Journal ArticleDOI
The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus.
Diabetes Control,David M. Nathan,Saul M. Genuth,John M. Lachin,Patricia A. Cleary,O Crofford,Matthew M. Davis,Larry Rand,Carolyn Siebert +8 more
TLDR
Intensive therapy effectively delays the onset and slows the progression of diabetic retinopathy, nephropathy, and neuropathy in patients with IDDM.Abstract:
Background Long-term microvascular and neurologic complications cause major morbidity and mortality in patients with insulin-dependent diabetes mellitus (IDDM). We examined whether intensive treatment with the goal of maintaining blood glucose concentrations close to the normal range could decrease the frequency and severity of these complications. Methods A total of 1441 patients with IDDM--726 with no retinopathy at base line (the primary-prevention cohort) and 715 with mild retinopathy (the secondary-intervention cohort) were randomly assigned to intensive therapy administered either with an external insulin pump or by three or more daily insulin injections and guided by frequent blood glucose monitoring or to conventional therapy with one or two daily insulin injections. The patients were followed for a mean of 6.5 years, and the appearance and progression of retinopathy and other complications were assessed regularly. Results In the primary-prevention cohort, intensive therapy reduced the adjusted mean risk for the development of retinopathy by 76 percent (95 percent confidence interval, 62 to 85 percent), as compared with conventional therapy. In the secondary-intervention cohort, intensive therapy slowed the progression of retinopathy by 54 percent (95 percent confidence interval, 39 to 66 percent) and reduced the development of proliferative or severe nonproliferative retinopathy by 47 percent (95 percent confidence interval, 14 to 67 percent). In the two cohorts combined, intensive therapy reduced the occurrence of microalbuminuria (urinary albumin excretion of > or = 40 mg per 24 hours) by 39 percent (95 percent confidence interval, 21 to 52 percent), that of albuminuria (urinary albumin excretion of > or = 300 mg per 24 hours) by 54 percent (95 percent confidence interval 19 to 74 percent), and that of clinical neuropathy by 60 percent (95 percent confidence interval, 38 to 74 percent). The chief adverse event associated with intensive therapy was a two-to-threefold increase in severe hypoglycemia. Conclusions Intensive therapy effectively delays the onset and slows the progression of diabetic retinopathy, nephropathy, and neuropathy in patients with IDDM.read more
Citations
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2014 ESC/EACTS guidelines on myocardial revascularization.
Stephan Windecker,Philippe Kolh,Fernando Alfonso,Jean-Philippe Collet,Jochen Cremer,Volkmar Falk,Gerasimos Filippatos,Christian W. Hamm,Stuart J. Head,Peter Jüni,A. Pieter Kappetein,Adnan Kastrati,Juhani Knuuti,Ulf Landmesser,Günther Laufer,Franz-Josef Neumann,Dimitrios J. Richter,Patrick Schauerte,Miguel Sousa Uva,Giulio G. Stefanini,David P. Taggart,Lucia Torracca,Marco Valgimigli,William Wijns,Adam Witkowski +24 more
TL;DR: In this paper, the Euroscore guidelines for acute coronary syndromes are presented. But they do not specify the risk stratification of stents, angina, and stable coronary artery disease.
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Malnutrition and clinical outcomes: the case for medical nutrition therapy.
TL;DR: This article identifies many well-conducted, published studies that support the findings that health outcomes of malnourished patients can be improved and that overall use of resources can be reduced by nutrition counseling, oral diet and oral supplements, enteral formula delivered via tube, and parenteral nutrition support via central or peripheral line.
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Toward Defining the Threshold Between Low and High Glucose Variability in Diabetes
Louis Monnier,Claude Colette,Anne Wojtusciszyn,Sylvie Dejager,Eric Renard,Nicolas Molinari,David R. Owens +6 more
TL;DR: A %CV of 36% appears to be a suitable threshold to distinguish between stable and unstable glycemia in diabetes because beyond this limit, the frequency of hypoglycemia is significantly increased, especially in insulin-treated subjects.
Journal ArticleDOI
An ingestible self-orienting system for oral delivery of macromolecules.
Abramson Alex G,Ester Caffarel-Salvador,Khang Minsoo,David Dellal,David Silverstein,Yuan Gao,Morten Revsgaard Frederiksen,Andreas Vegge,Frantisek Hubalek,Jorrit Jeroen Water,Anders V. Friderichsen,Johannes Josef Fels,Rikke Kaae Kirk,Cody Cleveland,Cody Cleveland,Joy Collins,Siddartha Tamang,Alison Hayward,Tomas Landh,Stephen T. Buckley,Niclas Roxhed,Niclas Roxhed,Ulrik Lytt Rahbek,Robert Langer,Giovanni Traverso,Giovanni Traverso +25 more
TL;DR: Inspired by the leopard tortoise’s ability to passively reorient, an ingestible self-orienting millimeter-scale applicator (SOMA) is developed that autonomously positions itself to engage with GI tissue and delivers active pharmaceutical ingredient plasma levels comparable to those achieved with subcutaneous millipost administration.
Journal ArticleDOI
Is there still a role for total pancreatectomy
Michael W. Müller,Helmut Friess,Jörg Kleeff,R. Dahmen,Markus Wagner,Ulf Hinz,Daniela Breisch-Girbig,Güralp O. Ceyhan,Markus W. Büchler +8 more
TL;DR: Global health status of TP patients was comparable to that of pp-Whipple patients, although a few single QoL items were reduced, and TP should no longer be generally avoided, because it is a viable option in selected patients.
References
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Journal ArticleDOI
The Wisconsin Epidemiologic Study of Diabetic Retinopathy: II. Prevalence and Risk of Diabetic Retinopathy When Age at Diagnosis Is Less Than 30 Years
TL;DR: In a population-based study in southern Wisconsin, 996 insulin-taking, younger-onset diabetic persons were examined using standard protocols to determine the prevalence and severity of diabetic retinopathy and associated risk variables.
Journal ArticleDOI
The Wisconsin epidemiologic study of diabetic retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years.
TL;DR: The severity of retinopathy was found to be related to longer duration of diabetes, younger age at diagnosis, higher glycosylated hemoglobin levels, higher systolic BP, use of insulin, presence of proteinuria, and small body mass.
Journal ArticleDOI
The effect of long-term intensified insulin treatment on the development of microvascular complications of diabetes mellitus.
TL;DR: Long-term intensified insulin treatment, as compared with standard treatment, retards the development of microvascular complications in patients with insulin-dependent diabetes mellitus.
Journal ArticleDOI
Effect of two years of strict metabolic control on progression of incipient nephropathy in insulin-dependent diabetes
TL;DR: 36 patients with insulin-dependent diabetes mellitus who had 'Albustix'-negative urine but raised urinary albumin excretion were randomly assigned to either remaining on conventional insulin treatment or continuous subcutaneous insulin infusion and followed up for 2 years.
Journal ArticleDOI
Prognosis of diabetics with diabetes onset before the age of thirty-one. I. Survival, causes of death, and complications
TL;DR: Clinical manifestations of late diabetic complications were considerably less common in patients who were still alive after more than forty years of diabetes than in Patients who died before their fortieth year of diabetes.
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