Teleretinal Imaging Improves Detection of Diabetic Retinopathy in Low Resource Setting

MedicalResearch.com Interview with:

Thulasiraj RavillaExecutive Director – LAICO &Director – OpeationsAravind Eye Care SystemTamilnadu, India 

Mr. Thulasiraj

Thulasiraj Ravilla
Executive Director – LAICO &
Director – Opeations
Aravind Eye Care System
Tamilnadu, India 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Diabetic Retinopathy (DR) is a visual consequence of diabetes and various other studies have reported that in India, 10% to 30% of adults with diabetes have DR, with higher rates found in older people and urban areas. Undetected DR leads to vision loss and eventually blindness. Thus early identification of DR is critical to initiate appropriate treatment to reduce the rate of vision loss.

Conventional approaches of requesting diabetologists to refer patients with diabetes to an ophthalmologist has been ineffective due to compliance issues, both by the diabetologists and the patients. Similarly screening through outreach eye camps have not been found to be effective in India and other developing countries owing to inadequate eye care resources. Teleretinal screening for Diabetic Retinopathy is increasingly being used in India. Evidence from randomized clinical trials on the benefits of teleretinal screening is limited. Whatever evidence is there are from high income countries, which often have little relevance to developing countries.

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FDA Approves EYLEA (aflibercept) To Treat All Stages of Diabetic Retinopathy, With Two Dosing Options

MedicalResearch.com Interview with:

Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. Illustration depicting diabetic retinopathy

Illustration depicting diabetic retinopathy


Robert L. Vitti, MD, MBA
Vice President and Head, Ophthalmology
Regeneron Pharmaceuticals

Dr. Vitti discusses the recent announcement that the FDA has approved EYLEA to treat all stages of diabetic retinopathy.

MedicalResearch.com: Can you provide additional background on this approval? Would you briefly explain diabetic retinopathy and it’s impact on patients?

Response: The FDA has approved EYLEA (aflibercept) Injection to treat all stages of diabetic retinopathy (DR). DR is the leading cause of blindness among working-aged American adults. Approximately 8 million people live with DR, a complication of diabetes characterized by damage to the blood vessels in the retina (per 2010 data).

The disease generally starts as non-proliferative diabetic retinopathy (NPDR) and often has no warning signs or symptoms. Over time, NPDR often progresses to proliferative diabetic retinopathy (PDR), a stage in which abnormal blood vessels grow on the surface of the retina and into the vitreous cavity, potentially causing severe vision loss.

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Drivers with Diabetic Neuropathy May Need Assistance Controlling Accelerator Pedal

MedicalResearch.com Interview with:
foot-neuropathyMonica Perazzolo

Research Centre for Musculoskeletal Science and Sports Medicine
School of Healthcare Science, Faculty of Science and Engineering,
Manchester Metropolitan University, Manchester, UK
Department of Biomedical and Neuromotor Sciences
University of Bologna, Bologna, Italy 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our research on motor control in diabetes focussed on the effect of diabetic peripheral neuropathy on driving. Drivers with diabetic peripheral neuropathy showed a less well controlled use of the accelerator pedal and sometimes larger, faster steering corrections needed to stay in lane when driving a simulator compared to healthy drivers and people with diabetes but no neuropathy.

Despite these negative findings, an important result is that drivers with diabetic peripheral neuropathy demonstrated an improvement in their driving with practice. 

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Small Increased Risk of Diabetes with Common Drug for Prostate Enlargement

MedicalResearch.com Interview with:

Professor Ruth Andrew PhDChair of Pharmaceutical EndocrinologyUniversity/BHF Centre for Cardiovascular ScienceQueen's Medical Research InstituteUniversity of Edinburgh

Dr. Andrew

Professor Ruth Andrew PhD
Chair of Pharmaceutical Endocrinology
University/BHF Centre for Cardiovascular Science
Queen’s Medical Research Institute
University of Edinburgh 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our research group has been interested for a number of years in how stress hormones (called glucocorticoids) influence the risk of heart disease and diabetes. Glucocorticoids help us control stress and regulate how the body handles its fuel, for example the carbohydrate and fat we eat. However exposure to high levels of glucocorticoids, can increase the risk of diabetes, obesity and high blood pressure.

We studied men with prostate disease who took 5α-reductase inhibitors, because over and above the beneficial actions of these drugs in the prostate, they also slow down inactivation of glucocorticoids. We had carried out some short term studies with the drugs in humans and found that they reduced the ability of insulin to regulate blood glucose. Therefore in the study we have just published in the BMJ, we examined how patients receiving these drugs long-term responded and particularly we were able to show that over an 11 year period that there was a small additional risk of developing type 2 diabetes, the type of disease common in older people, compared with other types of treatments. Continue reading

Metformin More Effective For Weight Loss Maintenance Than Lifestyle Alone

MedicalResearch.com Interview with:
Kishore M. Gadde, MD, Professor
Fairfax Foster Bailey Endowed Chair in Heart Disease Prevention
Medical Director, Clinical Services
Pennington Biomedical Research Centre
Baton Rouge, LA 70808 

MedicalResearch.com: What is the background for this study?

Response: Around 20 years ago, the Diabetes Prevention Program, DPP, enrolled 3,234 adults with excess body weight and impaired glucose tolerance. The idea was to compare the efficacy of either an intensive lifestyle intervention or metformin relative to placebo in preventing diabetes. Over approximately 3 years, both lifestyle and metformin were effective, but lifestyle intervention was better for weight loss as well as in reducing the risk of diabetes. After the blinded treatment phase ended, the researchers continued to follow this cohort in their originally randomised groups.  Continue reading

Most Diabetes Apps Do Not Provide Real Time Decision Support (yet)

MedicalResearch.com Interview with:

Associate Professor Josip CarMD, PhD, DIC, MSc, FFPH, FRCP (Edin)​Associate Professor of Health Services Outcomes Research,​Director, Health Services Outcomes Research Programme and DirectorCentre for Population Health SciencesPrincipal Investigator, Population Health & Living Laboratory

Prof. Car

Associate Professor Josip Car
MD, PhD, DIC, MSc, FFPH, FRCP (Edin)​
Associate Professor of Health Services Outcomes Research,​
Director, Health Services Outcomes Research Programme and Director
Centre for Population Health Sciences
Principal Investigator, Population Health & Living Laboratory 

MedicalResearch.com: What is the background for this study?

Response: In 2018, almost 8% of people with diabetes who owned a smartphone used a diabetes app to support self-management. Currently, most apps are not regulated by the US Food and Drug Administration (FDA). We downloaded and assessed 371 diabetes self-management apps, to see if they provided evidence-based decision support and patient education.  Continue reading

Acetaminophen and Stroke Risk in Diabetic Nursing Home Patients

MedicalResearch.com Interview with:
Philippe Girard, MD,

Gérontopôle de Toulouse, CHU Toulouse
Toulouse, France

MedicalResearch.com: What is the background for this study?

Response: The idea for this study came about in 2016 when a systematic review assessing acetaminophen’s adverse event (AEs) profile came out with results suggesting increased mortality and morbidity (Paracetamol: not as safe as we thought? A systematic literature review of observational studies, PMID: 25732175).

Pr Yves Rolland had collected data from his IQUARE study (Improving the Quality of Care of Long-Stay Nursing Home Residents in France, PMID: 26782872) including all prescriptions from over 6000 nursing home residents and all their medical history over an 18 month follow-up period.

We thought it would be a good idea to assess the safety profile of acetaminophen on this geriatric population.  Continue reading

Insulin Resistance Characterizes a Subset of Schizophrenia Patients

MedicalResearch.com Interview with:

Prof Sabine Bahn MD PhD MRCPsych FRSBCambridge Centre for Neuropsychiatric Research

Prof. Bahn


Prof Sabine Bahn MD PhD MRCPsych FRSB

Cambridge Centre for Neuropsychiatric Research

Jakub Tomasik, PhDDepartment of Chemical Engineering and Biotechnology

Dr. Tomasik

Jakub Tomasik, PhD
Department of Chemical Engineering and Biotechnology
University of Cambridge

 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Schizophrenia patients are at increased risk of impaired glucose metabolism, yet the comorbidity between the two conditions cannot be fully explained by known risk factors such as obesity, smoking, stress or antipsychotic medication. Previous family and genome-wide studies have suggested that the co-occurrence between schizophrenia and impaired glucose metabolism might be due to shared genetic factors, as exemplified by increased risk of diabetes in first-degree relatives of schizophrenia patients, but the biological mechanisms underlying this association remain unknown.

We examined the association between insulin resistance, schizophrenia polygenic risk and response to treatment in 58 drug-naive schizophrenia patients and 58 matched healthy individuals while controlling for a range of demographic (age, gender, body mass index), lifestyle (smoking, alcohol and cannabis use) and clinical (psychopathology scores, treatment drug) factors.

We found that insulin resistance, a key feature contributing to the development of type 2 diabetes, significantly correlated with schizophrenia polygenic risk score in patients, with higher genetic risk of schizophrenia associated with increased insulin resistance. Furthermore, we found that patients with higher insulin resistance were more likely to switch medication during the first year of treatment, which implies lower clinical response.  Continue reading

Shorter Individuals at Greater Risk of Heart Disease

MedicalResearch.com Interview with:

Eirini MarouliWilliam Harvey Research InstituteBarts and The London School of Medicine and Dentistry, Queen Mary University of London, London

Eirini Marouli

Eirini Marouli
William Harvey Research Institute
Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London

MedicalResearch.com: What is the background for this study?  

Response: Epidemiological studies suggest that shorter stature is associated with increased risk of coronary artery disease (CAD) or type 2 diabetes (T2D). It is not clear though whether these associations are causal or there are other factors mediating these effects. When randomized trials are inappropriate or impossible, we can use Mendelian Randomisation as a good alternative to study the causal relationship between a trait and a disease. Here, we examined over 800 places in the human genome known to be associated with adult height and evaluated how genetically predicted height can affect the risk of CAD or T2D. Furthermore, we evaluated the role of several risk factors including, cholesterol, triglycerides, blood pressure, body mass index, fat percentage, socio-economic parameters including education and income as well as lung function. Lung function was assessed by spirometry measures including FEV1: forced expiratory volume in 1 second, FVC: forced vital capacity.

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Gene Transfer Improved Cardiac Function in Diabetic Mouse Model

MedicalResearch.com Interview with:

H. Kirk Hammond, MDProfessor of Medicine at University of California, San DiegoBasic research scientist and cardiologistSan Diego Veterans' Affairs Healthcare System

Dr. Hammond

H. Kirk Hammond, MD
Professor of Medicine at University of California
San Diego
Basic research scientist and cardiologist
San Diego Veterans’ Affairs Healthcare System

Dr. Hammond is winner of the 2017 William S. Middleton Award – the highest research honor in the U.S. Department of Veterans Affairs 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Worldwide, 9% of adults have diabetes, predominantly due to insulin resistance, known as Type 2 diabetes. It is associated with obesity and diets high in fat and carbohydrates. In this gene transfer study we showed that a single injection of a vector encoding a natural hormone (urocortin 2, Ucn2) increased glucose disposal and improved heart function in a model of diet-induced Type 2 diabetes in mice. 

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Smartphone App Will Be Able to Predict Diabetes

MedicalResearch.com Interview with:

Robert Avram MD MScDivision of CardiologyUniversity of California, San Francisco

Dr. Robert Avram

Robert Avram MD MSc
Division of Cardiology
University of California, San Francisco

MedicalResearch.com: What is the background for this study? Would you briefly describe what is meant by Photoplethysmography?

While analyzing the heart rate data as collected using smartphones apps in the Health-eHeart study, we noticed that diabetic patients had, on average, a higher ‘free-living’ heart rate than non-diabetic patients when adjusted from multiple factors. This pushed us to analyze the signal to see if there were other features that would help differentiate diabetes patients from non-diabetes patients. By identifying these features, we saw a huge opportunity to develop a screening tool for diabetes using deep learning and a smartphone camera and flash, in order to classify patients as having prevalent diabetes/no-diabetes.

Photoplethysmography is the technique of measuring the difference in light absorption by the skin in order to detect blood volume changes in the microvasculature. Most modern mobile devices, including smartphones and many fitness trackers (Apple Wathc, FitBit), have the ability to acquire PPG waveforms, providing a unique opportunity to detect diabetes-related vascular changes at population-scale.  Continue reading

BELVIQ®: FDA accepts sNDA To Include Long Term Safety/Efficacy Data

WeightControl.com Interview with:

Dr. Lynn Kramer, MD FAANVP and Chief Clinical Officer & Chief Medical OfficeEisai Co., Ltd

Dr. Kramer

Dr. Lynn Kramer, MD FAAN
VP and Chief Clinical Officer & Chief Medical Office
Eisai Co., Ltd

WeightControl.com: What is the background for this announcement?

Response: On February 25th, Eisai announced that the U.S. Food and Drug Administration (FDA) accepted its supplemental New Drug Application to potentially update the label for BELVIQ® (lorcaserin HCI) CIV 10 mg twice-daily/BELVIQ XR (lorcaserin HCI) CIV once daily to include long-term efficacy and safety data from CAMELLIA-TIMI 61, a clinical trial of BELVIQ in 12,000 overweight and obese patients with cardiovascular (CV) disease and/or multiple CV risk factors such as type 2 diabetes mellitus (T2DM).

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Fast Food Servings Have Gotten Bigger and Saltier

MedicalResearch.com Interview with:

Megan A McCrory, PhD, FTOSResearch Associate ProfessorDept of Health SciencesSargent College of Health and Rehabilitation SciencesBoston University 02215

Dr. McCrory

Megan A McCrory, PhD, FTOS
Research Associate Professor
Dept of Health Sciences
Sargent College of Health and Rehabilitation Sciences
Boston University 02215

MedicalResearch.com: What is the background for this study?

Response: The prevalence of overweight and obesity has increased in the US, along with documented increases in portion size in the food supply. Fast food is popular, making up about 11% of adult daily calorie intake in the US, and over 1/3 of U.S. adults eat at fast food establishments on any given day. We therefore sought to examine changes in portion size, calories, and selected nutrients in fast-food entree, side, and dessert menu items across the years 1986, 1991, and 2016.

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Diabetes-Risk Associated With Statin Use

MedicalResearch.com Interview with:
Fariba Ahmadizar, PharmD, MSc, PhD
Department of Epidemiology
Erasmus University Medical Centre
Rotterdam, the Netherlands

MedicalResearch.com: What is the background for this study?

Response: Several observational studies and trials have already reported an increased risk of incident type 2 diabetes in subjects treated with statins; however, most of them lack details, meaning that there were limited studies on the association of statin use with glycemic traits. Studies on this association underestimated type 2 diabetes incident cases due to including either questionnaire-based data, short follow-up time or lack of a direct comparison between different statin types, dosages and duration of use with respect to diabetes-related outcomes.

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Is Behavioral Change Among Overweight Diabetics Feasible and Sustainable?

MedicalResearch.com Interview with:
Giuseppe Pugliese, MD, PhD
for the Italian Diabetes and Exercise Study 2 (IDES_2) Investigators
Department of Clinical and Molecular Medicine
‘‘La Sapienza’’ University
Diabetes Unit, Sant’Andrea University Hospital
Rome, Italy

MedicalResearch.com: What is the background for this study?

Response: There is a growing epidemic of obesity and type 2 diabetes worldwide,
which are causally related to the increasing prevalence of “physical
inactivity”, i.e., an insufficient amount of moderate-to-vigorous
physical activity according to current guidelines, and
“sedentariness”, i.e., too many hours, especially if uninterrupted,
spent in a sitting or reclined position.  These two unhealthy
behaviors exert their detrimental effects independently of each other
and are very common among people suffering from type 2 diabetes, who
would therefore benefit from increasing physical activity and reducing
sedentary time, as recommended by current guidelines.

However, such a behavior change is generally difficult for a number of
internal and external barriers and requires behavioral interventions
targeting both physical activity and sedentary habits.  Unfortunately,
there is no definitive evidence that this is indeed feasible and,
particularly, that, if adopted, change in behavior can be maintained
in the long term.  Continue reading

Pioglitazone (Actos) Reduced Risk of Secondary Stroke and New Onset of Diabetes

MedicalResearch.com Interview with:

David Spence M.D., FRCPC, FAHA Professor of Neurology and Clinical Pharmacology Director, Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, Western University London, ON Canada

Dr. Spence

David Spence M.D., FRCPC, FAHA
Professor of Neurology and Clinical Pharmacology
Director, Stroke Prevention & Atherosclerosis Research Centre,
Robarts Research Institute, Western University
London, ON Canada

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: The motivation for the study was the chair of the committee that advises the Ontario Drug Benefit which medications to pay for said the IRIS results were not relevant to clinical practice. This because the Insulin Resistance Intervention after Stroke (IRIS) trial reported effects of pioglitazone in patients with stroke or TIA and insulin resistance assessed by the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) score for insulin resistance.1 ( However, few clinicians measure a HOMA-iR score, so the clinical impact of that trial was limited.

In this study we analyzed the effect of pioglitazone in stroke/TIA patients with prediabetes, which is commonly assessed by clinicians. Prediabetes was defined by the American Diabetes Association: a glycosylated hemoglobin (A1C) of  5.7% to <6.5% (we did not do glucose tolerance tests).  We analyzed primarily the results for patients with 80% adherence, but also did  an intention-to-treat (ITT) analysis.  The reason for focusing on patients with good adherence was that pioglitazone cannot be taken by about 10-20% of patients, because of fluid retention and weight gain (mainly due  to fluid retention).  (The reasoning was that third party payers would not need to pay for the medication in patients who do not take it.)

In stroke/TIA patients with good adherence, the benefits of pioglitazone were greater than in the original IRIS trial. We found a 40% reduction of stroke/MI, a 33% reduction of stroke, and an 80% reduction of new-onset diabetes, over 5 years.  Pioglitazone also improved blood pressure, triglycerides and HDL-cholesterol. As expected, pioglitazone was somewhat less beneficial in the ITT analysis.

Fluid retention can usually be managed by reducing the dose of pioglitazone; even small doses still have a beneficial effect . Also, amiloride has been shown to reduce fluid retention with pioglitazone.

  1. Kernan WN, Viscoli CM, Furie KL, Young LH, Inzucchi SE, Gorman M, Guarino PD, Lovejoy AM, Peduzzi PN, Conwit R, Brass LM, Schwartz GG, Adams HP, Jr., Berger L, Carolei A, Clark W, Coull B, Ford GA, Kleindorfer D, O’Leary JR, Parsons MW, Ringleb P, Sen S, Spence JD, Tanne D, Wang D, Winder TR and Investigators IT. Pioglitazone after Ischemic Stroke or Transient Ischemic Attack. N Engl J Med. 2016;374:1321-31. 

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Stroke: Intensive Blood Sugar Control Did Not Improve Outcomes

MedicalResearch.com Interview with:

Prof-Karen-C-Johnston

Prof. Johnston

Karen C. Johnston MD
Professor and Chair, Neurology
School of Medicine
University of Virginia

MedicalResearch.com: What is the background for this study?

Response: We know that acute ischemic stroke patient with hyperglycemia at presentation have worse outcomes. We also know if we lower the glucose too low that this is bad for ischemic brain also. T

he SHINE trial addressed a world wide debate about whether intensive treatment of hyperglycemia is beneficial. We assessed the efficacy and safety of an intensive glucose control protocol with a target glucose of 80-130 mg/dL compared to a more standard protocol with a target of less than 180 mg/dL.

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Gastric Bypass Surgery Linked to Diabetes Remission

MedicalResearch.com Interview with:
Lene Ring Madsen, MD, Ph.d.
Medicinsk Afdeling  Herning
Hospitalsenheden Vest

Lene Ring Madsen, MD, Ph.d. Medicinsk Afdeling  Herning Hospitalsenheden Vest
MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We know from previous studies that there is a significant chance of diabetes remission following Roux-en-Y gastric bypass, but most studies evaluate smaller cohorts of selected patients (e.g. from a single center or only patients covered by a specific type of insurance). By using Danish registries, which hold information on all Danish Citizens independent of social- or economic status and have complete follow-up, we wanted to evaluate the Roux-en-Y gastric bypass surgery (RYGB) in a real-world setting.

The main findings are that more than 70 % of patients with obesity (BMI>35 kg/m2) and type 2 diabetes treated by RYGB had their diabetes go into remission or every 6-month period in the first 5 years after the procedure. Out of those who were in remission within the first year of follow-up 27% had undergone relapse at 5 years.

The most important predictor of a patient not going into remission was if they required insulin to control their disease. Other factors included older age and higher starting HbA1c level. During the more than five years of follow-up, the risk of microvascular complications was 47% lower in the RYGB group than in the control population, with largest decreases in the risk of diabetic retinopathy and diabetic kidney disease. There was a smaller impact on the risk of macrovascular events, which were 24% lower among patients who had received bariatric surgery; however, this difference was not large enough to achieve statistical significance. The 90-day mortality was very low (<0.5%).

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Study Find No Difference in Standardized Test Scores in Children With/Without Diabetes

MedicalResearch.com Interview with:

Niels Skipper PhD Associate Professor, Department of Economics and Business Economics Aarhus University

Dr. Skipper

Niels Skipper PhD
Associate Professor, Department of Economics and Business Economics
Aarhus University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: It is unclear if there is an association between type 1 diabetes and school performance in children. Some studies have found type 1 diabetes to be associated with worse performance, while others have found no differences. However, most of the existing literature are based on smaller, non-random samples of children with diabetes. In this study we used data on all public school children in the country of Denmark, involving more than 600,000 schoolchildren where approximately 2,000 had a confirmed diagnosis of type 1 diabetes. The children were tested in math and reading using a nationally standardized testing procedure, and we found no difference in the obtain test scores between children with diabetes compared to children without diabetes.  Continue reading

Primary Care Settings Offer Opportunity for Wider Screening for Diabetic Retinopathy

MedicalResearch.com Interview with:

Diane M. Gibson, Ph.D. Executive Director – New York Federal Statistical Research Data Center, Baruch RDC Associate Professor – Marxe School of Public and International Affairs, Baruch College - CUNY

Dr. Gibson

Diane M. Gibson, Ph.D.
Executive Director – New York Federal Statistical Research Data Center, Baruch RDC
Associate Professor – Marxe School of Public and International Affairs, Baruch College – CUNY

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Prior studies have found that screening for diabetic retinopathy in primary care settings using telemedicine increased screening rates among individuals with diabetes and among subgroups of individuals with diabetes who are at high risk of missing recommended eye exams.  In a previous paper I looked at how often U.S. adults with diabetes visited primary care and eye care providers for recommended diabetes preventive care services using a sample from the 2007-2013 Medical Expenditure Panel Survey.  I found that while visits to eye care providers were often skipped, most adults with diabetes did visit primary care physicians.  I argued that these findings suggest that screening for diabetic retinopathy in primary care settings using telemedicine has the potential to fulfill unmet needs and reach most U.S. adults with diabetes.

My brief report in JAMA Ophthalmology examines patterns of eye examination receipt and visits to primary care physicians among U.S. adults with diabetes using a sample from the 2016 National Health Interview Survey.  The report pays particular attention to individuals who are at high-risk of missing recommended eye exams.

The study found that 87.7% of the sample of adults with diabetes visited a primary care physician in the past year and that, except for the uninsured subgroup, more than 78% of each high-risk subgroup visited a primary care provider in the past year.  Continue reading

Going to Bed Right After Dinner May Raise Diabetes Risk

MedicalResearch.com Interview with:
Chiyori Haga, R.N. P.H.N Ph.D
Department of Community Nursing
Graduate School of Health Science
Okayama University in Japan

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In Japan, we have a health checkup system for middle and elderly people to prevent their non-communicable diseases (NCDs) including the Metabolic Syndrome (MetS) and give them some health guidance based a guideline. The guideline has suggested that short duration between bed time and dinner time will be a risk factor of metabolic syndrome or diabetes mellitus for some duration.

However, there may be no association between them, it is the main findings.  Continue reading

Type 1 Diabetes Cases Drop After Rotavirus Vaccine Introduced

MedicalResearch.com Interview with:

Dr Kirsten Perrett MBBS FRACP PhD Team Leader / Clinician-Scientist Fellow, Population Allergy, Murdoch Children's Research Institute Consultant Paediatrician, Department of Allergy and Immunology and General Medicine The Royal Children's Hospital Fellow, School of Population and Global Health, The University of Melbourne Murdoch Children's Research Institute Parkville, Victoria  Australia

Dr. Kirsten Perrett

Dr Kirsten Perrett MBBS FRACP PhD
Team Leader / Clinician-Scientist Fellow, Population Allergy, Murdoch Children’s Research Institute
Consultant Paediatrician, Department of Allergy and Immunology and General Medicine
The Royal Children’s Hospital
Fellow, School of Population and Global Health
The University of Melbourne
Parkville, Victoria  Australia

MedicalResearch.com: What is the background for this study?

Response: Before rotavirus vaccines were available, rotavirus infection was the most common cause of severe gastroenteritis in infants and young children. Because it is so contagious, infection in childhood is thought to be universal in unvaccinated children.

Previous studies indicated that rotavirus infection of infants might be an environmental promoter of type 1 diabetes. Therefore, we anticipated that the introduction of the rotavirus vaccine might alter the disease incidence in young children. 

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Increase Risk of Blistering Disorder with Diabetes Medication

MedicalResearch.com Interview with:

Example of Bullous Pemphigoid Derm NZ image

Example of Bullous Pemphigoid
Derm NZ image

Dong Hyun Kim M.D.
Associate professor
Department of Dermatology
CHA Bundang Medical Center
CHA University School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: As a dermatologist, we see many patients with newly diagnosed with bullous pemphigoid (BP), many of whom have diabetes.

The use of DPP-4 inhibitors is a common treatment for diabetes, we have noted previous case reports that DPP-4 inhibitors may be the cause of BP. For this reason, we started this study.

The most important thing in my article is DPP-4 inhibitors, particularly vildagliptin, may be associated with the development of bullous pemphigoid in male patients with diabetes. We have confirmed these points based on the nationwide, population-based study. It is very meaningful because there have been few studies using large sample sizes so far.

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Mental Illness Risk Increased in Young Onset Diabetes

MedicalResearch.com Interview with:

Juliana CN Chan MD Chair Professor of Medicine and Therapeutics Head, Division of Clinical Pharmacology, Department of Medicine and Therapeutics Director, Hong Kong Institute of Diabetes and Obesity Director, Clinical Research Management Office Faculty of Medicine The Chinese University of Hong Kong

Dr. Chan

Juliana CN Chan MD
Chair Professor of Medicine and Therapeutics
Head, Division of Clinical Pharmacology, Department of Medicine and Therapeutics
Director, Hong Kong Institute of Diabetes and Obesity
Director, Clinical Research Management Office
Faculty of Medicine
The Chinese University of Hong Kong

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The prevalence of young onset diabetes (YOD) is increasing world-wide with doubling of its prevalence in the last 10 years in many developed nations. Using the Hong Kong Diabetes Register established since 1995, we first reported that 1 in 5 Chinese adults with diabetes were diagnosed before the age of 40 years. These young patients had poor control of multiple risk factors with 1.5 fold higher risk of premature death and cardiovascular-renal complications compared to patients with usual onset of diabetes after the age of 40 (Chan JC et al AJM 2014, Luk A et al Diabetes Care 2014). Due to the multisystem nature of diabetes, we asked the question whether these young patients might have recurrent hospitalizations during their 3-4 decades of complex clinical course.

Using a territory-wide diabetes database involving 0.42 million people followed up between 2002 and 2014, we compared the hospitalization rates accrued till the age of 75 years and found that patients with young onset diabetes had the highest hospitalization rates by attained age. Compared to patients with usual onset of diabetes, patients with YOD had 1.8- 6.7 higher risk of hospitalizations due to all-causes, notably renal disease compared to those with usual onset of disease.

Amongst patients with young onset diabetes, over one-third of the bed-days were due to mental illness before the age of 40 years. We used mathematical modeling and estimated that intensified risk factor control in YOD can reduce the cumulative bed-days by 30% which can be further reduced by delaying the onset of diabetes. These original data is a wakening call to the community regarding the complex nature of YOD involving interactions amongst environment, lifestyles and personal factors (e.g. genetics, education and socioeconomic status) and the biomedical-psychological-behavioral needs of these high risk population, which if undiagnosed, untreated or suboptimally managed, can have huge economic impacts on health care system and loss of societal productivity, leaving personal suffering aside. Continue reading

Diabetes: Study Find Statins Protect Against Vision Loss

MedicalResearch.com Interview with:

Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. Illustration depicting diabetic retinopathy

Illustration depicting diabetic retinopathy

Eugene Yu-Chuan Kang, MD.
House Staff,
Department of Ophthalmology
Chang Gung Memorial Hospital
Chang Gung University, School of Medicine

MedicalResearch.com: What is the background for this study?

 

Response: More and more patients suffered from diabetes mellitus (DM) around the world, as well diabetic complications such as diabetic retinopathy (DR). DR is one of the major causes of blindness in working-age adults. In addition to the cost of treatment for patients with advanced DR, loss of visual function also yields a great burden to the family and society. For advanced DR, surgical interventions such as retinal laser, intravitreal injection, and vitrectomy are needed. However, those surgical interventions for severe DR can only retard or stop disease progression. If DR can be prevented or slowed by medical treatments, the burden of medical costs for treating severe DR may be decreased.

Statin, an HMG-CoA reductase inhibitor, was discussed frequently in the recent years. Multiple functions of statins besides their lipid lowering effect were discovered. Previous investigations have reported that statin therapy could reduce mortality rate and decrease risk of cardiovascular diseases.

In our study, we wanted to figure out if statin therapy may have any association between diabetic retinopathy.  Continue reading

Link Between Number of Migraines and Diabetes Risk

MedicalResearch.com Interview with:

Guy Fagherazzi, MSc, PhD, HDR Senior Research Scientist in Digital & Diabetes Epidemiology Center of Research in Epidemiology and Population Health  Inserm, Paris-South Paris-Saclay University

Dr. Guy Fagherazzi

Guy Fagherazzi, MSc, PhD, HDR
Senior Research Scientist in Digital & Diabetes Epidemiology
Center of Research in Epidemiology and Population Health
Inserm, Paris-South Paris-Saclay University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response:  Migraine has further been associated with increased risk of overall and specific cardiovascular disease events.

Because migraine has also been associated with factors related with insulin resistance and type 2 diabetes, an association between migraine and diabetes has been hypothesized.

We observed a lower risk of type 2 diabetes in women with active migraine.

We also show a linear decrease of migraine prevalence long before and a plateau long after type 2 diabetes diagnosis. 

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Chronic Kidney Disease Rate Rising Faster Than Other Noncommunicable Diseases

MedicalResearch.com Interview with:

Dr. Ziyad Al-Aly, MD Associate Chief of Staff for Research and Education Veterans Affairs St. Louis Health Care System

Dr. Al-Aly

Dr. Ziyad Al-Aly, MD
Associate Chief of Staff for Research and Education
Veterans Affairs St. Louis Health Care System
Institute for Public Health
Washington University, St. Louis MO

MedicalResearch.com: What is the background for this study?

Response: A lot has changed in the US over the past 15 years including aging, population growth, and increased exposure to risk factors such as obesity, elevated blood pressure, etc. With all of these changes, we wondered, how did the burden of kidney disease change in the United States over the past 15 years.
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Rotating Night Shift Work Adds To Risk of Type II Diabetes

MedicalResearch.com Interview with:

"Night Shift" by Yuchung Chao is licensed under CC BY-ND 3.0Dr. Zhilei Shah PhD
Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety
Ministry of Education Key Lab of Environment and Health, School of Public Health
Tongji Medical College, Huazhon
University of Science and Technology
Wuhan,  China

MedicalResearch.com: What is the background for this study?

Response: Shift work has progressed in response to changes in economic pressure and greater consumer demand for 24-hour services. There are many economic advantages to increased shift work, including higher employment, increased services to customers, and improved trade opportunities. Currently, one in five employees in the U.S. works nonstandard hours in the evening, night, or rotating shifts. However, shift work, especially night shift work, has been associated with a higher risk of chronic diseases, including type 2 diabetes, cardiovascular disease, and several types of cancer.

Compelling evidence has shown that body weight and lifestyle behaviors, such as smoking, diet, and physical activity can influence type 2 diabetes risk. Among shift workers, excess adiposity and increased smoking are frequently and consistently reported, whereas the evidence on physical activity and diet is mixed. Additionally, no previous study has examined the joint associations of rotating night shift work duration and unhealthy lifestyle factors with risk of type 2 diabetes, or evaluated their potential interactions.

Therefore, we prospectively assessed the joint association of rotating night shift work and established type 2 diabetes lifestyle risk factors with risk of type 2 diabetes and quantitatively decomposed the proportions of the joint association to rotating night shift work alone, to lifestyle alone and to their interaction in two large US cohorts.

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Obesity Strongly Related to Coronary Artery Disease and Diabetes

MedicalResearch.com Interview with:
"Obesity runs rampant in Indiana." by Steve Baker is licensed under CC BY-ND 2.0Haris Riaz MD
(Cardiology Fellow
Haitham Ahmed MD, MPH , Preventive Cardiologist,
Cleveland Clinic, Ohio

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Elevated cholesterol (specially low density lipoprotein) has been causally linked to the development of coronary artery disease whereas the causal relationship between obesity and cardiovascular disease has remained controversial. This is important because of increasing epidemic of obesity and metabolic syndrome. Mendelian randomization studies provide one way of determining a causal association where we can look at the outcomes of individuals stratified by the presence or absence of a particular allele. Since these alleles are randomly distributed in the population of interest, this is “nature’s randomized trial” in that the particular allele is naturally distributed and hence minimal risk of bias.

In other words, lets say that I hypothesize that a particular gene “A” is linked with coronary artery disease. If the given gene is indeed causally linked with coronary artery disease, patients with activation of that gene should have significantly greater risk of developing coronary artery disease.

Based on these principles, we conducted a systematic review and meta-analysis of the available evidence and found that the risk of developing coronary artery disease and diabetes is significantly increased with obesity. Although hypothesis generating, we think that these findings may suggest a causal association between obesity and cardiovascular disease.  Continue reading

Cannabis May Raise Risk of Diabetic Ketoacidosis

MedicalResearch.com Interview with:

Viral Shah, MD Assistant Professor of Medicine & Pediatrics Barbara Davis Center for Diabetes, Adult Clinic School of Medicine University of Colorado Anschutz Medical Campus

Dr. Shah

Viral Shah, MD
Assistant Professor of Medicine & Pediatrics
Barbara Davis Center for Diabetes, Adult Clinic
School of Medicine
University of Colorado Anschutz Medical Campus

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Cannabis use is increasing in Colorado and many patients with type 1 diabetes (which is an autoimmune form of diabetes that requires life insulin therapy) are using cannabis. Therefore, we surveyed adult patients with type 1 diabetes to study the association between cannabis use and glycemic control and diabetes acute complications (such as diabetic ketoacidosis) in adults with type 1 diabetes.

Main findings of the study:  The risk for diabetic ketoacidosis (a serious condition where body produces high levels of acids called ketones in patients with diabetes)  was two times higher among adults with type 1 diabetes who reported using cannabis in the past 12 months compared to adults with type 1 diabetes who reported not using cannabis. Continue reading