What Best Treats Diabetic Retinopathy?

Here we are in 2010, and the headlines keep coming. We hope that these articles help you bring up new treatments and warnings about old ones when you visit your physician. Knowledge is your tool for good health and helps you become your own advocate.

By the way, the Wall Street Journal's Informed Patient section included an interesting take on the health benefits of exercise in its January 5th edition. It reported that even moderate exercise can help the immune system protect against chronic diseases, such as diabetes. To read the complete article, click here.

We have plenty of information on exercise and type 2 diabetes and exercise and type 1 diabetes, so please read these articles and ask your healthcare team about a program that may be appropriate for you.

Diabetics at Risk for Several Pulmonary Complications
From the day we are diagnosed with diabetes, we are told about the long- and short-term complications of the disease. Here are a few more to talk over with your physician. The January issue of Diabetes Care has an article titled "Patients Diagnosed with Diabetes are at Increased Risk for Asthma, Chronic Obstructive Pulmonary Disease, Pulmonary Fibrosis, and Pneumonia but Not Lung Cancer" by Samantha F. Ehrlich, MPH et al.

The researchers, noting that little research had been done on this subject, conducted a study using electronic records of a large health plan in northern California. The study group included people who had diabetes and those who did not. Age and sex data were available for everyone in the study group.

No difference was observed for lung cancer, but the incidence of asthma, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, and pneumonia were significantly higher in people with diabetes. The risk of pneumonia and COPD increased with increasing A1c.

The researchers concluded that this increased risk for people with diabetes to develop asthma, COPD, pulmonary fibrosis, and pneumonia may be linked to declining lung function in people with the disease. If you smoke and have not had the pneumonia injection, now is the time to talk to your physician.

You can review the abstract of this study here.

What's the Best Treatment for Diabetic Retinopathy?
The December issue of the Archives of Ophthalmology has an interesting article titled "Exploratory Analysis of Diabetic Retinopathy Progression Through 3 Years in a Randomized Clinical Trial That Compares Intravitreal Triamcinolone Acetonide With Focal/Grid Photocoagulation," which compares laser treatment to steroid injections for the treatment of diabetic retinopathy.

Neil M. Bressler, MD et al of the Johns Hopkins Wilmer Eye Institute studied 693 men and women (average age 63) with diabetic retinopathy with macular edema. Diabetic retinopathy is a long-term complication of diabetes that can result in blindness. Macular edema, which also negatively impacts vision, is caused by inflammation in the retina.

The participants were given either corticosteroids injections into their eyes or a laser treatment (which is the typical treatment).

The authors found that steroid treatments reduced the risk of diabetic retinopathy progression, but they did not prevent the progression of macular edema. While the use of steroids did help improve vision, the results were no better than the laser treatments. Steroids in the eye can also an increase in the risk of other eye diseases, such as glaucoma and cataracts.

"Steroid treatment worked, but because of safety issues, cannot be recommended routinely at this time," concluded Dr. Bressler.

To learn more about this article, click this link.

ADA Pushes New A1c Guidelines for Diagnosing Diabetes
Finally, we bring you the latest clinical guidelines that the American Diabetes Association (ADA) is promoting using the hemoglobin A1c blood test in the diagnosis of type 2 diabetes.

These new limits call for a diagnosis of type 2 diabetes at A1c levels above 6.5%. For pre-diabetes, the new guidelines propose a diagnosis if the A1c levels are between 5.7% and 6.4%.

Those of us with diabetes know that an A1c measurement shows your average blood glucose levels for the previous 2 to 3 months. It does this by measuring glycated hemoglobin levels. Glycated hemoglobin occurs when a glucose molecule attaches to hemoglobin (a red blood cell). This process occurs in everyone—not just people with diabetes. The difference, though, is that glycation happens much more often in people with uncontrolled diabetes, so they have much higher counts of glycated hemoglobin.

Generally, people who do not have diabetes have an A1c of less than 5%. Doctors hope that using the A1c will make it easier to diagnose diabetes and pre-diabetes, which is thought to be grossly under-diagnosed.

To learn more about why the ADA is promoting these new A1c guidelines, click here.

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