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Application of Mobile and Wearable Technology in Data Collection for Ophthalmology
Published in Ching-Yu Cheng, Tien Yin Wong, Ophthalmic Epidemiology, 2022
Ashwin Venkatesh, Pradeep Ramulu
Regular screening and monitoring of risk factors, glycemic control, and prompt diagnosis form an important strategy to prevent or limit the progression of DR. The Diabetes Control and Complications Trial (DCCT) has shown that optimal glucose control in diabetes slows the onset and worsening of complications such as DR.24 There is therefore a need for monitoring in the remote setting to measure and reinforce appropriate glycemic control. Traditional devices (e.g., Accu-Chek) involved pricking the finger with a lancet and placing a drop of blood on a disposable test strip that is read with a digital meter.
Immunosuppressants, rheumatic and gastrointestinal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
The results of the diabetes control and complications trial (DCCT), which compared intensive insulin therapy (in the form of a multiple-injection regime or pump therapy) with conventional twice daily therapy, demonstrated intensive insulin treatment led to improvement in glycaemic control and reduced risk of the complications of diabetes in adolescents [17]. This has led to a move away from conventional twice-daily regimen towards multiple-injection therapy and pump therapy [18]. In the intensively treated arm of DCCT, there was an increased risk of severe hypoglycaemia and excessive weight gain, particularly in the girls. However, as experience with multiple-injection regimen and pump therapy grows, improvements in control are now being achieved without unwanted side effects [19].
Fibrinolysis and Diabetes Mellitus
Published in Pia Glas-Greenwalt, Fibrinolysis in Disease Molecular and Hemovascular Aspects of Fibrinolysis, 2019
Michael W. Mansfield, Peter J. Grant
The pathogenesis of the vascular complications of diabetes is not entirely clear, although evidence from the recently presented Diabetes, Control and Complications Trial indicates quite unequivocally that improved metabolic control in type 1 diabetic patients leads to a reduction in the incidence of microvascular complications. In type 2 diabetes the situation is rather more complex, with strong support for the hypothesis that the relative hyperinsulinemia present in this condition contributes to macrovascular disease in addition to the effects of hyperglycemia.
Automated Microaneurysm Counts on Ultrawide Field Color and Fluorescein Angiography Images
Published in Seminars in Ophthalmology, 2021
Abdulrahman Rageh, Mohamed Ashraf, Alan Fleming, Paolo S. Silva
In the Diabetes Control and Complications Trial (DCCT) study, MAs were counted in all the seven standard ETDRS fields on CI and only on fields 1 F and 2 F for FA images.16 Most of the eyes in the study had either no DR or mild NPDR. MA counts were only directly compared between CI ETDRS field 2 and FA field 2 F. Unlike ETDRS field 2, FA field 2 F is centered at 0.5-disc diameters temporal to the center of the macula. While comparing FA 2 F to CI ETDRS field 2, 16% of eyes were found to have MAs on FA but none on CI, which contrasts with 2% detected on CI and not on FA. Direct comparison of total counts was difficult given that the graders counted up to 5 MAs in each field, after which counts were designated as ≥6 MAs. Of note, FA images detected 64 eyes with ≥6 MA counts in field 2 F compared to only 31 eyes on CI. On CI, only 8/320 had a more severe MA count compared to FA.
Treatment strategies for hypertension in patients with type 1 diabetes
Published in Expert Opinion on Pharmacotherapy, 2020
Alexandra Katsimardou, Konstantinos Imprialos, Konstantinos Stavropoulos, Alexandros Sachinidis, Michalis Doumas, Vasilios G. Athyros
The Diabetes Control and Complications Trial (DCCT), a landmark clinical trial that examined the effects of intensive versus conventional insulin treatment in T1DM people, excluded hypertensive patients at randomization. Participants were frequently examined for the development of hypertension during the DCCT trial and its’ successor, the Epidemiology of Diabetes Intervention and Complications (EDIC) study. During a 15.8-year follow up period, 630 of 1441 participants, 96.5% of whom were white, developed hypertension. Although the incidence of hypertension was similar between the two study groups during the DCCT trial, participants that received intensive treatment had a reduction in the risk of incident hypertension by 24% during the EDIC study follow-up compared to those assigned to conventional treatment, highlighting the importance of glycemic control and metabolic memory in the development of hypertension in T1DM people. However, the benefits of intensive insulin treatment on the incidence of hypertension were partially mitigated by greater weight gain observed in this group. Older age, male sex, family history of hypertension, greater BMI and albuminuria were independently associated with the development of hypertension [21].
Trends in glycaemic control and morbidity over 10 years in patients with type 1 diabetes mellitus at Inkosi Albert Luthuli Central Hospital
Published in Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2020
Muhammed Zaid Hoosen, Imran M Paruk, Fraser J Pirie, Ayesha A Motala
The Diabetes Control and Complications Trial (DCCT) established that the risk of microvascular complications (new retinopathy, albuminuria and neuropathy) in subjects with type 1 diabetes (T1D) was significantly reduced with intensive therapy (IT) (median HbA1c 7.2%; 55 mmol/mol), compared with conventional treatment (CT), (median HbA1c 9.1%; 76 mmol/mol).1 The DCCT findings supported the improved outcome with better glycaemic control in T1D shown in earlier studies.2–4 In the follow-up study to the DCCT, the Epidemiology of Diabetes Interventions and Complications (EDIC) trial, despite the difference in HbA1c being negligible between the two groups by year five, the original IT group had a lower risk of micro- and macro-vascular complications as long as 18 years after the commencement of EDIC (and 28 years after starting the DCCT).5,6 This supported the concept of metabolic memory/legacy effect and the long-term benefit of stringent glycaemic control. This was confirmed in a recent systematic review and meta-analysis of 12 studies, which showed that when compared with CT, IT had a significantly lower risk of developing retinopathy (6.2 vs. 23.2%), nephropathy (16.3 vs. 28.4%) and neuropathy (4.9 vs. 13.9%).7