Damien Luviano, MD, FACS
<ul><li>What is Diabetes? </li></ul>Damien Luviano, MD, FACS
<ul><li>Diabetes:  </li></ul><ul><ul><li>Impaired Insulin </li></ul></ul><ul><ul><li>leads increased glucose </li></ul></u...
<ul><li>How do I know I have it? </li></ul><ul><li>Diagnosis </li></ul>Damien Luviano, MD, FACS
<ul><li>DIAGNOSE </li></ul><ul><li>Fasting Plasma Glucose FPG  </li></ul><ul><li>HgA1c  </li></ul><ul><ul><li>3 month Aver...
<ul><li>CONTROLLED </li></ul><ul><ul><li>HemoglobinA1c less 7.0 </li></ul></ul><ul><li>unCONTROLLED </li></ul><ul><li>Hemo...
<ul><li>What is the big deal with a little sugar?  </li></ul>Damien Luviano, MD, FACS
<ul><li>DEATH (MORTALITY) </li></ul><ul><ul><ul><li>Brain-Stroke </li></ul></ul></ul><ul><ul><ul><li>Heart- Myocardial Inf...
<ul><li>Lets talk about Eyes </li></ul>Damien Luviano, MD, FACS
<ul><li>Blindness  </li></ul><ul><ul><li>Diabetes is  LEADING  cause of new cases of blindness among adults aged 20-74 yea...
<ul><li>TWO TYPES </li></ul><ul><ul><li>NON-PROLIFERATIVE (mild, moderate, severe) </li></ul></ul><ul><ul><li>PROLIFERATIV...
<ul><li>How does diabetes hurt all these organs? </li></ul><ul><li>Are all these organs connected? </li></ul>Damien Luvian...
<ul><li>PATHOPHYSIOLOGY (MECHANISM) </li></ul>Damien Luviano, MD, FACS
<ul><ul><ul><li>Genetic </li></ul></ul></ul><ul><ul><ul><li>Environmental </li></ul></ul></ul><ul><ul><ul><li>Immunologica...
Frank RN: Etiologic mechanisms in diabetic retinopathy.  In Ryan SJ, ed: Retina, Schachat AP and Murphy RP, eds  vol. 2 Me...
<ul><li>NUMBERS </li></ul><ul><li>STATISTICS </li></ul><ul><li>DEMOGRAPHICS </li></ul><ul><li>RISK FACTORS </li></ul>Damie...
Damien Luviano, MD, FACS
Damien Luviano, MD, FACS
Damien Luviano, MD, FACS
<ul><li>HGA1C </li></ul><ul><li>1%  REDUCES 50% RISK </li></ul>Damien Luviano, MD, FACS
<ul><li>WHAT MAKES DISEASE WORSE? </li></ul>Damien Luviano, MD, FACS
Adverse Risk Factors 1.  Long duration of diabetes <ul><li>Obesity </li></ul><ul><li>Hyperlipidaemia </li></ul>2.  Poor me...
<ul><li>I SEE FINE, I HAVE NO SYMPTOMS MY DOCTOR SAYS I HAVE DIABETES DAMAGE, CAN THAT BE TRUE? </li></ul>Damien Luviano, ...
<ul><li>SYMPTOMS </li></ul>Damien Luviano, MD, FACS
<ul><li>In the initial stages </li></ul><ul><ul><li>NO Symptoms </li></ul></ul><ul><li>Advanced stages of the disease </li...
<ul><li>What does the Doctor Actually see? </li></ul>Damien Luviano, MD, FACS
<ul><li>CLINICAL FINDINGS (DOCTOR EXAM) </li></ul>Damien Luviano, MD, FACS
Damien Luviano, MD, FACS
Preproliferative diabetic retinopathy Treatment  - not required but watch for proliferative disease <ul><li>Cotton-wool sp...
Proliferative diabetic retinopathy  <ul><li>Flat or elevated </li></ul><ul><li>Severity determined by comparing with area ...
Indications for treatment of proliferative diabetic retinopathy NVD > 1/3 disc in area Less extensive NVD  +  haemorrhage ...
<ul><li>How is the Doctor Going to Fix my eyes? </li></ul>Damien Luviano, MD, FACS
<ul><li>TREATMENT </li></ul><ul><ul><li>NONPROLIFERATIVE </li></ul></ul><ul><ul><ul><li>Glucose Control </li></ul></ul></u...
<ul><li>Spot size (200-500   m ) depends </li></ul><ul><li>on contact lens magnification </li></ul><ul><li>Gentle intensi...
Assessment after photocoagulation <ul><li>Persistent neovascularization </li></ul><ul><li>Hemorrhage </li></ul>Poor involu...
Treatment of clinically significant  macular oedema <ul><li>For microaneurysms in centre of hard  </li></ul><ul><li>exudat...
Indications for vitreoretinal surgery Retinal detachment involving macula Severe persistent vitreous  haemorrhage Dense, p...
<ul><li>DOCTOR </li></ul><ul><li>Glucose Control </li></ul><ul><ul><li>Goal less HgA1c 7.0 </li></ul></ul><ul><li>Hyperten...
<ul><li>How often should I see the Eye Doctor? </li></ul>Damien Luviano, MD, FACS
<ul><li>FOLLOW UP </li></ul><ul><ul><li>Controlled Diabetes </li></ul></ul><ul><ul><ul><li>12 months </li></ul></ul></ul><...
<ul><li>How many kinds of eye doctors are there? </li></ul>Damien Luviano, MD, FACS
<ul><li>PHYSICIANS </li></ul><ul><li>M.D </li></ul><ul><li>Surgeons </li></ul><ul><ul><li>Laser  </li></ul></ul><ul><ul><l...
<ul><li>PROBLEMS </li></ul><ul><li>DIABETES IS SERIOUS </li></ul><ul><li>HURT MANY ORGANS </li></ul><ul><li>PREVENTABLE </...
Damien Luviano, MD, FACS
<ul><li>INTERPRETATION: Treatment with fenofibrate in individuals with type 2 diabetes mellitus reduces the need for laser...
<ul><li>CONCLUSIONS: Intensive glycemic control and intensive combination treatment of dyslipidemia, but not intensive blo...
<ul><li>CONCLUSIONS: Early blockade of the renin-angiotensin system in patients with type 1 diabetes did not slow nephropa...
<ul><li>Regardless of vision, PRP is beneficial (reduced severe vision loss by  50%-60%) in the management of patients wit...
<ul><li>Conclusions: Early vitrectomy is recommended for type 1 DM with severe visual loss secondary to vitreous hemorrhag...
<ul><li>Aspirin has no benefitOnly patients with high-risk PDR and possibly severe NPDR in both eyes should receive immedi...
<ul><li>Results: Tighter BP control decreased diabetes related mortality by 32%.Tighter BP control decreased deterioration...
<ul><li>Result:  Intensive treatment group had a 12% reduced risk of diabetes associated complication when compared with t...
<ul><li>Results:  (6.5 years follow up) Intensive therapy reduced– development of DR by 76% and severe NPDR/PDR by 47%, pr...
<ul><li>Objective:  Follow up patients after termination of DCCT Results: (Additional 4 years follow up)Intensive therapy ...
<ul><li>THE END </li></ul><ul><li>QUESTIONS </li></ul>Damien Luviano, MD, FACS
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Diabetes and hga1c

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How does your glucose levels affect your life, sight, and life

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Diabetes and hga1c

  1. 1. Damien Luviano, MD, FACS
  2. 2. <ul><li>What is Diabetes? </li></ul>Damien Luviano, MD, FACS
  3. 3. <ul><li>Diabetes: </li></ul><ul><ul><li>Impaired Insulin </li></ul></ul><ul><ul><li>leads increased glucose </li></ul></ul><ul><ul><li>Increased glucose Damages blood vessels </li></ul></ul><ul><ul><li>Tissues are deprived of blood, thus injured </li></ul></ul><ul><ul><ul><li>Brain-Stroke </li></ul></ul></ul><ul><ul><ul><li>Heart- Myocardial Infarctions </li></ul></ul></ul><ul><ul><ul><li>Dental-Periodontal Disease </li></ul></ul></ul><ul><ul><ul><li>Eye-Retinopathy </li></ul></ul></ul><ul><ul><ul><li>Kidney-Nephropathy </li></ul></ul></ul><ul><ul><ul><li>Nerves-Neuropathy </li></ul></ul></ul>Damien Luviano, MD, FACS
  4. 4. <ul><li>How do I know I have it? </li></ul><ul><li>Diagnosis </li></ul>Damien Luviano, MD, FACS
  5. 5. <ul><li>DIAGNOSE </li></ul><ul><li>Fasting Plasma Glucose FPG </li></ul><ul><li>HgA1c </li></ul><ul><ul><li>3 month Average </li></ul></ul><ul><li>Oral Glucose Tolerance </li></ul><ul><ul><ul><li>At 2 hrs </li></ul></ul></ul><ul><ul><ul><li>140-199 prediabetes </li></ul></ul></ul><ul><ul><ul><li>200 diabetes </li></ul></ul></ul><ul><li>FASTING PLASMA GLUCOSE FPG </li></ul><ul><ul><ul><li>Easy </li></ul></ul></ul><ul><ul><ul><li>100-125 Pre-Diabetes </li></ul></ul></ul><ul><ul><ul><li>126: Diabetes </li></ul></ul></ul><ul><ul><ul><li>Closer to 126 bad </li></ul></ul></ul><ul><ul><ul><ul><li>Patients with 95 are 50% more likely than 85 FPG </li></ul></ul></ul></ul>Damien Luviano, MD, FACS
  6. 6. <ul><li>CONTROLLED </li></ul><ul><ul><li>HemoglobinA1c less 7.0 </li></ul></ul><ul><li>unCONTROLLED </li></ul><ul><li>HemoglobinA1c MORE 6.5 </li></ul><ul><ul><li>Higher incidence </li></ul></ul><ul><ul><li>Strokes </li></ul></ul><ul><ul><li>Blindness </li></ul></ul><ul><ul><li>Tooth Loss </li></ul></ul><ul><ul><li>Heart Attacks </li></ul></ul><ul><ul><li>Kidney Failure </li></ul></ul><ul><ul><li>Leg Loss </li></ul></ul><ul><ul><li>Life Loss </li></ul></ul>Damien Luviano, MD, FACS
  7. 7. <ul><li>What is the big deal with a little sugar? </li></ul>Damien Luviano, MD, FACS
  8. 8. <ul><li>DEATH (MORTALITY) </li></ul><ul><ul><ul><li>Brain-Stroke </li></ul></ul></ul><ul><ul><ul><li>Heart- Myocardial Infarctions </li></ul></ul></ul><ul><ul><ul><li>Infections </li></ul></ul></ul><ul><li>MISERY (MORBIDITY) </li></ul><ul><ul><ul><li>Dental-Periodontal Disease </li></ul></ul></ul><ul><ul><ul><ul><li>Tooth loss </li></ul></ul></ul></ul><ul><ul><ul><li>Eye-Retinopathy </li></ul></ul></ul><ul><ul><ul><ul><li>blindness </li></ul></ul></ul></ul><ul><ul><ul><li>Kidney-Nephropathy </li></ul></ul></ul><ul><ul><ul><ul><li>Dialysis </li></ul></ul></ul></ul><ul><ul><ul><li>Nerves-Neuropathy </li></ul></ul></ul><ul><ul><ul><ul><li>Pain </li></ul></ul></ul></ul><ul><ul><ul><li>Limb loss </li></ul></ul></ul><ul><ul><ul><ul><li>Wheel Chair </li></ul></ul></ul></ul><ul><ul><ul><li>Erectile dysfunction </li></ul></ul></ul>Damien Luviano, MD, FACS
  9. 9. <ul><li>Lets talk about Eyes </li></ul>Damien Luviano, MD, FACS
  10. 10. <ul><li>Blindness </li></ul><ul><ul><li>Diabetes is LEADING cause of new cases of blindness among adults aged 20-74 years. </li></ul></ul><ul><ul><li>Can occur from within months </li></ul></ul>Damien Luviano, MD, FACS
  11. 11. <ul><li>TWO TYPES </li></ul><ul><ul><li>NON-PROLIFERATIVE (mild, moderate, severe) </li></ul></ul><ul><ul><li>PROLIFERATIVE (Laser) </li></ul></ul><ul><li>MACULAR EDEMA </li></ul><ul><ul><li>Present (LASER) </li></ul></ul><ul><ul><li>Absent </li></ul></ul>Damien Luviano, MD, FACS
  12. 12. <ul><li>How does diabetes hurt all these organs? </li></ul><ul><li>Are all these organs connected? </li></ul>Damien Luviano, MD, FACS
  13. 13. <ul><li>PATHOPHYSIOLOGY (MECHANISM) </li></ul>Damien Luviano, MD, FACS
  14. 14. <ul><ul><ul><li>Genetic </li></ul></ul></ul><ul><ul><ul><li>Environmental </li></ul></ul></ul><ul><ul><ul><li>Immunological </li></ul></ul></ul><ul><ul><ul><ul><li>HLA-DR4+ and DR3 </li></ul></ul></ul></ul><ul><ul><ul><li>Long term hyperglycemia </li></ul></ul></ul><ul><ul><ul><ul><li>Most important factor at present </li></ul></ul></ul></ul>Frank RN: Etiologic mechanisms in diabetic retinopathy. In Ryan SJ, ed: Retina, Schachat AP and Murphy RP, eds vol. 2 Medical Retina,, St. Louis, 1994, Mosby, p. 1245-1246 Damien Luviano, MD, FACS
  15. 15. Frank RN: Etiologic mechanisms in diabetic retinopathy. In Ryan SJ, ed: Retina, Schachat AP and Murphy RP, eds vol. 2 Medical Retina,, St. Louis, 1994, Mosby, p. 1263 Damien Luviano, MD, FACS
  16. 16. <ul><li>NUMBERS </li></ul><ul><li>STATISTICS </li></ul><ul><li>DEMOGRAPHICS </li></ul><ul><li>RISK FACTORS </li></ul>Damien Luviano, MD, FACS
  17. 17. Damien Luviano, MD, FACS
  18. 18. Damien Luviano, MD, FACS
  19. 19. Damien Luviano, MD, FACS
  20. 20. <ul><li>HGA1C </li></ul><ul><li>1% REDUCES 50% RISK </li></ul>Damien Luviano, MD, FACS
  21. 21. <ul><li>WHAT MAKES DISEASE WORSE? </li></ul>Damien Luviano, MD, FACS
  22. 22. Adverse Risk Factors 1. Long duration of diabetes <ul><li>Obesity </li></ul><ul><li>Hyperlipidaemia </li></ul>2. Poor metabolic control 3. Pregnancy 4. Hypertension 5. Renal disease 6. Other <ul><li>Smoking </li></ul><ul><li>Anemia </li></ul>Damien Luviano, MD, FACS
  23. 23. <ul><li>I SEE FINE, I HAVE NO SYMPTOMS MY DOCTOR SAYS I HAVE DIABETES DAMAGE, CAN THAT BE TRUE? </li></ul>Damien Luviano, MD, FACS
  24. 24. <ul><li>SYMPTOMS </li></ul>Damien Luviano, MD, FACS
  25. 25. <ul><li>In the initial stages </li></ul><ul><ul><li>NO Symptoms </li></ul></ul><ul><li>Advanced stages of the disease </li></ul><ul><ul><li>experience floaters </li></ul></ul><ul><ul><li>blurred vision </li></ul></ul><ul><ul><li>progressive visual acuity loss </li></ul></ul><ul><ul><li>Red eye </li></ul></ul><ul><ul><li>Pain </li></ul></ul>Damien Luviano, MD, FACS
  26. 26. <ul><li>What does the Doctor Actually see? </li></ul>Damien Luviano, MD, FACS
  27. 27. <ul><li>CLINICAL FINDINGS (DOCTOR EXAM) </li></ul>Damien Luviano, MD, FACS
  28. 28. Damien Luviano, MD, FACS
  29. 29. Preproliferative diabetic retinopathy Treatment - not required but watch for proliferative disease <ul><li>Cotton-wool spots </li></ul><ul><li>Venous irregularities </li></ul><ul><li>Dark blot haemorrhages </li></ul><ul><li>Intraretinal microvascular </li></ul><ul><li>abnormalities (IRMA) </li></ul>Signs Damien Luviano, MD, FACS
  30. 30. Proliferative diabetic retinopathy <ul><li>Flat or elevated </li></ul><ul><li>Severity determined by comparing with area of disc </li></ul>Neovascularization Neovascularization of disc = NVD <ul><li>Affects 5-10% of diabetics </li></ul><ul><li>IDD at increased risk (60% after 30 years) </li></ul>Neovascularization elsewhere = NVE Damien Luviano, MD, FACS
  31. 31. Indications for treatment of proliferative diabetic retinopathy NVD > 1/3 disc in area Less extensive NVD + haemorrhage NVE > 1/2 disc in area + haemorrhage Damien Luviano, MD, FACS
  32. 32. <ul><li>How is the Doctor Going to Fix my eyes? </li></ul>Damien Luviano, MD, FACS
  33. 33. <ul><li>TREATMENT </li></ul><ul><ul><li>NONPROLIFERATIVE </li></ul></ul><ul><ul><ul><li>Glucose Control </li></ul></ul></ul><ul><ul><li>PROLIFERATIVE </li></ul></ul><ul><ul><ul><li>Glucose Control </li></ul></ul></ul><ul><ul><ul><li>Laser of retina outside macula </li></ul></ul></ul><ul><ul><ul><li>Surgery to remove vitreous and scars (jelly) </li></ul></ul></ul><ul><ul><li>MACULAR EDEMA </li></ul></ul><ul><ul><ul><li>Glucose Control </li></ul></ul></ul><ul><ul><ul><li>Laser of Macula </li></ul></ul></ul><ul><ul><ul><li>Steroids and Avastin not FDA approved </li></ul></ul></ul><ul><ul><ul><li>Lucentis in Clinical Trials </li></ul></ul></ul>Damien Luviano, MD, FACS
  34. 34. <ul><li>Spot size (200-500  m ) depends </li></ul><ul><li>on contact lens magnification </li></ul><ul><li>Gentle intensity burn (0.10-0.05 sec) </li></ul><ul><li>Follow-up 4 to 8 weeks </li></ul><ul><li>Area covered by complete PRP </li></ul><ul><li>Initial treatment is 2000-3000 burns </li></ul>Laser panretinal photocoagulation Damien Luviano, MD, FACS
  35. 35. Assessment after photocoagulation <ul><li>Persistent neovascularization </li></ul><ul><li>Hemorrhage </li></ul>Poor involution <ul><li>Re-treatment required </li></ul><ul><li>Regression of neovascularization </li></ul><ul><li>Residual ‘ghost’ vessels or </li></ul><ul><li>fibrous tissue </li></ul>Good involution <ul><li>Disc pallor </li></ul>Damien Luviano, MD, FACS
  36. 36. Treatment of clinically significant macular oedema <ul><li>For microaneurysms in centre of hard </li></ul><ul><li>exudate rings located 500-3000  m </li></ul><ul><li>from centre of fovea </li></ul>Focal treatment <ul><li>Gentle whitening or darkening of </li></ul><ul><li>microaneurysm (100-200  m , 0.10 sec) </li></ul><ul><li>For diffuse retinal thickening located more </li></ul><ul><li>than 500  m from centre of fovea and </li></ul><ul><li>500  m from temporal margin of disc </li></ul>Grid treatment <ul><li>Gentle burns (100-200  m , 0.10 sec), </li></ul><ul><li>one burn width apart </li></ul>Damien Luviano, MD, FACS
  37. 37. Indications for vitreoretinal surgery Retinal detachment involving macula Severe persistent vitreous haemorrhage Dense, persistent premacular haemorrhage Progressive proliferation despite laser therapy Damien Luviano, MD, FACS
  38. 38. <ul><li>DOCTOR </li></ul><ul><li>Glucose Control </li></ul><ul><ul><li>Goal less HgA1c 7.0 </li></ul></ul><ul><li>Hypertension Control </li></ul><ul><li>Lipid Control </li></ul><ul><li>Lasers (temporary) </li></ul><ul><li>Injections (temporary) </li></ul><ul><li>PATIENT </li></ul><ul><li>Weight Control </li></ul><ul><li>Smoking Control </li></ul><ul><li>Exercise </li></ul><ul><li>Alcohol Control </li></ul>Damien Luviano, MD, FACS
  39. 39. <ul><li>How often should I see the Eye Doctor? </li></ul>Damien Luviano, MD, FACS
  40. 40. <ul><li>FOLLOW UP </li></ul><ul><ul><li>Controlled Diabetes </li></ul></ul><ul><ul><ul><li>12 months </li></ul></ul></ul><ul><ul><li>Diabetic Retinopathy Present </li></ul></ul><ul><ul><ul><li>1-16 weeks </li></ul></ul></ul>Damien Luviano, MD, FACS
  41. 41. <ul><li>How many kinds of eye doctors are there? </li></ul>Damien Luviano, MD, FACS
  42. 42. <ul><li>PHYSICIANS </li></ul><ul><li>M.D </li></ul><ul><li>Surgeons </li></ul><ul><ul><li>Laser </li></ul></ul><ul><ul><li>Surgery </li></ul></ul><ul><ul><li>Eyeglasses prescription </li></ul></ul><ul><li>Medical School </li></ul><ul><ul><li>Manage medical problems </li></ul></ul><ul><li>12-14 years of Training </li></ul><ul><li>Mandatory Dilation </li></ul><ul><li>EYE GLASS DOCTORS </li></ul><ul><li>O.D </li></ul><ul><li>Optometrist </li></ul><ul><ul><li>Eyeglasses prescription </li></ul></ul><ul><ul><li>Optical Service (optician) </li></ul></ul><ul><li>Optometry School </li></ul><ul><li>6-8 years of Training </li></ul><ul><li>Optional Dilation (cost extra) </li></ul>Damien Luviano, MD, FACS
  43. 43. <ul><li>PROBLEMS </li></ul><ul><li>DIABETES IS SERIOUS </li></ul><ul><li>HURT MANY ORGANS </li></ul><ul><li>PREVENTABLE </li></ul><ul><li>SOLUTIONS </li></ul><ul><li>GLUCOSE CONTROL </li></ul><ul><li>FOLLOW PHYSICIANS ADVICE </li></ul>Damien Luviano, MD, FACS
  44. 44. Damien Luviano, MD, FACS
  45. 45. <ul><li>INTERPRETATION: Treatment with fenofibrate in individuals with type 2 diabetes mellitus reduces the need for laser treatment for diabetic retinopathy, although the mechanism of this effect does not seem to be related to plasma concentrations of lipids. </li></ul>Damien Luviano, MD, FACS
  46. 46. <ul><li>CONCLUSIONS: Intensive glycemic control and intensive combination treatment of dyslipidemia, but not intensive blood-pressure control, reduced the rate of progression of diabetic retinopathy. (Funded by the National Heart, Lung, and Blood Institute and others; ClinicalTrials.gov numbers, NCT00000620 for the ACCORD study and NCT00542178 for the ACCORD Eye study.) </li></ul>Damien Luviano, MD, FACS
  47. 47. <ul><li>CONCLUSIONS: Early blockade of the renin-angiotensin system in patients with type 1 diabetes did not slow nephropathy progression but slowed the progression of retinopathy. </li></ul>Damien Luviano, MD, FACS
  48. 48. <ul><li>Regardless of vision, PRP is beneficial (reduced severe vision loss by  50%-60%) in the management of patients with severe NPDR, preproliferative and especially beneficial in high-risk proliferative retinopathy.  PRP is also indicated for NVI   </li></ul>Damien Luviano, MD, FACS
  49. 49. <ul><li>Conclusions: Early vitrectomy is recommended for type 1 DM with severe visual loss secondary to vitreous hemorrhage. Earlyvitrectomy is recommended for eyes with useful vision and advancedactive PDR, especially with extensive neovascularization. Endolaser at the time of vitrectomy  was not preformed at the time of vitrectomy </li></ul>Damien Luviano, MD, FACS
  50. 50. <ul><li>Aspirin has no benefitOnly patients with high-risk PDR and possibly severe NPDR in both eyes should receive immediate PRP in nasal and inferior quadrantsAll patients with CSME should be treated regardless of visionIn NPDR focal macular laser is performed before scatter PRP </li></ul>Damien Luviano, MD, FACS
  51. 51. <ul><li>Results: Tighter BP control decreased diabetes related mortality by 32%.Tighter BP control decreased deterioration of retinopathy and visual acuity by 34% and 47% respectively.  Conclusion: Tighter BP control is beneficial in reducing complications from diabetic retinopathy. </li></ul>Damien Luviano, MD, FACS
  52. 52. <ul><li>Result: Intensive treatment group had a 12% reduced risk of diabetes associated complication when compared with the conventional group.Intensive treatment reduced mortality by 10% and morbidity by 6%.Intensive treatment had a significant 25% risk reduction in microvascular endpoints (fewer cases of PRP)  Conclusion: Tighter BS control is beneficial in type 2 DM. </li></ul>Damien Luviano, MD, FACS
  53. 53. <ul><li>Results: (6.5 years follow up) Intensive therapy reduced– development of DR by 76% and severe NPDR/PDR by 47%, progression ofDR by 54%, macular edema by 23%, and risk of laser treatment by 56%. HgA1c is strongly related to incidence of diabetic retinopathy Conclusion: Tighter BS control should be recommended. Aim for HgA1c o 7% or less </li></ul>Damien Luviano, MD, FACS
  54. 54. <ul><li>Objective: Follow up patients after termination of DCCT Results: (Additional 4 years follow up)Intensive therapy reduced - progression of DR by 75%, macular edema by 58%, risk of laser treatment by 52%. Despite a similar HgA1c of 7.5%-8% in each group. Conclusion: Tighter BS control has long-term benefit. </li></ul>Damien Luviano, MD, FACS
  55. 55. <ul><li>THE END </li></ul><ul><li>QUESTIONS </li></ul>Damien Luviano, MD, FACS

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