Manifestations of type 2 diabetes in corneal endothelial cell density,corneal thickness and intraocular pressure

We sought to evaluate central corneal thickness（CCT）,corneal endothelial cell density（ECD）and intraocular pressure（IOP）in patients with type 2 diabetes mellitus（DM）and to associate potential differences with diabetes duration and treatment modality in a prospective,randomized study.We measured ECD,CCT and IOP of125 patients with type 2 DM（mean age 57.1±11.5 years）and compared them with 90 age-matched controls.Measured parameters were analyzed for association with diabetes duration and glucose control modalities（insulin injection or oral medication）while controlling for age.In the diabetic group,the mean ECD（2511±252 cells/mm^2）,mean CCT（539.7±33.6μm）and mean IOP（18.3±2.5 mmHg）varied significantly from those the control group[ECD：2713±132 cells/mm^2（P〈0.0001）,CCT：525.0±45.3μm（P=0.003）and IOP：16.7±1.8 mmHg（P〈0.0001）].ECD was significantly reduced by about 32 cell/mm^2 for diabetics with duration of〉10 years when compared with those with duration of〈10 years（P〈0.05）.CCT was thicker and IOP was higher for diabetics with duration of〉10 years than those with duration of〈10 years（P〉0.05）.None of the measured parameters was significantly associated with diabetes duration and treatment modality（P〉0.05）.In conclusion,subjects with type 2DM exhibit significant changes in ECD,IOP and CCT,which,however,are not correlated with disease duration or if the patients receive on insulin injection or oral medications.

Guidelines and standards for comprehensive clinical diagnosis and interventional treatment for diabetic foot in China(Issue 7.0)

Diabetic foot(DF)is one of the most common complications of diabetes and is associated with high morbidity,disability,lethality and low cure-rate.The clinical diagnosis and treatment of DF need to be standardized.The Chinese Diabetic Foot Cell and Interventional Therapy Technology Alliance has released six editions of guidelines and standards for clinical diagnosis and interventional treatment of DF,which filled the gap in the domestic DF treatment standard and played an important role in improving the level of diagnosis and treatment in China.In line with the latest developments in diagnosis and treatment,the Alliance,along with other 89 institutions,developed and issued the new edition based on the sixth edition to help standardize the clinical diagnosis and treatment of DF in China.

Intravitreal dexamethasone implants for diabetic macular edema

AIM： To evaluate the safety and efficacy of a dexamethasone（DEX） intravitreal implant for diabetic macular edema（DME）.METHODS： Totally 113 eyes of 84 patients were divided in three subgroups： naive patients（n=11）, pseudophakic patients（n=72） and phakic patients（n=30）. Inclusive criterion comprised adult diabetic patients with central fovea thickening and impaired visual acuity resulting from DME for whom previous standard treatments showed no improvement in both central macular thickness（CMT） and best corrected visual acuity（BCVA） after at least 3 mo of treatment. Outcome data were obtained from patient visits at baseline and at months 1, 3, 5, 9 and 12 after the first DEX implant injection. At each of these visits, patients underwent measurement of BCVA, a complete eye examination and measurement of CMT and macular volume（MV） carried out with optical coherence tomography（OCT） images. RESULTS： Seventy-three eyes（64.5%） received a single implant, 30（26.5%） received two implants and 10（9%） received three implants. At baseline, average in BCVA, CMT and MV were 43.5±20.8, 462.8±145 and 12.6±2.5 respectively. These values improved significantly at 1 mo（BCVA： 47.2±19.5, CMT： 339.6±120, MV： 11.11±1.4） and 3 mo（BCVA： 53.2±18.1, CMT： 353.8±141, MV： 11.3±1.3）（P≤0.05）. At 5 mo（BCVA： 50.9±19.8, CMT： 425±150, MV： 12.27±2.3）, 9 mo（BCVA： 48.4±17.6, CMT： 445.5±170, MV： 12.5±2.3） and 12 mo（BCVA： 47.7±18.8, CMT： 413.2±149, MV： 12.03±2.5）, improvements in the three parameters were no longer statistically significant and decreased progressively but did not reach baseline values. There were no clinical differences between subgroups. Ocular complications were minimal.CONCLUSION： Patients with DEX implants show maximum efficacy at 3 mo which then declined progressively, but is still better than baseline values at the end of follow-up.

The Beijing Desheng Diabetic Eye Study:rationale,design,methodology and baseline data

AIM： To present the rationale, design, methodology, and the baseline data of the Beijing Desheng Diabetic Eye Study（BDDES）, and to determine the prevalence of diabetic retinopathy（DR） and possible risk factors in patients with type 2 diabetes mellitus（T2DM） in an urban community of Beijing, China.METHODS： Community-based prospective cohort study of persons diagnosed with T2DM aged 30 y or older. The main variables of interest are the presence and progression of DR as determined by the standardized ETDRS grading of seven fields fundus photographs. The presence and severity of DR were analyzed for possible correlations to non-genetic and genetic dispositions.RESULTS： A total of 1438 participants with data available for analysis, the prevalence of any DR was 35.4%. The prevalence of mild non-proliferative diabetic retinopathy（NPDR）, moderate NPDR, severe NPDR, and proliferative diabetic retinopathy was 27.7%, 2.6%, 0.5% and 4.5%, respectively. By multiple logistic regression analysis, risk factors for the presence of any DR included male（P=0.031）, lower income level（P=0.011）, lower education background（P=0.022）, longer duration of diabetes（P=0.001）, younger age at diabetic onset（P=0.001）, higher systolic blood pressure（P=0.007）, higher glycosylated hemoglobin A1 c levels（P=0.001）, high albuminuria（P=0.03）, and use of insulin（P〈0.001）. For vision-threatening DR, four factors were significant： younger age at diabetic onset（P〈0.001）,higher systolic blood pressure（P=0.042）, high albuminuria（P〈0.001）, and use of insulin（P〈0.001）. CONCLUSION： The BDDES is the first large-scale ongoing cohort study of a Chinese urban population of persons with type 2 diabetes. Using standardized grading system comparable to large cohort studies from western populations, our baseline data shows that the prevalence of DR and major risk factors in this Chinese ethnic population are comparable to that found in the western population studies.

Effect of Internet technology on extended care in elderly patients with diabetic feet

Objective： To evaluate the effect of Internet technology on continuing nursing in elderly patients with diabetic feet, Method： From January 2015 to July 2016,12 elderly patients with diabetic foot ulcers were enrolled from the Endocrinology Department in our hospital. We used ＂WeChat＂, ＂E nursing＂ and other Internet technologies to perform remote extended care and to observe the foot ulcer outcomes. Results： All foot ulcers healed with a wound healing time between 38 and 73 days （average 57.08 ~ 12.69 days）. Patients did not need to travel long distances to seek medical treatment for foot ulcers, improving their satisfaction. Conclusions： The implementation of extended care for elderly patients with diabetic foot ulcers was based on the application of Internet technology. It is helpful to facilitate medical treatment, share high quality health resources and promote disease rehabilitation.

Ocular findings in Zucker Diabetic Fatty rats emphasize the key role of neuroglia degeneration in diabetic retinopathy pathophysiology

Diabetes mellitus is a leading cause of acquired vision loss and one of the world＇s fastest growing chronic diseases. Diabetic retinopathy （DR）, a specific complication of chronic hyperglycemia, is the leading cause of acquired vision loss worldwide in middle-aged and there- fore economically active people that also increases the medical and economic burden on the society （Klein, 2007）.

Roles of the eye care workforce for task sharing in management of diabetic retinopathy in Cambodia

AIM： To identify the current roles of eye and health care workers in eye care delivery and investigate their potential roles in screening and detection for management of diabetic retinopathy（DR） through task sharing.METHODS： Purposive sampling of 24 participants including health administrators, members from non-government organizations and all available eye care workers in Takeo province were recruited. This cross sectional mixed method study comprised a survey and in-depth interviews. Data were collected from medical records at Caritas Takeo Eye Hospital（CTEH） and Kiri Vong District Referral Hospital Vision Centre, and a survey and interviews with participants were done to explore the potential roles for task sharing in DR management. Qualitative data were transcribed into a text program and then entered into N-Vivo（version 10） software for data management and analysis. RESULTS： From 2009 to 2012, a total of 105 178 patients were examined and 14 030 eye surgeries were performed in CTEH by three ophthalmologists supported by ophthalmic nurses in operating and eye examination for patients. Between January 2011 and September 2012, 151 patients（72 males） with retinal pathology including 125（83%） with DR visited CTEH. In addition 170 patients with diabetes were referred to CTEH for eye examinations from Mo Po Tsyo screening programs for people with diabetes. Factors favouring task sharing included high demand for eye care services and scarcity of ophthalmologists.CONCLUSION： Task sharing and team work for eye care services is functional. Participants favor the potential role of ophthalmic nurses in screening for DR through task sharing.

Regulation of Zishen Qinggan( Shuangyi) Prescription to Insulin Resistance of GK Rats

[Objective] To study the effects of Zishen Qinggan( Shuangyi) Prescription on blood glucose,Hb A1c( glycosylated hemoglobin A1c),C-peptide( C-P),glucagon-like peptide( GLP-1),and α-glucosidase activity in GK( Goto-Kakizaki) rats. [Methods]Selected fasting blood glucose( FBG) > 11. 1mmol/L GK rats and randomly divided into groups: model group,Zishen Qinggan( Shuangyi) Prescription low dosage( ig,400 mg/kg/d),medium dosage( ig,800 mg/kg/d),and high dosage groups( ig,1600 mg/kg/d),and metformin group(ig,85 mg/kg/d). After continuous administration for 28 d,fasting blood glucose(FBG),oral glucose tolerance test(OGTT),Hb A1 c,C-P,GLP-1 and α-glucosidase activity were detected. [Results] Compared with the control group,FBG and Hb A1 c of the model group was significantly higher( P < 0. 01); compared with the model group,Zishen Qinggan( Shuangyi) Prescription could significantly reduce the levels of blood glucose,Hb A1 c,and the elevated blood glucose levels after 120 min of glucose loading in OGTT( P < 0. 05,P < 0. 01),and also can significantly improve the level of C-P,GLP-1( P < 0. 05,P < 0. 01),reduce Homa-IR,and inhibit α-glucosidase activity. [Conclusions]Zishen Qinggan( Shuangyi) Prescription can effectively reduce the blood glucose of GK rats,the action mechanism of which is possibly that it can improve insulin resistance,increase GLP-1 content and inhibit α-glucosidase activity.

Dual Blockade of the Renin-angiotensin-aldosterone System in Type 2 Diabetic Kidney Disease

Objective： To examine the efficacy and safety of dual blockade of the renin-angiotensin-aldosterone system （RAAS） among patients with type 2 diabetic kidney disease. Data Sources： We searched the major literature repositories, including the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE, for randomized clinical trials published between January 1990 and October 2015 that compared the efficacy and safety of the use of dual blockade of the RAAS versus the use ofmonothempy, without applying any language restrictions. Keywords for the searches included ＂＇diabetic nephropathy,＂ ＂chronic kidney disease,＂ ＂chronic renal insufficiency,＂ ＂diabetes mellitus,＂ ＂dual therapy,＂ ＂combined therapy,＂ ＂dual blockade,＂ ＂renin-angiotensin system,＂ ＂angiotensin-converting enzyme inhibitor,＂ ＂angiotensin-receptor blocker,＂ ＂aldosterone blockade,＂ ＂selective aldosterone blockade,＂ ＂renin inhibitor,＂ ＂direct renin inhibitor,＂ ＂mineralocorticoid receptor blocker,＂ etc. Study Selection： The selected articles were carefully reviewed. We excluded randomized clinical trials in which the kidney damage of patients was related to diseases other than diabetes mellitus. Results： Combination treatment with an angiotensin-converting enzyme inhibitor supplemented by an angiotensin I I receptor blocking agent is expected to provide a more complete blockade of the RAAS and a better control of hypertension. However, existing literature has presented mixed results, in particular, related to patient safety. In view of this, we conducted a comprehensive literature review in order to explain the rationale for dual blockade of the RAAS, and to discuss the pros and cons. Conclusions： Despite the negative results of some recent large-scale studies, it may be immature to declare that the dual blockade is a failure because of the complex nature of the RAAS surrounding its diversified functions and utility. Further trials are warranted to study the combination therapy as an evidence-based practice.

Protective Effects of Leukemia Inhibitory Factor on Retinal Vasculature and Cells in Streptozotocin-induced Diabetic Mice

Background： Leukemia inhibitory factor （LIF） has been reported to possess various pharmacological effects, including displaying vascular and neuroprotective properties, during retinal disease. The aim of this study was to investigate the vascular and structural changes in the retina of diabetic mice and to explore whether LIF prevents experimental diabetes-induced retinal injury in the early stages. Methods： Diabetes was induced in C57BI/6J mice with streptozotocin （STZ） injections. Successful diabetic animal models were randomly separated into two groups： the diabetic group （n = 15） and the LIF-treated group （n = 15）. Normal C57BL/6 mice served as the normal control group （n = 14）. Recombinant human LIF was intravitreally injected 8 weeks after the diabetic model was successfully established. Retinas were collected and evaluated using histological and immunohistochemical techniques, and flat-mounted retinas and Western blotting were performed at 18 weeks after the induction of diabetes and 2 days after the intravitreal injection of LIF. The analysis of variance test were used. Results： Histological analysis showed that there were fewer retinal ganglion cells （RGCs） and the inner nuclear layer （INL） became thinner in the diabetic model group （RGC 21.8 ± 4.0 and INL 120.2 ± 4.6 μm） compared with the normal control group （RGC 29.0 ± 6.7, t = -3.02, P = 0.007; INL 150.7 ±10.6 lain, t = -8.88, P 〈 0.001, respectively）. After LIF treatment, the number of RGCs （26.9 ± 5.3） was significantly increased （t = 3.39, P = 0.030） and the INL （ 134.5± 14.2 lain） was thicker compared to the diabetic group （t - 2.75, P = 0.013）. In the anti-Brn-3a-labeled retinas, the number of RGCs in the LIF-treated group （3926.0 ± 143.9） was obviously increased compared to the diabetic group （3507.7 ± 286.1, t = 2.38, P = 0.030）, while no significance was found between the LIF-treated group and the control group （4188.3 ± 114.7, t= -2.47, P- 0.069）. Flat-mounted retinas demonstrated that a disorganized, dense distribution of the vessel was prominent in the diabetic model group. Vessel distribution in the LIF-treated mouse group was typical and the thickness was uniform. The levels of phosphosignal transducer and activator of transcription 3 activation were obviously higher in the LIF-injected retinas than those in the diabetic control group （t = 3.85, P = 0.019） and the normal control （t = -3.20, P - 0.019）. Conclusion： The present study provides evidence that LIF treatment protects the integrity of the vasculature and prevents retinal injury in the early stages of diabetic retinopathy in STZ-induced diabetic models.