Guest guest Posted May 16, 2009 Report Share Posted May 16, 2009 1.MedWatch - Disetronic Medical Systems Inc. ACCU-CHEK Spirit Insulin Pump. Disetronic Medical Systems Inc. and FDA notified healthcare professionals about a defect in the " up " and/or " down " buttons of some ACCU-CHEK Spirit insulin pumps. This failure may present as an intermittent or complete loss of function of the " up " and/or " down " buttons. If the buttons do not function, users may not be able to change any programmed setting on the pump. If this failure occurs, the pump may not respond with a vibration or acoustic confirmation signal to a button press and the display will remain unchanged. Users may contact ACCU-CHEK Spirit hotline noted in the Press Release for a replacement pump or for any other questions regarding this potential defect. 2.%% Ophthalmology Vol 116,Issue 5 (May 2009) Intravitreal Triamcinolone Acetonide Injection for Treatment of Refractory Diabetic Macular Edema: A Systematic Review Conclusions - Intravitreal triamcinolone acetonide injection is effective in improving VA [visual acuity] in patients with refractory DME in the short-term, but the benefits do not seem to persist in the long-term. 3.%% Ophth Vol 116, Issue 5 (May 2009) Optical Coherence Tomographic Hyperreflective Foci: A Morphologic Sign of Lipid Extravasation in Diabetic Macular Edema Conclusions - Well-demarcated, hyperreflective foci were identified in the retina of patients with DME. The deposits were located within walls of intraretinal microaneurysms and scattered throughout all retinal layers, forming confluent plaques in the outer plexiform layer. It is suggested that the foci represent extravasated lipoproteins and/or proteins being a very early subclinical barrier breakdown sign in DME. 4.%% Ophth Vol 116,issue 5 May 2009 Vitreous Mediators after Intravitreal Bevacizumab [avastin] or Triamcinolone Acetonide in Eyes with Proliferative Diabetic Retinopathy Conclusions - Intravitreal injection of bevacizumab potentially diminishes not only VEGF but also SDF-1a. These findings suggest that intravitreal bevacizumab may influence intraocular mediators beyond VEGF. 5.%% Microincision Vitrectomy Surgery and Intravitreal Bevacizumab as a Surgical Adjunct to Treat Diabetic Traction Retinal Detachment Purpose - To investigate the feasibility and efficacy of microincision vitrectomy surgery (MIVS) combined with intravitreal bevacizumab (IVB) as a surgical adjunct for treating traction retinal detachment (TRD) secondary to severe proliferative diabetic retinopathy . [71 eyes of 59 patients] Conclusions - Intravitreal bevacizumab plus MIVS offers comparable anatomic success .. This technique shortens the surgical time with fewer intraoperative complications and favorable visual recovery. However, caution should be taken because of rapid progression of the preexisting TRD after IVB in some patients. 6.%% MW - Higher Cardiorespiratory Fitness Tied to Lower Mortality in Diabetic Men April 17, 2009 - Among middle-aged and older men with T2DM, exercise capacity is a strong predictor of death from any cause over a 7-year period .. Reasearchers say their study supports a strong association between increased exercise capacity and lower risk of all-cause mortality, and suggests that this association may be more pronounced in Caucasians than in African Americans. [1703 Af Amer;1445 cauc men with T2]Compared with subjects in the low-fit category, the mortality risk reduction for those in the moderate-fit category was 43% for Caucasians and 34% for African Americans. In the high-fit category, the mortality risk was lowered by 67% in Caucasians and only by 46% in African Americans. It's important to note, they say, that their cohort consists of veterans who mostly represent relatively low socioeconomic strata, whereas most information on the benefit of fitness on mortality in diabetics has been derived from more privileged populations... health care professionals should encourage DM subjects to initiate and maintain a physically active lifestyle consisting of moderate-intensity activities. " Diabetes Care. 2009;32: Reuters Health Information 2009. 7.%% MW- CRP Measurement Does Not Improve Mortality Prediction in Diabetics April 24, 2009 - Plasma C-reactive protein (CRP) values are associated with mortality risk in patients with T2DM, but are no more useful than traditional risk factors for predicting 5-year mortality in this population. CRP measurements were available for 2,381 DM patients; follow-up 5.4 years. CRP values were positively correlated with body mass index, waist circumference, BP, plasma glucose, hemoglobin A1c, total and LDL cholesterol, apolipoprotein B, uric acid, and albumin excretion rate. There was a negative correlation between CRP and HDL cholesterol and apolipoprotein A1 . Still, the research team maintains, " From a clinical point of view, CRP measurement allows the reclassification of a very limited proportion of patients on the basis of their 5-year probability of surviving. " Reuters Health Information 2009. Diabetes. 2009;58: 8.%%Sexual Dysfunction Is Prevalent in Women With Type 1 Diabetes May 4, 2009 In general, studies of sexual dysfunction in women have lagged behind those in men..[652 subjects;10year study] Specific problems noted by women with female sexual dysfunction FSD were loss of libido (57%); problems with orgasm (51%), lubrication (47%), arousal (38%); and pain (21%). " FSD is common in women with T1and affects all aspects of sexual function and satisfaction, " the authors write. " Depression is the major predictor of sexual dysfunction in women with T1. " In contrast to findings in men, our results showed that in women with T1,depression and marital status are the main predictors of FSD, whereas glycemic control and complications were not associated with FSD, " the study authors conclude. Diabetes Care. 2009;32:780-785. 9.%% WM - Intravitreal Bevacizumab (Avastin) for Primary Treatment of Diabetic Macular Oedema (DME)5/01/2009 Thirty eyes of 30 DM patients were treated with 2.5 mg of intravitreal bevacizumab injection as the primary therapy for DME. Results: visual acuity increased in 80% of eyes during a mean follow-up of 5.6 months. Discussion - DME is the most important cause of visual acuity impairment in patients with DM. . The important pathophysiology of DME is the loss of retinal capillary pericytes [a cell found around a capillary], resulting in increased vascular permeability [leakage] In conclusion, this study demonstrated that intravitreal bevacizumab application is an effective approach with promising results for the primary treatment of DME. Intravitreal bevacizumab [avastin]provides significant resolution of macular oedema and improvement in VA. However, further studies are needed to obtain the long-term results of such application. 10.%% Fasting Glucose and A1C Point to Diabetes Onset (Reuters Health) Apr 28 - Combined measurement of fasting plasma glucose (FPG) and A1C appears to be an effective means of predicting the onset of T2DM. Moreover, the lead investigator told Reuters Health, " I think that the combined measurement of FPG and A1C is a more useful marker to estimate the risk of T2 than the oral glucose tolerance test in clinical practice, because it is convenient and easily available. " [6700 non-diabetic men 40 to 55 years;4 years follow-up, DM was confirmed in 659 of the participants. Both FPG and A1C were independently associated with the risk of DM. However, the combination had greater precision Diabetes Care 2009;32: 11.%% From Faculty of 1000 Medicine - The Effect of a Low-Fat, High-Protein or High-Carbohydrate Ad Libitum Diet on Weight Loss Maintenance and Metabolic Risk Factors. 4/24/2009 Int J Obes (Lond) 2009 Mar 33(3):296-304 Commentary : High-protein diets should be considered more often in weight reduction programs. This randomized clinical trial show that weight maintenance during 12 weeks after a 5-week very-low-energy diet was better in participants eating a high-protein, moderate- carbohydrate diet, compared to a moderate-protein, high- carbohydrate diet. The type of protein (fast or slow absorption) did not have an effect on weight maintenance. .The diet composition (as % in energy intake) in the present study was: high-protein, moderate -carbohydrate diet: protein 35%, carbohydrate 42%,fat 24%; moderate- protein, high-carbohydrate diet: protein 16%, carbohydrate 63%, fat 21%. The combined high-protein groups lost about 1kg [2.2 lb] during the 12-week intervention period, whereas the high- carbohydrate group gained an approximately equal amount. The focus on weight maintenance period after weight loss was the new aspect and strength in the present study. . future studies should use longer interventions and/or follow the participants for at least 1 year after the intervention. It would also be important to compare the long-term effects on weight maintenance of high-protein, moderate carbohydrate, low-fat diets with high-protein, high-fat, low- carbohydrate diets. Faculty of 1000 Medicine C 2009 Medicine Reports Ltd. 12.%% Medscape Psychiatry & Mental Health > Viewpoints Understanding the Pathophysiology of Depression in Diabetes 4/29/2009 Focal Subcortical Biophysical Abnormalities in Patients Diagnosed With T2DM and Depression Arch Gen Psychiatry. 2009;66: Summary - Patients with T2 often also have major depressive disorder, but the underlying neurobiological substrates are still poorly understood. The goal of this study was to elucidate the pathophysiology of depression in DM by evaluating the biophysical integrity of proteins in critical white and gray matter regions in [these patients] Using MRI, this cross-sectional study looked at the anterior cingulate, corpus callosum, frontal and occipital white matter, and the caudate and lenticular nuclei in 16 patients with T2 and major depression, in 22 patients with DM but without depression (diabetic controls), and in 30 controls without DM or major depression (healthy controls). Magnetization transfer ratios, which reflect the structure of proteins in the gray and white matter, were significantly lower bilaterally in the head of the caudate nucleus, but not in other regions, in the group with diabetes and depression vs the 2 control groups Limitations of this study include relatively small sample sizes, and the absence of a group with depression but without DM Nonetheless, this study has identified a subcortical biophysical component to depression in patients with T2, which also has broad implications for the neuronal circuitry underlying other mood disorders.. it may be useful to develop preclinical models targeting the caudate and other components of prefrontal-subcortical circuits involved in mood and behavior. 13.%% Medscape Medical News - Acellular Matrix Skin Graft Better Than Standard Care for the Treatment of Diabetic Foot Ulcers 4/27/09 - Treating diabetic foot ulcers with an acellular matrix (AM) skin graft resulted in faster and more complete healing than standard treatment.. " Bioengineered skin grafts, including [AM] grafts, are promising alternatives for DM lower extremity wounds that often are unresponsive to traditional wound management modalities, " write the researchers...Complete healing was achieved in 32 (69.6%) of the 46 patients in the AM group and in 18 (46.2%) of the 39 patients in the standard treatment group with odds of healing in the AM group 2.7 times higher than in the standard group. The mean time to complete healing was 5 to 7 weeks in the AM group and 6 to 8 weeks in the standard treatment group. AM grafts have several advantages over other bioengineered skin grafts. They promote cellular proliferation at the graft site and provide a scaffold for building dermal tissue, which can often be achieved in a single application. Because they are derived from human tissue, they are easily recognized by the body's immune system and do not provoke a foreign body or inflammatory tissue response. sponsored by Medical Technology, 14 %% MNTD Simultaneous Transplant Gives Best Results In Diabetics With Kidney Disease 1 May 2009 For patients with T1DM who need a kidney transplant, simultaneous pancreas-kidney (SPK) transplantation offers a higher survival rate than other options but with some increased risks. [6,900 T1subjects undergoing SPK] When SPK transplant was successful with both organs functional at one year, the long-term survival rate was 89% compared to 80% for patients receiving a kidney from a living donor and 65 % for those receiving a kidney (but not pancreas) (All SPK transplants came from deceased donors). However, SPK recipients were about 2% more likely to die during the first year after transplantation. There was also a 10-15% chance that the transplanted pancreas would fail during the first year - with long-term survival rate dropping to 74%.. The study is limited by a lack of information on why the SPK recipients lived longer .. although the study provides important new evidence that survival rate is higher after successful SPK transplantation, it does not help in predicting which patients will have a successful SPK transplant. Source: American Society of Nephrology (ASN) 15.%% MNTD Detecting Diabetes Without A Needle: The Spit Factor 29 Apr 2009 Research promoting a painless new method for detecting DM, utilizing saliva, will be revealed May 15, at the American Association of Clinical Endocrinologists (AACE) 18th Annual Meeting . While searching for biomarkers that may indicate diabetes, doctors examined the saliva of 40 different patients. patients need only to spit into a cup. The spit test could be performed for little cost in a doctor's office or at a patient's home. " Our goal was to characterize proteins in human saliva that may indicate prediabetes and T2, " said a member of the research team. " Analysis of these proteins allowed us to develop a new method for screening, detecting and monitoring the diabetic state. " 16.%% Heartwire - No Link Between Hypoglycemia and Mortality or Stroke/MI in Diabetic AMI Patients: DIGAMI-2 Analysis May 7, 2009 - A new analysis from the DIGAMI-2 study suggests that hypoglycemia during hospitalization for suspected AMI [acute heart attack-MI] is not, in itself, a risk factor for future adverse events in people with T2DM. The study is the latest to offer some reassurances to physicians treating hyperglycemia in AMI patients and to suggest that other comorbidities are likely responsible for the development of hypoglycemia during hospital admission. " These findings underline the safety of using insulin in hyperglycemic patients with T2 during the acute phase of a myocardial infarction, provided a careful blood glucose monitoring to ascertain early detection and treatment of hypoglycemic episodes, " 17.%% Adherence to Mediterranean Diet May Ward Off Diabetes Heartwire June 3, 2008 - People who eat a Mediterranean-style diet are less likely to develop new-onset diabetes, new research suggests. Results suggest that the benefits of a traditional Mediterranean diet, rich in olive oil, vegetables, fruits, nuts, cereals, legumes, and fish but relatively low in meat and dairy products, may be especially pronounced in people who are at higher risk of developing DM due to weight, family history, BP, or other factors. [13,380 subjects] Strikingly, people with the highest scores for diet adherence were also more likely to have risk factors for diabetes, yet incidence of the disease was no higher in this group, " suggesting that the diet might have a substantial potential for prevention, " the authors write. 18.%%Reuters Health Information - Antibiotic Use in Childhood Not Linked to Type 1 Diabetes May 1, 2009 - Contrary to what several other studies have shown, the results of a nationwide study of Danish children suggest that antibiotic use does not affect the development of T1DM. The proposed mechanism for the association is that early antibiotic use affects the gut microflora, which in turn influences the gut immune system. Dysfunction in this immune system is thought to be involved in the pathogenesis of T1. However, the studies " have all been case-control studies, and most of them have focused on infections and vaccinations and have not analyzed the association in any detail. " the lead author said. [606,420 children] The present findings, the authors conclude, suggest no association between antibiotic use and T1 Nonetheless, there remains a need for " large, analytical studies of the long-term health effects of drug use in susceptible groups, such as children, and especially so for drugs used as prevalently as antibiotics and for common chronic diseases, such as T1. 19.%% NY Times May 12, 2009 Vitamins Found to Curb Exercise Benefits .. Exercise is known to have many beneficial effects on health, including on the body's sensitivity to insulin. " Get more exercise " is often among the first recommendations given by doctors to people at risk of DM. But exercise makes the muscle cells metabolize glucose, by combining its carbon atoms with oxygen and extracting the energy that is released. In the process, some highly reactive oxygen molecules escape and make chemical attacks on anything in sight. These reactive oxygen compounds are known to damage the body's tissues. The amount of oxidative damage increases with age. The body has its own defense system for combating oxidative damage, but it does not always do enough. So antioxidants, which mop up the reactive oxygen compounds, may seem like a logical solution. The team led by a nutritionist, tested this proposition by having young men exercise, giving half of them moderate doses of vitamins C and E and measuring sensitivity to insulin ..The team found that in the group taking the vitamins there was no improvement in insulin sensitivity and almost no activation of the body's natural defense mechanism against oxidative damage. The reason, they suggest, is that the reactive oxygen compounds, inevitable byproducts of exercise, are a natural trigger for both of these responses. The vitamins, by efficiently destroying the reactive oxygen, short-circuit the body's natural response to exercise. " If you exercise to promote health, you shouldn't take large amounts of antioxidants. The co-author from Joslin Diabetes Center added The effect of vitamins on exercise and glucose metabolism " is really quite significant..If people are trying to exercise, this is blocking the effects of insulin on the metabolic response. " The advice does not apply to fruits and vegetables, he said ; even though they are high in antioxidants, the many other substances they contain presumably outweigh any negative effect. . it might be that reactive oxygen is beneficial in small doses, because it touches off the body's natural defense system, but harmful in higher doses. study results published in this weeks The Proceedings of the National Academy of Sciences 20.%% MW FDA Safety Changes: Glyburide (DiaBeta) May 7 FDA approved safety labeling revisions [March 25] for glyburide to advise of drug interactions. The hypoglycemic action of sulfonylureas may be potentiated by certain medications such as nonsteroidal anti- inflammatory drugs and agents that are highly protein bound, the FDA warned, noting that the latter category includes salicylates, sulfonamides, chloramphenicol, probenecid, monoamine oxidase inhibitors, beta-adrenergic blocking agents, and also clarithromycin. Patients receiving any of these products in conjunction with glyburide therapy should be observed closely for hypoglycemia and also for loss of glycemic control when such drugs are withdrawn. The FDA also warned of glyburide drug interactions with cyclosporine and bosentan. Concomitant use of glyburide can increase cyclosporine plasma concentrations and the risk for toxicity. Patients receiving combination therapy may require cyclosporine dose adjustments. In a clinical trial of glyburide in patients with chronic heart failure, an increased incidence of elevated levels of liver transaminases was observed during concomitant treatment with bosentan, a dual endothelin receptor antagonist. The mechanism of action is unknown but in part may be the result of additive inhibition of the hepatocellular bile salt export pump, resulting in increased hepatocyte concentrations of toxic bile salts. Concomitant use of glyburide and bosentan is therefore contraindicated. Glyburide is a second-generation sulfonylurea drug indicated as an adjunct to diet and exercise to improve glycemic control in adults with T2 21.%% MNTD Levemir® Once-Daily Substantially Lowered Average Blood Sugar Levels Of Patients With T2 In TITRATE® Study 11 May 2009 Novo Nordisk announced results from the TITRATER study showing that LevemirR (insulin detemir), taken once-daily, substantially lowered average blood sugar. Approximately 60% of patients on LevemirRreached their (ADA) recommended average blood sugar level. " Teaching and empowering patients to adjust their own insulin doses can help them achieve good blood sugar control, " said the lead researcher...Rates of minor hypoglycemic events were low and comparable between the two treatment groups [244 T2 patients taking oral antidiabetes drugs, who had never before used insulin, were assigned to one of two treatment groups .Source Novo Nordisk 22.%% Medscape Medical News -ARVO 2009: Ruboxistaurin [arxxant] Associated With Decreased Visual Acuity Decline in Moderate to Severe Diabetic Retinopathy May 12, 2009 Ruboxistaurin, a selective protein kinase C (PKC) B inhibitor, is associated with less decline in visual acuity in patients with moderate to severe nonproliferative diabetic retinopathy over a 6-year period. " The total number of cases of 3-line vision loss worldwide is currently at a quarter to two thirds of a million per year, " said one researcher " A single occurrence of 3-line vision loss is not necessarily predictive of permanent vision loss, but 2 occurrences 6 months apart can lead to an irreversible case of vision loss for that patient. " [514 patients] Results showed that ruboxistaurin reduced the occurrence of sustained moderate visual loss SMVL from 9.1% in the placebo group to 5.5% in the ruboxistaurin group ARVO Abstract 4330. 23.%% ARVO 2009: Candesartan [Atacand] May Improve Regression of Retinopathy in Patients With T2DM May 12, 2009 Treatment with candesartan, an angiotensin-receptor blocker, can induce significant improvement in retinopathy patients with T2 irrespective of hypertension status at baseline. " In patients with nephropathy, the evidence is particularly strong for agents that block the renin- angiotensin system [RAS], " said the lead author " However, the role of RAS blockers in retinopathy is less clear. " The DIRECT program is made up of 3 randomized placebo-controlled studies on the effects of candesartan on incidence, progression, and regression of diabetic retinopathy in both T1 and T2 " DIRECT is the largest trial on diabetic retinopathy ever performed, with the total number of patients enrolled at more than 5000, " When analyzing regression by hypertension treatment, the effects from candesartan treatment appeared similar in patients with normal BP at baseline and in those on treatment for hypertension Subgroup analyses showed that regression was induced in the eyes of patients in the candesartan- treatment group up to level 35 on the ETDRS scale, but not in the eyes with more severe retinopathy. " We have speculated that during the early stages, there is a possibility of a treatment effect with candesartan, whereas in the later stages, we have a preponderance of ischemia and seem to reach a point of no return,..the treatment effect of candesartan on regression was consistent across subgroups based on baseline hemoglobin A 1c, urinary albumin excretion rate, and waist-hip ratio. the number 1 take-away is that in patients with T2 and mild retinopathy, there is a potential for improvement in lowering retinopathy with this drug, which is also efficient in lowering BP - an issue for these types of patients. What we also found was that the effect of the treatment seemed to be in patients with mild eye disease, irrespective of BP level at baseline. " This study was funded by AstraZeneca and Takeda. 24.%% Eye (2009) 23, Management of diabetic retinopathy: could lipid-lowering be a worthwhile treatment modality? Diabetic eye disease confers substantial burden on the patient quality of life. Current therapeutic strategies indicate an unmet clinical need for preventive therapy. Tight control of BP and glycaemia are mandatory components of primary prevention strategies, but are insufficient to eliminate risk in all patients. A body of evidence supports a role for lipid-modifying therapy in reducing diabetic retinopathy endpoints. Although inconclusive for statin therapy, results from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study show beneficial effects of fenofibrate in reducing the requirement for laser therapy, and particularly in preventing disease progression in patients with pre-existing DM retinopathy. However, there is a need for confirmation of these findings in large prospective studies with progression of retinopathy as the primary endpoint, such as the ACCORD-EYE (Action to Control Cardiovascular Risk in Diabetes- EYE) study, 25.%% Eye (2009) 23, Vitreous levels of erythropoietin EPOin patients with macular oedema secondary to retinal vein occlusions RVO.. Conclusions - EPO [hormone which stimulates production of red blood cells] levels are not elevated in patients with macular oedema secondary to RVO. Patients with DME have high levels of EPO. These results suggest that EPO could be involved in the pathogenesis of DM retinopathy, but not in macular oedema secondary to RVO. 26.%% MW Vegetarian Diets May Protect Against Obesity, Type 2 Diabetes May 14, 2009 - Vegan and vegetarian diets may protect against obesity and T2DM . " The European Prospective Investigation found that BMI [body mass index] was highest in meat eaters, lowest in vegans, and intermediate in fish eaters, " write the researchers. " The protective effects of vegetarianism against overweight may be due to avoidance of major food groups, displacement of calories toward food groups that are more satiating, or other factors. Based on a review of experimental data, investigators have suggested that the portfolio of foods found in vegetarian diets may carry metabolic advantages for the prevention of T2. " This study compared the prevalence of T2 in people on different types of vegetarian diets vs that in nonvegetarians; 22,434 men and 38,469 women. Vegans had the lowest BMI. There was a progressive increase in BMI with increased content of animal products The prevalence of T2 also increased with increasing consumption of animal products: 2.9% for the vegan diet, 3.2% for the lacto-ovo diet, 4.8% for the pesco -vegetarian diet, 6.1% for the semi-vegetarian diet, and 7.6% for the nonvegetarian diet. Compared with nonvegetarians, vegetarians had a lower risk for T2, after adjustment for age, sex, ethnicity, education, income, physical activity, TV watching, sleep habits, alcohol use, and BMI. Limitations of this study include lack of data on glycemic load of the diets.Diabetes Care. 2009;32: 27.%% Reuters Health Information Cardiac Abnormalities Seen in Girls With Poorly Controlled Diabetes May 13 - Adolescent girls with poorly controlled T2DM are more likely to have structural and functional cardiac abnormalities than are their healthy peers or even girls with T1DM. The study " highlights the potential high cardiovascular risk occurring in adolescent T2, " even though the disease has been present for just a few years, [8 girls with T2; 11 T1;control group 9 lean and 11 overweight girls]. Although the groups were similar in age and height, girls with T2 weighed more than the other girls. Echocardiography revealed that the left ventricular dimensions and left ventricular mass were greater in the T2 group than in the others, a finding that remained after indexed to height..Only 1 of the 8 girls with T2 had no cardiac abnormalities. By comparison, in the lean healthy and T1 groups, abnormalities were almost non-existent, and even in the overweight control group, many girls had no cardiac abnormalities. " This study is the first to demonstrate that important cardiac abnormalities occur early in adolescent-onset T2 and highlights the potential for higher cardiovascular risk, " the authors conclude. " If left unchecked, it is likely that these changes will lead to the development of clinically overt cardiovascular disease. " Diabetes Care 2009;32:883-888. 28.%% Chronic Kidney Disease Increases Risk for Hypoglycemia With or Without Diabetes May 14, 2009 - Patients with chronic kidney disease (CKD) have an increased incidence of hypoglycemia, which is associated with excessive mortality rate, . " Adverse consequences of hypoglycemia may at least partially explain the greater risk for cardiovascular disease (CVD) outcomes observed in at least three recent studies of intensive glucose lowering in patients with diabetes, " [ 243,222 patients] " The excessive mortality associated with hypoglycemia makes this complication a significant threat to patient safety in CKD....Although the extent to which the increased risk for hypoglycemia is due to medical therapy is unknown, this metabolic disturbance should be considered an important patient safety outcome in CKD or diabetes populations. " ARVO - Association for Research in Vision and Ophthalmology 2009 Annual Meeting. Abbreviations: DM - diabetes Mellitus;T1DM - type 1 diabetes mellitus T2DM - type 2; DME - diabetic macular edema; BP - blood pressure; CV - cardio-vascular; MI -myocardial infarction or heart attack ;HTN - hypertension or high BP; OCT - [optical coherence tomography -ADA - Amer Diabetes Asso; AFB - Amer Foundation for the Blind ;CDC Centers for Disease Control and Prevention; FDA Federal Drug Administration; JH - s Hopkins ; MW Medscape Web MD; NIH - National Institutes of Health; VA - Veterans Administration. MNTD- Medical News Today Definitions - Dorlands 31st Ed and Google. Disclaimer, I am a BSN RN but not a diabetic or diabetic educator. Reports are excerpted unless otherwise noted. This project is done as a courtesy to the blind/visually impaired and diabetic communities. Dawn Wilcox Coordinator The Health Library at Vista Center contact above e-mail or thl@... 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