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The randomized, controlled OpT2mise study was sponsored by Medtronic and conducted with participation from 331 patients, ranging in age from 30 to 75 years. Study findings showed that MiniMed insulin pumps safely provided significant, sustainable and reproducible improvements in glucose control in comparison to MDI.
Initial results of OpT2mise showed that after six months, people with insulin-requiring type 2 diabetes who used insulin pumps achieved better glucose control than those using MDI. The Diabetes Media Foundation is a 501(c)(3) tax-exempt nonprofit media organization devoted to informing, educating, and generating community around living a healthy life with diabetes. Please, complete the form with your suscription data.If you are a member of the Spanish Society of Cardiology, you can use the same login and password that you use to access the Society's website.
Diabetes mellitus, more commonly known as diabetes, is a condition of elevated blood sugar levels (hyperglycaemia) which can affect various organs, including the eyes. Type 1: results from a failure to produce adequate levels of insulin, often presenting in teenage years.
Type 2: most common type due to development of a resistance to insulin, usually affects people over the age of 45yrs. Diabetic retinopathy is the term used when the raised blood sugar damages the retina (image capturing tissue at the back of the eye).
Background retinopathy This is the earliest stage whereby high sugar levels weaken and damage the retinal blood vessels. Pre-proliferative retinopathy Also known now as "non-proliferative retinopathy", there are more advanced signs in the retinal circulation, with visible changes in the blood vessels suggestive of a restricted blood flow to the eye. Proliferative retinopathy This arises when the damaged retina releases growth chemicals which encourage new retinal blood vessels to grow (retinal neovascularisation). Proliferative diabetic retinopathy right eye with new blood vessels and pale scar tissue extending from the optic nerve above and below. Another newer approach to treat proliferative retinopathy is to block the chemical messengers which are responsible for the new blood vessel growth. In very advanced cases of proliferative diabetic retinopathy bleeding can occur into the jelly of the eye resulting in sudden loss of vision = vitreous haemorrhage or scar shrinkage from leaking blood vessels can cause a retinal detachment.
Diabetic maculopathy The macular is the central part of the retina and is responsible for detailed central vision eg reading, recognising faces.
Diabetic maculopathy can occur with any of the stages of retinopathy mentioned above ie background, pre-proliferative or proliferative retinopathy. Checking for diabetic retinopathy has become very much more standardised since the introduction of the NHS Diabetic Eye Screening Programme. Everyone on a general practitioners database with a diagnosis of diabetes, over the age of 12yrs, is invited to attend annually for retinal screening. Initial six-month study results comparing MiniMed insulin pump therapy to MDI were published in The Lancet in July 2014. It is more common in type 1 compared to type2 diabetes, but overall affects approximately 80% of people with diabetes once they have had the condition for more than 10 years.

Tiny bulges (called microaneurysms) occur in the blood vessel walls which can result in fluid (exudates) or blood (blot haemorrhages) leaking onto the retinal surface. In milder cases no treatment to the eye is required but more frequent monitoring for new blood vessel growth (retinal neovascularisation) is recommended. Although this may initially seem like a helpful solution to improve the blood supply to the retina, the new vessels are thin and fragile. Fluoroscein dye, injected into a vein in the arm, travels to the eye and highlights abnormal blood vessels by leaking out (bright area above and below the optic nerve). In both circumstances specialist vitreo-retinal surgery, usually a vitrectomy, is often required.
The term diabetic maculopathy is used when this important area is affected, usually secondary to leaking retinal blood vessels.
Laser photocoagulation is the traditional treatment but anti-VEGF agents and steroids eg: Ozurdex - dexamethasone intravitreal implant, are also proving to be extremely useful. This aims to reduce the risk of sight loss in people with diabetes by early detection and treatment. Pictures are taken which are looked at by photographers who have been trained to detect the signs of diabetic eye disease. Anyone with diabetes will automatically be offered an annual screening photograph, often in a mobile unit near their home.
Daryl Norwood Diabetes CasePresentationR.C is a 57-year-old man with Type 2 diabetes first diagnosed two years ago. Daryl Norwood Weight changes should be monitored to assess the need for more aggressive treatments or diet restriction. The OpT2mise study is the largest randomized controlled trial to compare the efficacy and safety of insulin pump therapy versus multiple daily injections (MDI) for poorly controlled type 2 patients.
Diabetic retinopathy is the commonest cause of severe sight impairment in the UK's working population.
This process often occurs "silently" and the patient is unaware, with no symptoms or change in vision. Lifestyle changes can be important to reverse the retinal signs eg: balanced diet, regular exercise, blood pressure and blood sugar control. Anti-VEGF drugs eg: Avastin, Lucentis, which are already established treatments for macular degeneration (see AGE RELATED MACULAR DEGENERATION section), are currently being trialled for use in diabetic eye disease. Another very serious sign of advanced diabetic eye disease is the development of new blood vessels on the iris, at the front of the eye, which results in raised eye pressure = rubeotic glaucoma. This "waterlogging" can occur silently without there being any symptoms or often the person affected will be aware of reduced vision in the eye. Although a national initiative the programme is delivered locally in line with set standards and protocols.
The result is usually available within 4-6 weeks and if anything significant is detected the patient will be seen by an ophthalmologist in Eastbourne, Bexhill or the Conquest Hospitals. The MDI group, which switched to insulin pump therapy after six months, experienced a similar reduction in A1C to the results seen in the original insulin pump group. No specific treatment is required but patients are encouraged to be strict with their blood sugar monitoring and control.

In severe cases laser treatment is applied to the retina to prevent new blood vessel growth. Additionally, at the end of the continuation phase, participants who switched from MDI to insulin pump showed a 19.0% reduction in total daily insulin dose, making it equivalent in both treatment arms.
In addition to its contributions to hyperglycemia, alcohol has a negative interaction on the drugs Metformin and Simvastatin that can cause liver toxicities.
To achieve adequate control of diabetes, lifestyle modifications are an important part of therapy. Dietary restrictions, increase in physical activity, and gradual weight loss will be more beneficial than taking medication, alone.
Body fat distribution, rather than overall adiposity, influences serum lipids and lipoproteins in healthy men independently of age. Yusuf S, Hawken S, Ounpuu S, Bautista L, Franzosi MG, Commerford P, et al; INTERHEART Study Investigators. Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study.
Globalization, coca-colonization and the chronic disease epidemic: can the doomsday scenario be averted? Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association. Toumilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, et al; Finnish Diabetes Prevention Study Group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss.
An Update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease From the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Effects of the cannabinoid-1 receptor blocker rimonabant on weight reduction and cardiovascular risk factors in overweight reduction and cardiovascular risk factors in overweight patients: 1-year experience form the RIO-Europe study. Efficacy and tolerability of rimonabant in overweight or obese patient with type 2 diabetes: a randomised controlled study.
Efficacy and safety of the weight-loss drug rimonabant: a meta-analysis of randomised trials.
Malmberg K, Ryden L, Wedel H, Birkeland K, Bootsma A, Dickstein K, et al; DIGAMI 2 Investigators.
Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): effects on mortality and morbidity.

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