Controlling glycated hemoglobin prevent diabetic retinopathy

2019 ◽  
Vol 7 (2) ◽  
pp. 125-137
Author(s):  
Philip Patel ◽  
Alan Craig

The overall number of patients with Diabetic retinopathy (DR) will continue to increase in parallel with the increasing global pandemic of type 2 diabetes. Diabetic retinopathy is the most common cause of visual loss in United Kingdom. A systematic medline search was conducted initially using the following keywords: clinical trials, diabetic retinopathy, hyperglycemia, macular edema, visual loss. Relevant abstracts and computer links to these abstracts were reviewed and a preliminary list of possible articles from this search was compiled. Next, the original articles from the list were retrieved and evaluated. Based on landmark of data, DR have become preventable by controlling hyperglycemia targeting HbA1c<7.0%, with other multifactorial treatment.

2019 ◽  
Vol 7 (2) ◽  
pp. 125-137
Author(s):  
Philip Patel ◽  
Alan Craig

The overall number of patients with Diabetic retinopathy (DR) will continue to increase in parallel with the increasing global pandemic of type 2 diabetes. Diabetic retinopathy is the most common cause of visual loss in United Kingdom. A systematic medline search was conducted initially using the following keywords: clinical trials, diabetic retinopathy, hyperglycemia, macular edema, visual loss. Relevant abstracts and computer links to these abstracts were reviewed and a preliminary list of possible articles from this search was compiled. Next, the original articles from the list were retrieved and evaluated. Based on landmark of data, DR have become preventable by controlling hyperglycemia targeting HbA1c<7.0%, with other multifactorial treatment.


Author(s):  
Fazilat Arifovna Bakhritdinova ◽  
◽  
Urmanova Firuza Makhkamovna ◽  
Nabiyeva Iroda Fayzullayevna ◽  
◽  
...  

In this review, the authors performed an overview of the literature on early diagnosis, treatment and methods for predicting the outcomes of the disease. According to regional endocrinological dispensaries, for 2020 registered SD for RUZ 277 926., Of these, type 1 type 18178, SD 2 type 259,748 patients. At the same time, the number of patients with DR was 2020 g of 83,632 persons, of which 73690 persons with di type 2. The real number of patients exceeds a registered 10 times, over the past 18 years, the number of patients with a rope in Uzbekistan increased by 2.4 times (according to the Ministry of Health of RUZ). The prevalence of others among patients of the CD is 10-90%, according to some specialists, up to 97-98.5%. For example, the frequency of development dr in India is lower than among Europeans and Americans, and among the black population more frequent than among the white. According to the WHO research group, it was revealed that the highest frequency of DR was detected in Oklahoma (76.4%), Zagreb (73.1%) and Hong Kong (58.1%). The lowest frequency was observed in Tokyo (29.7%). The prevalence of DR in patients in China amounted to 47.4%, and the frequency of DR in Poland was 31.4%.


2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Manuela de Lucca Michels ◽  
Ana Clara d’Acampora ◽  
Camila Sartor Spivakoski ◽  
Priscila Nobre Dantas Mattje ◽  
Bruna da Silva Réus ◽  
...  

Abstract Introduction: Physical activity plays an important role in glycemic control in patients with type 2 diabetes, but overall adherence rate is low. For patients not able or willing to engage in regular physical exercise, whole body vibration comes as a potential alternative. Objective: To evaluate the effect of 28Hz whole body mechanical vibration on glycemic control and other metabolic parameters in patients with type 2 diabetes. Methods: 24 adults with type 2 diabetes on oral antidiabetic agents, with a baseline HbA1c between 6.5 and 9.0%, were randomized into two groups. The control group (CG) was advised to adopt lifestyle modifications, and the intervention group (IG) received the same orientations and used a 28 Hz whole body vibrating platform daily for 20-30 minutes during 12 weeks. Results: Data from 22 patients were analyzed (one from each group was excluded). Baseline characteristics of both groups were similar except for triglycerides, which were higher in the CG (111.8±39.9 mg/dL vs. 188.9±68.8 mg/dL, p&lt;0.05). After 12 weeks, there was a significant reduction in glycated hemoglobin in the IG (7.69±0.49 vs. 7.17±0.77%, p&lt;0.05), not observed in the CG (8.05±0.98 vs. 7.92±1.07%, p=0.52). A non-significant trend for weight loss in IG was observed (78.14±10.47 vs. 77.14±11.08Kg, p=0.069). There were no significant differences between the groups regarding fasting blood glucose or any other clinical and biochemical variables analyzed. Conclusion: This study suggests an improvement in glycated hemoglobin at 12 weeks with the use of the 28Hz vibration platform in patients with type 2 diabetes. However, further studies with a larger number of patients and longer follow-up are needed to better define the role of whole body vibration as an adjuvant in glycemic control.


Author(s):  
Arash A Nargesi ◽  
Gini P Jeyashanmugaraja ◽  
Nihar Desai ◽  
Kasia Lipska ◽  
Harlan Krumholz ◽  
...  

Abstract Background Sodium glucose transporter‐2 (SGLT‐2) inhibitors and glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) effectively lowered cardiovascular risk in large clinical trials for patients with type 2 diabetes at high risk for these complications, and have recommended by guidelines. To evaluate the contemporary landscape in which these recommendations would be implemented, we examined the use of these medications according to clinical guideline practice. Methods and Results In the National Health and Nutrition Examination Survey for 2017‐2018, we defined compelling indications for SGLT‐2 inhibitors by the presence of atherosclerotic cardiovascular disease (ASCVD), heart failure, or chronic kidney disease (CKD), and for GLP‐1RAs by the presence of established or high risk ASCVD, based on large clinical trials that have been incorporated in guideline recommendations of the American College of Cardiology (ACC) and American Diabetes Association (ADA). We then evaluated utilization of these medications among patients with physician‐diagnosed type 2 diabetes. All analyses incorporated complex survey design to produce nationally representative estimates. A total 1104 of 9254 sampled individuals had type 2 diabetes, representing 10.6% (95% CI 9.7‐11.6) of the US population or 33.2 million adults nationally. Of these, 52.6% (47.7‐57.5) had an indication for SGLT‐2 inhibitors, 32.8% (28.8‐37.2) for GLP‐1RAs, and 26.6% (22.2‐31.7) for both medications. During 2017‐2018, 4.5% (2.4‐8.2) were treated with SGLT‐2 inhibitors and 1.5% (0.7‐3.2) with GLP‐1RAs. ASCVD, heart failure, or CKD were not independently associated with SGLT‐2 inhibitor or GLP‐1RA use in patients with diabetes. Conclusions Despite a large number of patients being eligible for guideline recommended cardiorenal protective therapies, there are substantial gaps in the use of SGLT‐2 inhibitors and GLP‐1RAs, limiting their public health benefits.


2018 ◽  
Vol 11 (4) ◽  
pp. 5-13
Author(s):  
L. A. Mineeva ◽  
L. I. Balashevich ◽  
A. A. Baranov ◽  
L. B. Shubin ◽  
A. V. Kabanov

Purpose: To assess the changes in eye optics and visual functions depending on the level of blood sugar and glycated hemoglobin (HbA1c) in insulin-dependent type 2 diabetes mellitus (IPSD) patients with excessive body weight, who receive long-term insulin therapy.Material and methods. 32 patients (64 eyes), of which 84.4 % were women and 15.6 % men, with insulin-dependent diabetes mellitus (IPSD) but without severe general diabetic complications or concomitant eye pathology were monitored ophthalmologically for 3 years. The average duration of insulin therapy was 6 years. The average age of the patients was 60.94 ± 1.04 years; average weight, 89.1 ± 14.8 kg; average height, 163.8 ± 7.3 cm; average body mass index, 31.3 ± 4.8 kg/m2. The level of blood glucose level was determined daily with individual Accu-Check and/or OneTouch select glucometers, supplemented by scheduled monthly examinations with an endocrinologist. The level of glycated hemoglobin (HbA1c) was determined once every 3–6 months. Vision was measured by international requirements for patients with diabetes using the ETDRS (Early Treatment Diabetic Retinopathy Study Research Group) system with an ESV-3000 device. To assess lens transparency, the international Lens Opacities Classification System III (LOCS III) was used. Glycaemia level was monitored by the patients themselves with the help of individual blood glucose meters and by endocrinologists in scheduled monthly checkups. HbA1c level was measured once every 3 to 6 months.Results. Over the follow-up period, the subjective visual acuity slightly deteriorated. The anterior segment remained practically unchanged, the vitreous body showed a destruction increase, the state of the retina remained stable and conformed to that of nonproliferative diabetic retinopathy. The glucose level showed a significant drop, while the level of glycated hemoglobin HbA1c practically remained constant. The LOCS III criteria showed an increased clarity of the lens nucleus (NO), a worse transparency of cortical layers (C) deteriorated; the NC nucleus colour and P parameters of the posterior subcapsular layer practically remained the same. Conclusions. According to our data, during the development of diabetic cataracts in patients with type 2 IPSD, NO of the lens changes first followed by C changes (they become worse). With the normalization of glycemia level, diabetic retinopathy does not progress, the NO of the lens can improve, and the NC and P do not change. Normalization of glycemia is not a retarding factor for the already existing changes in C or the state of the vitreous. HbA1c is a marker and trigger for possible lens changes in patients with type 2 diabetes and prolonged insulin therapy. HbA1с is effective for tracking the dynamics of changes in the eye in these patients. The fact that the positive correlation of HbA1c and C at follow-up start changed to the negative correlation toward the end of the study indicates a disruption in lens state compensation and does not cancel the negative dynamics of state C even with a decrease in the level of HbA1c.


2015 ◽  
Vol 22 (2) ◽  
pp. 159-165
Author(s):  
Mónika Deák ◽  
Monica Lasca ◽  
Ioan Andrei Vereşiu

AbstractBackground and Aims. There is no unanimous opinion regarding the risk factors associated with progression of diabetic retinopathy (DR). We have done a retrospective analysis of risk factors and clinical features associated with DR progression.Material and Methods. This analysis included consecutive patients with moderate non-proliferative or severe retinopathy between December 1, 2013 and May 31, 2014 who had at least two eye examinations before that period. We have collected demographic, clinical and lab data.Results. 51.28% of patients were diagnosed with moderate non-proliferative diabetic retinopathy (NPDR), 24.68% with severe NPDR and 21.05% with proliferative diabetic retinopathy. In 82.16% of cases, DR had progressed. The risk factor correlated with DR progression in the whole group was anemia; hypertension, anemia and diabetes duration were risk factors in type 1 and smoking status at diabetes diagnosis in type 2 diabetes. Total cholesterol, triglycerides, diabetes control and presence of diabetic renal disease were positively but not statistically significant correlated with DR progression.Conclusions. In our study the risk factors correlated with DR progression were hypertension, anemia and diabetes duration in type 1, respectively smoking at diabetes diagnosis in type 2 diabetes. Glycemic goals were achieved in a small number of patients.


2012 ◽  
Vol 4 ◽  
pp. CMT.S7283
Author(s):  
Maneesh V Udiawar ◽  
Stephen C Bain

Type 2 diabetes is a progressive disease characterized by decline in β-cell function and insulin resistance. The development of liraglutide, a glucagon-like peptide 1 (GLP-1) receptor agonist, has been shown in clinical trials to be an effective drug with beneficial effects on β-cell function and improved glycemic control, without the side effects of weight gain and hypoglycemia that frequently limit the use of oral anti-diabetic drugs. Furthermore, its prolonged half-life makes it suitable for once daily administration. Liraglutide is demonstrated to be an effective agent in combination with commonly used oral antidiabetic drugs such as metformin and sulphonylureas, with a significant number of patients achieving their glycemic targets without hypoglycemia. In this review, the results from clinical trials utilizing liraglutide in combination with metformin or sulphonylurea are summarized with regards to efficacy and safety.


2021 ◽  
Vol 9 (3) ◽  
pp. 14-20
Author(s):  
S.S. Lytvynenko

Background. In patients with type 2 diabetes mellitus (DM2) and diabetic retinopathy (DR), vitreous hemorrhage is one of the most common complications after pars plana vitrectomy (PPV) and ranges from 12 to 63 %. The study was aimed to analyze the frequency and causes of the development of hemophthalmia after surgical treatment of diabetic retinopathy in patients with type 2 diabetes mellitus. Materials and methods. The study involved 118 patients (118 eyes) with type 2 diabetes mellitus and DR, who were divided into three groups: the first group — with initial non-proliferative DR (NPDR; 28 eyes), the second group — with moderate to severe NPDR (49 eyes) and the third group — with proliferative DR (РDR; 41 eyes). The age of patients ranged from 44 to 84 years, men — 52 (44.1 %), women — 66 (55.9 %). The study did not include the patients with severe PDR and tractional retinal detachment or massive hemorrhage that required silicone oil tamponade of the vitreal cavity. All patients underwent closed subtotal vitrectomy 25G with panretinal laser photocoagulation and tamponade with an air-gas C3F8 mixture or the operation was completed with BSS plus solution injected into the vitreal cavity. Patients were examined based on a standard protocol of clinical and ophthalmological studies. Results. Within three months after vitrectomy, 33.1 % of patients developed postoperative hemophthalmia, which happened more often in РDR (39.0 %). In most cases (71.4 %), the preoperative hemophthalmia in РDR was accompanied by the development of postoperative hemophthalmia. Gender did not significantly impact the incidence of postoperative hemophthalmia. Patients with hemophthalmia were 9.3 years older than patients without hemophthalmia (p < 0.001), which affected both men and women equally. Patients with hemophthalmia had a longer history of type 2 diabetes mellitus compared to those wi­thout it (three years; p = 0.007), which was confirmed for men: men with hemophthalmia had a longer history of type 2diabetes mellitus than those without hemophthalmia (seven years; p = 0.026). Elevated blood levels of glycated hemoglobin (HbA1c) and a high score on the ETDRS scale are the risk factors for the development of postoperative hemophthalmos in patients with РDR. Conclusions. A study within three months after PPV in patients with DR and type 2 diabetes mellitus found that 33.1 % of patients developed postoperative hemophthalmia, which occurred more often in РDR (39.0 %). In most cases (71.4 %), the preoperative hemophthalmos in РDR was accompanied by the development of postoperative hemophthalmia. The risk factors for postoperative hemophthalmia after vitrectomy in type 2 diabetes mellitus and DR were age and diabetes duration, and for РDR — the presence of preoperative hemophthalmia, increased blood glycated hemoglobin, and a high score on the ETDRS scale.


Author(s):  
Наталия Александровна Полушкина ◽  
Жанна Владимировна Вечеркина ◽  
Кристина Павловна Кубышкина ◽  
Татьяна Павловна Калиниченко

Рост числа больных сахарным диабетом 2 типа в мире носит характер эпидемии. Сахарный диабет 2-го типа - это нарушение углеводного обмена, который характеризуется комбинацией резистентности к инсулину и неадекватной реакции инсулина. Степень гипергликемии при этом типе сахарного диабета достаточна, чтобы привести к функциональным и патологическим изменениям в органах-мишенях, но эта гипергликемия еще не вызывает клинических симптомов и может существовать в течение длительного периода времени до момента выявления диабета. Заболевание до определенного момента носит скрытый характер, что обусловливает позднее выявление и, соответственно, несвоевременное лечение. Это приводит к высокой частоте сосудистых осложнений, ранней инвалидизации и смертности больных. Однако, в течение этого периода, можно путём определения глюкозы плазмы натощак и после пероральной нагрузки глюкозой обнаружить нарушение углеводного обмена. Изучение гликемической изменчивости - является важным компонентом системного подхода к контролю качества и компенсации сахарного диабета. Показатели гликемии натощак и гликемии через два часа после нагрузки проводили с целью подтверждения диагноза - сахарный диабет. Уровень гликированного гемоглобина HbAIc считается золотым стандартом в оценке гликемического статуса пациентов с сахарным диабетом. Гликемический контроль - это метод диагностики сахарного диабета 2-го типа снижения риска развития осложнений диабета, с целью предотвращения, задержки, замедления или остановки развития поздних осложнений. Было доказано, что гликированный гемоглобин оказался достоверен, продемонстрировав корреляцию со средними гликемическими значениями, а также отразил среднюю концентрацию глюкозы в крови за предыдущие два-три месяца. В этой связи становится актуальным повышение качества проводимых скрининговых обследований населения по выявлению нарушений углеводного обмена. Использование теста на определение гликированного гемоглобина HbA1c представляется наиболее информативным и экономически обоснованным. Вместе с этим ключевое значение приобретает выбор способа измерения гликогемоглобина (HbA1c). Он должен быть стандартизован по референсной методике - высокоэффективной жидкостной хроматографии, в соответствии с результатами исследований DCCT и UKPDS The increase in the number of patients with type 2 diabetes in the world has the character of an epidemic. Type 2 diabetes mellitus is a violation of carbohydrate metabolism, which is characterized by a combination of insulin resistance and an inadequate insulin response. The degree of hyperglycemia in this type of diabetes mellitus is sufficient to lead to functional and pathological changes in target organs, but this hyperglycemia does not yet cause clinical symptoms and can exist for a long period of time until diabetes is detected. The disease is latent up to a certain point, which causes late detection and, accordingly, untimely treatment. This leads to a high frequency of vascular complications, early disability and mortality of patients. However, during this period, it is possible to detect a violation of carbohydrate metabolism by determining fasting plasma glucose and after oral glucose loading. The study of glycemic variability is an important component of a systematic approach to quality control and compensation of diabetes mellitus. Indicators of fasting glycemia and glycemia two hours after exercise were carried out to confirm the diagnosis - diabetes mellitus. The level of glycated hemoglobin HbAic is considered the gold standard in assessing the glycemic status of patients with diabetes mellitus. Glycemic control is a method of diagnosing type 2 diabetes mellitus, reducing the risk of developing complications of diabetes, in order to prevent, delay, slow down or stop the development of late complications. It was proved that glycated hemoglobin was reliable, demonstrating a correlation with average glycemic values, and also reflected the average concentration of glucose in the blood over the previous two to three months. In this regard, it becomes urgent to improve the quality of screening surveys of the population to identify disorders of carbohydrate metabolism. The use of a test for the determination of glycated hemoglobin HbA1c seems to be the most informative and economically justified. At the same time, the choice of the method of measuring glycohemoglobin (HbA1c) becomes of key importance. It should be standardized according to the reference method - high-performance liquid chromatography, in accordance with the results of DCCT and UKPDS studies


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