Assessing the Effect of Personalized Diabetes Risk Assessments During Ophthalmologic Visits on Glycemic Control

Aiello, Lloyd Paul; Ayala, Allison R.; Antoszyk, Andrew N.; Arnold-Bush, Bambi; Baker, Carl W.; Bressler, Neil M.; Elman, Michael J.; Glassman, Adam R.; Jampol, Lee M.; Melia, Michele; Nielsen, Jared S.; Wolpert, Howard

doi:10.1001/jamaophthalmol.2015.1312

Cited by 34 publications

(33 citation statements)

References 16 publications

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“…Furthermore, the primary health care physicians will need to be kept updated on the current DR screening and referral guidelines, ensuring early detection and prompt intervention for patients with VTDR. However, personalized education and structured interventions had recently been shown to have minimal effect on long‐term HbA1c control . This study suggests that HbA1c control still remains a substantive challenge in the real world, outside the confines of a clinical study.…”

Section: Major Public Health Challengesmentioning

confidence: 84%

“…However, personalized education and structured interventions had recently been shown to have minimal effect on long-term HbA1c control. 170 This study suggests that HbA1c control still remains a substantive challenge in the real world, outside the confines of a clinical study. Further research will be invaluable to explore more alternative and effective lifestyle interventions in optimizing the glycaemic controls for these patients.…”

Section: Major Public Health Challengesmentioning

confidence: 90%

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Diabetic retinopathy: global prevalence, major risk factors, screening practices and public health challenges: a review

Ting

Cheung

Wong

2016

Clinical Exper Ophthalmology

812

528

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Diabetes retinopathy (DR) is a leading cause of vision loss in middle-aged and elderly people globally. Early detection and prompt treatment allow prevention of diabetes-related visual impairment. Patients with diabetes require regular follow-up with primary care physicians to optimize their glycaemic, blood pressure and lipid control to prevent development and progression of DR and other diabetes-related complications. Other risk factors of DR include higher body mass index, puberty and pregnancy, and cataract surgery. There are weaker associations with some genetic and inflammatory markers. With the rising incidence and prevalence of diabetes and DR, public health systems in both developing and developed countries will be faced with increasing costs of implementation and maintenance of a DR screening program for people with diabetes. To reduce the impact of DR-related visual loss, it is important that all stakeholders continue to look for innovative ways of managing and preventing diabetes, and optimize cost-effective screening programs within the community.

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Section: Major Public Health Challengesmentioning

confidence: 84%

Section: Major Public Health Challengesmentioning

confidence: 90%

Diabetic retinopathy: global prevalence, major risk factors, screening practices and public health challenges: a review

Ting

Cheung

Wong

2016

Clinical Exper Ophthalmology

812

528

View full text Add to dashboard Cite

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“…The TetO model permits modulation of the degree of hyperinsulinaemia and hyperglycaemia, enabling reproduction of clinically relevant situations, such as glucose concentration fluctuations, which can trigger progression of diabetic retinopathy [42,43]. This model could also reproduce characteristics closer to those found in proliferative diabetic retinopathy or diabetic macular oedema, as well as other long-term effects, within a considerably shorter time than in other rodent models.…”

Section: Discussionmentioning

confidence: 99%

The TetO rat as a new translational model for type 2 diabetic retinopathy by inducible insulin receptor knockdown

et al. 2016

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Aims/hypothesis Although the renin-angiotensin system plays an important role in the progression of diabetic retinopathy, its influence therein has not been systematically evaluated. Here we test the suitability of a new translational model of diabetic retinopathy, the TetO rat, for addressing the role of angiotensin-II receptor 1 (AT1) blockade in experimental diabetic retinopathy. Methods Diabetes was induced by tetracycline-inducible small hairpin RNA (shRNA) knockdown of the insulin receptor in rats, generating TetO rats. Systemic treatment consisted of an AT1 blocker (ARB) at the onset of diabetes, following which, 4-5 weeks later the retina was analysed in vivo and ex vivo. Retinal function was assessed by Ganzfeld electroretinography (ERG). Results Retinal vessels in TetO rats showed differences in vessel calibre, together with gliosis. The total number and the proportion of activated mononuclear phagocytes was increased. TetO rats presented with loss of retinal ganglion cells (RGC) and ERG indicated photoreceptor malfunction. Both the inner and outer blood-retina barriers were affected. The ARB treated group showed reduced gliosis and an overall amelioration of retinal function, alongside RGC recovery, whilst no statistically significant differences in vascular and inflammatory features were detected. Conclusions/interpretation The TetO rat represents a promising translational model for the early neurovascular changes associated with type 2 diabetic retinopathy. ARB treatment had an effect on the neuronal component of the retina but not on the vasculature.

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“…It is not clear why the addition of personalized education during retinal ophthalmologic visits did not lead to a better metabolic control during the first year (protocol M, DRCR.net), although an extensive collection of leaflets and an individualized risk assessment were provided to patients [22]. Empowerment and activation will remain a key step in overcoming clinical inertia and improving the systemic management [23].…”

Section: Discussionmentioning

confidence: 99%

Limited Time from the Diabetes Patients' Perspective: Need for Conversation with the Eye Specialist

Marahrens

Ziemssen

Fritsche³

et al. 2016

Ophthalmologica

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Purpose: Facing the lack of time, busy retina consultants should be aware of how the patients would prefer that time is spent and whether they wish the specialist to talk more at the expense of other medical activities. Methods: 810 persons with diabetes were asked to divide the time of 10 min between examination, consultation and treatment when envisioning a real-life scenario of diabetic retinopathy (NCT02311504). Results: With the increasing duration of diabetes, patients wanted significantly more time for diagnostics (p = 0.028), while age was found to be associated with less time for treatment (p = 0.009). Female subjects tended to prefer only little more time for talking (p = 0.051) in comparison with males, who slightly favored therapy (p = 0.025). Conclusions: The large majority recognized the need for diagnostics in their allocation of time. If individual patients are confronted with the health care perspective of time constraints, this might improve the understanding of prioritization.

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Assessing the Effect of Personalized Diabetes Risk Assessments During Ophthalmologic Visits on Glycemic Control

Cited by 34 publications

References 16 publications

Diabetic retinopathy: global prevalence, major risk factors, screening practices and public health challenges: a review

Diabetic retinopathy: global prevalence, major risk factors, screening practices and public health challenges: a review

The TetO rat as a new translational model for type 2 diabetic retinopathy by inducible insulin receptor knockdown

Limited Time from the Diabetes Patients' Perspective: Need for Conversation with the Eye Specialist

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