 pts received

injections of either BCG vac or placebo. D Faustman & team assessed

insulin-auto-reactive T cells & regulatory T cells (Tregs) as well as

C-peptide levels, a marker of insulin sensitivity. They found that all of

the pts who got the BCG vac had increases in dead insulin- auto-reactive T

cells. The vac appeared to improve insulin sensitivity, with significant

increases in C-peptide levels for 2 vac recipients. The team concluded that

the vaccine, at low doses appears safe & well tolerated, & that it lessens

the advanced auto-immune process underlying T1 by stimulating TNF which

selectively kills only disease- causing cells. Future trials should

investigate higher doses or more frequent BCG administration. Ca Source:

Faustman DL, et al " Proof-of-concept, randomized, controlled clinical trial

of [bCG] for treatment of long-term [T1] " PLoS One 2012.

+ 16B %%- M 8/9 Reuters - Human Study Re-Ignites Debate Over Controversial

DM 'Cure' A controversial experimental cure for T1 using a TB vaccine

invented nearly a century ago, appeared to temporarily vanquish the disease

in a handful of pts, according to a report from a scientist long criticized

by her peers. Other DM researchers criticized it for going beyond the

evidence in its claims about what caused the observed effects. If the

findings do hold up, however, they would mean that the generic (BCG)

vaccine, in use since 1921, can regenerate insulin-secreting cells in the

pancreas. " We found that even low doses of the vac could transiently reverse

T1.. " Dr. F said. The effect lasted for about one week. " Our measure- ments

showed that autoimmune T cells that destroy the islet cells died, & we saw

evidence that insulin production was restored. " Other DM experts have

doubts. " There is a bit of magical thinking here, " said D Accili Columbia U

.. The idea that BCG wipes out autoimmune cells " is totally unproved. " The

study is nevertheless within the mainstream of current efforts to cure DM ,

said cellular immunologist R Clynes Berrie Center,who was not involved in

the research. " Folks had presumed that by the time pts had overt diabetes,

all their islet cells had been destroyed, We now know there are preserved

islet cells many years out. The presumption is, if you can get rid of the

inflamm, autoimmune response, the islet cells could regenerate. " Faustman's

research on lab mice, begun in the 1990s, suggested that one way to get them

to regenerate was with tumor necrosis factor. TNF is difficult to obtain

commercially, but the BCG vaccine increases the body's production of it. By

2006, other scientists - including some who had attacked Dr. F's claims -

had replicated key findings of her mouse studies, laying the foundation for

the clinical trial. 3 pts with long standing DM had 2 injections of BCG, 4wk

apart. 3 others received saline injections. In 2 of the 3 BCG pts levels of

islet- attacking T cells fell. Dead autoimmune cells were released into the

blood-stream, a hint that TNF was killing them as intended.A measure of

insulin production rose. The only placebo pt with similar results had become

infected with the Epstein-Barr virus, which also triggers production of TNF.

The restored insulin produc-tion lasted only a week In the next trial for

which Dr. F is recruiting, she plans to give more frequent BCG shots. She

has already faced significant challenges to her theory. The Juvenile DM

Resear Found rejected her funding requests & circulated a 2003 letter from 2

of her colleagues at Harvard Med School, casting doubt on her work &

apologizing to diabetics for " having their expectations cruelly raised " by

stories about her research. Reaction to this study was not much better. " The

paper shows that BCG is assoc with a transient improvement in a couple of

pts, but it's hard to conclude that TNF is the causative factor, " said

Columbia's Dr. Clynes. " It's certainly interesting & worth further

investigation, " said JDRF Chief Ex. " But it's really important to be careful

about how we interpret early results " Curing T1DM may finally be within

reach, " but it will be a marathon, not a sprint. " Dr. F's team says the

study was funded " by philanthropic grants only. " Reuters Health Information

17.%% MPD 8/9 Statin Benefits Offset Diabetes Risk In this analysis of the

Jupiter trial, cardiovascular benefits of statin Rx for primary prevention

outweighed the risk of developing DM [17603pts; 2yrs] rosuvastatin reduced

rate of MI, stroke, hospitalization for unstable angina, arterial

revascularization, or CV death by 44%. In this analysis pts were divided

into 2 grps -- those with at least one of 4 major risk factors for DM

(metabolic syn, impaired fasting glucose, obesity, or Hb1C over 6%) & those

with none of those risk factors. " A major take-home message.. is that all

pts on a statin who have major risk factors for DM need to be informed of

the risk, monitored regularly for hyperglycemia, & advised to lose weight &

take regular physical EX to mitigate the emergence of DM, " JUPITER funded by

AstraZeneca.

18.%% M 8/10 Severity of Diabetes & Accelerated Cognitive Aging

Summary - goals of this prospective cohort study were to examine whether ..

DM is assoc with increased risk for cognitive decline & whether poor

glycemic control among elderly adults with DM is related to worse cognitive

performance. [3069pts;10yrs] At baseline & selected intervals pts were

evaluated for DM status & also completed the Modified Mini-Mental State Exam

(3MS) & Digit Symbol Substi-tution Test (DSST).Compared to pts without DM,

those with DM had lower baseline scores (3MS: 88.8 vs 90.9; DSST:32.5 vs

36.3).Even after multivariate adjustment, HbA1c level was assoc with lower

av mean cognitive scores among those with DM. Results suggest that among

well-functioning older adults, DM & poor glucose control are assoc with

worse & greater decline in cognitive function. Severity of DM may increase

the likelihood of accelerated cognitive aging. The underlying mechanisms may

include hyperglycemia as well as increased risk for renal disease,

depression, stroke, hypertension, hyperlipidemia, & CVD, each of which may

hinder cognitive function. Additional research should address the effects of

early diagnosis & Rx of DM, & of maintaining optimal glucose control, on the

risk of developing cognitive dysfunction. Yaffe K; ArchNeur2012 June 18.

19.%% M 8/10 Life Expectancy Has Improved With Childhood T1DM For children

diagnosed with T1, life expectancy has increased, to a 15-year improvement

from a 1950-1964 study to a 1965-1980 study. The article was based on the

Diabetes Complications (EDC) study of childhood-onset <17 yrs for the year

of diagnosis (1950-64 390 pts) & (1965-80 w 543pts] Mortality was assessed

up to 12-31-09. Death occurred in 60.8% of pts in the earlier time-frame, vs

16.2% of the pts in the 1965-80 time-frame. Results support the need for

insurance companies to update their analysis of the life expectancy of

children with T1, since the current weighting is based on earlier, outdated

estimates. pub 7/30/12 in Diabetes R ,U Pittsburgh. Ca

20.%% M 8/13 Pain & Other Symptoms Common in Patients With DM

[13,171 pts T2; mean age 60] 41.8% reported having acute pain & 39.7%

chronic pain. In addition, 24.6% had fatigue, 23.7% neuropathy, 23.5%

depression, 24.2% insomnia, & 15.6% had physical/ emotional disability. " Our

study suggests that pts with DM would also benefit from palliative care

services over the disease course & in conjunction with aggressive disease

management, " they conclude. R Sudore, UCSF J Gen Intern Med. 8/2/12

21.%% ADA Mini-epidemics of T1DM appear to be occurring among Australian

children every 5 yrs. The 25 yr study found that T1, a condition that occurs

when the body's immune system seems to spontaneously attack & kill the cells

that produce insulin, has also been increasing by more than 2% per year. One

co-author said the reason for the increase & the cyclical pattern, was not

understood. " .. There are probably multiple triggers, including

environmental factors such as viruses & toxins. ..the increases in allergies

at the same time may reflect similar underlying causes. " The team found the

pattern in West Aus. to be " almost identical " to a pattern found in north

England with very different demographic & climatic conditions. He said the

peaks could be caused by cycles in which viruses are dominant, similar to

those with cold & flu viruses, where different strains are common each year.

Research is also complicated by the fact that 80% of children whose parents

have T1 will not develop [it].

22. %% ADA 8/14 Stress & DM Stress is often blamed or associated with a

number of health issues.. A UCSF team found that a molecule (TXNIP) is

intimately involved with inflammation that can result in the death of the

beta cells in the pancreas..that this molecule " takes stress & makes it

worse. " Each beta cell (like all cells) has a structure (organelle or

" little organ " ) the endoplasmic reticulum, [ER] which serves as a processing

center.When the ER in beta cells are stressed, a protein-interleukin-1

(IL-1) initiates inflamm, which in turn leads to the destruction of beta

cells. The team proposed if you eliminate TXNIP from the process, you should

be able to protect the beta cells. An indication that this concept is viable

was seen when they bred mice without the protein with mice susceptible to

DM. The offspring of these mice did not develop DM because their beta cells

were protected. Another team in Brazil discovered that specific forms of

TXNIP were significantly assoc. with DM & hypertension. The authors noted

that their findings " suggest that genetic variation in the TXNIP gene may

act as a 'common ground' modulator of both: DM & hyper-tension. " These &

other studies on TXNIP point to an important role for this protein in stress

& DM. Results of the UCSF study suggest that inhibiting the protein TXNIP

may protect beta cells in people, which in turn could delay the onset of DM.

.. Ferreira NE et al. Athero-sclerosis 2012 Mar; Lerner AG et al.Cell

Metabolism 2012 Aug 8; 16(2)

23.%% M 8/17 t Generic Actos [pioglitazone] Receives FDA Approval Use of the

drug should be coupled with diet & EX.Pioglitazone comes with a boxed

warning that states the drug can cause or exacerbate heart failure...

Consequently, clinicians should monitor pts when they start the drug or

switch to a higher dose. In addition, using [it] for more than 1 year might

be linked to an increased risk for bladder cancer, according to the drug's

label. Adverse events most commonly reported include cold-like symptoms,

headache, sinus infection, muscle pain, and sore throat.

24.%% NatRevEndo 8, 504 Sep 2012 Heart is target of autoimmune attack after

myocardial infarction in patients with T1DM MI in people with T1 leads to a

'runaway' autoimmune response that specifically targets cardiac tissue,

Harvard researchers suggest. They showed persistent presence of

autoantibodies against the cardiac tissue- specific protein myosin-6

(MyHC-a) in the serum of pts with T1 who have experienced such a cardiac

event.

25.%% 8/15 Automated System Controls Overnight Glucose Levels in T1DM The

Medtronic Portable Glucose Control Sys (PGCS) consists of 2 subcutaneous

glucose sensors, a control algorithm in a Black- berry phone, Bluetooth

radiofrequency translator & insulin pump. [8 pts adolesents-young

adult;16nights] glucose values remained between 3.9 -8 mmol/L 85% of the

time, compared to just 47% on open-loop control. " Further study is necessary

to determine the optimum fault detection settings to maximize pt safety yet

minimize disruption to the operation of the closed-loop system. " equipment

provided by Medtronic. Diabetes Care 2012. Reuters Health

26.%% M 8/17 Tight Glycemic Control Linked to Hip Fractures in Elderly With

T2 Researchers found a three-fold increase in the odds of hip fracture for

HbA1c below 6% vs levels above 8%. For HbA1c 6-7 % the odds were doubled.

Longitudinal studies are needed to confirm the link between fractures & BS

control. " We believe that older pts with DM should still receive optimal

control (HbA1C of < 7%..)as long as they are not experiencing hypoglycemia

secondary to Tx,.. use of insulin & sulphonylureas are well known to cause

hypo. However, meds such as metformin & acarbose were protective, which may

be due to (their) ability to lower glucose levels without causing hypo. " Dr.

Puar said adding that Rx should be individualized. [558pts;av age 77].. Dr.

Schwartz noted that in a recent meta-analysis HbA1c was positively

correlated with bone density. J Am Geriatri Soc 2012

27.%% M 8/23 Walking or other light exercise after meals may reduce glucose

levels by more than half in both healthy people & T1. " Minimal activity

sustained for 30 min (walking 0.7 miles in 33m) lowers post-meal glucose

concentrations. Such activity has little or no risk for almost everybody, "

said Y Kudva, Mayo Clinic. [24pts T1 or cntrls;3 days;4nights] In total, the

subjects walked for 5-6hrs every day at 1.2 mph, for roughly 3.5-4.2 miles)

in each 24 hour period. 4.5 hrs after eating healthy people had a 113%

increase in glucose levels after inactivity compared to when they walked.

The DM pts had 145% higher glucose after inactivity compared to when they

walked. other activities such as washing dishes after a meal could have

similar effects to walking, the team suggests " In general, walking improved

glucose after about 10m with the improvement lasting until 5m after such

activity ceased. " Diabetes Care 2012.

28.%%M 8/27 Results of Treating DM Patients With Insulin Glargine & PUFAs:

Treating ptss with dysglycemia [abnormal lipid levels] at high risk for CVD

with polyunsaturated fatty acids (PUFAs) failed to halt the progression of

atherosclerosis as assessed by carotid intima- media thickness, while

treatment with insulin glargine in the same patient pop showed a trend

toward benefit. These are the conclusions of the (GRACE) trial presented at

the Euro Soc Cardiology 2012 Con- gress.. " [1091pts;5yrs] N Engl J Med

2012;367: Abstract

29.%% M 8/28 Linagliptin for T2DM Rev of the Pivotal Clinical Trials

Pts with T2 frequently require multiple Rx to effectively control

hyperglycemia.. Linagliptin is a recently approved oral anti-DM drug that

acts by inhibiting the enzyme dipeptidyl peptidase-4 (DPP-4). Unlike other

DPP-4 inhibitors, linagliptin is excreted chiefly via the enterohepatic

system, [liver to intestine] & can be used in pts with renal or hepatic

impairment. Conclusion - The efficacy & safety of linagliptin once daily for

improving glycemic control in adults with T2 has been shown in these 4 RCT

pivotal trials. When used alone or in combination with other commonly used

therapies for T2, linagliptin provided clinically meaningful reductions in

fasting glucose & HbA1c, significantly increasing the odds of reaching HbA1c

targets. In addition, [it] was well tolerated & had low rates of hypo

30.%% M 8/30 Cardiovascular Events in Patients With DME Micro and

macrovascular complications in DM stem from chronic hyperglycemia & are

thought to have overlapping pathophysiology. The aim of this study was to

investigate the incidence rate of hospitalized myocardial infarctions (MI)

and cerebrovascular accidents (CVA) in pts with diabetic macular edema (DME)

compared with DM patients without retinal diseases. retrospective cohort

study [3519 w DME;10557 without] Conclusion - Event rates of MI or CVA were

higher in pts with DME than in diabetes controls. DME may occur at any stage

of diabetic retinopathy (DR) & is the leading cause of mod vision loss in

adults of working age. Micro-vascular complications, like DR and DME, are

associated with progressive or uncontrolled DM. CV events, such as MI or

CVA/stroke, are known macrovascular complications of DM. ..This presents an

opportunity for risk communication between ophthalmologists & their diabetic

2012 BioMed Central, Ltd.

31.%% M Sex differences in the association between plasma copeptin & T2

Vasopressin plays a role in glucose homeostasis and inflammation. The aim of

this study was to evaluate the usefulness of copeptin, a precursor of

vasopressin, for prediction of future T2 [4,063 women & 3,909 men;7.7

years.] Conclusions: The association of plasma copeptin with the risk of

developing DM was stronger in women than in men. Plasma copeptin alone, &

along with existing biomarkers (glucose, hs-CRP and UAE), significantly

improved the risk prediction for diabetes in women. PreMedline

Identifier:22526609

%% Abbreviations-acronyms fup-follow up; pt - patient/participant ;

DM - diabetes Mellitus; T1- type 1 DM;T1A -autoimmune T1; T2 - type 2; DME -

diabetic macular edema;DR - DM retinopathy; BS/BG- blood sugar/glucose;

HA1C, glycated hemoglobin A1C; BP -blood pressure; CVD - cardio-vascular

disease; IR- insulin resistance; OCT-optical coherence tomography; BCVA -

best corrected visual acuity; RYGB- Roux-en-Y gastric bypass; RCT

-Randomized controlled trial; ADA - Am Diab Ass;J- Joslin DMCenter; M-

Medscape Web MD; MA- Medline Abstract, MP- Medline Plus; MPD - Med Page

Today; NEI - Nat Eye Institute;SciA-Scientific Amer. Definitions via online

Medical dictionaries. Disclaimer, I am a BSN RN but not a diabetic or

diabetic educator. Assistant Editor: Cam Acker, 50yr DM survivor. Reports

excerpted unless otherwise noted. [translations/explanations by thl] This

project is done as a courtesy to the blind/visually impaired & diabetic

communities. Dawn Wilcox RN BSN Coordinator The Health Library at Vista

Center; an affiliate of the Stanford Hospital Health Library. contact above

e-mail or thl@...

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