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Going gluten-free might actually increase your risk of diabetes Men's Fitness But those people who mistakenly think that going gluten-free is healthier may end up with higher risk of developing type-2 diabetes, say the researchers. Their study, which analyzed almost 200,000 people from three long-term studies and 4.24 million ... Type 2 diabetes linked to low gluten dietsBel Marra Health Could Going Gluten Free Raise Your Risk Of Diabetes?Coach all 9 news articles »

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Going gluten-free might actually increase your risk of diabetes - Men's Fitness

March 13 at 10:00 AM

Gluten-free diets are all the rage, but shunning gluten may offer no benefit to overall health for most people, a new analysis suggests.

In fact, the people in the study who ate more gluten were 13 percent less likely to develop Type 2 diabetes over the 30-year study than those who ate less gluten, the researchers found.

For some individuals, there are health reasons to avoid gluten, a protein found in grains such as wheat, rye and barley. Certain people, for example, have an intolerance to gluten, which can lead to abdominal pain, bloating or fatigue. Others have celiac disease, an autoimmune disorder that affects mostly the small intestine; when people with this disease eat gluten, their immune system responds by attacking the intestines lining.

However, even some people who do not have celiac disease or an intolerance to gluten believe that gluten-free diets are healthier than those that include gluten products, and the researchers wanted to see whether this belief might have any scientific merit, said lead study author Geng Zong, a nutrition research fellow at Harvard Universitys T.H. Chan School of Public Health in Boston.

[Science you can eat]

In the study, the researchers looked at surveys conducted every two to four years in which nearly 200,000 people reported what they ate. The researchers estimated the participants gluten intake based on this information, and then looked at which participants went on to develop Type 2 diabetes over the 30-year study period. Type 2 the most common form of diabetes occurs when the body has lost the ability to use insulin efficiently. This inability leads to high blood sugar levels, which can damage blood vessel walls, nerves and other tissues.

The researchers focused on studying the participants risk of diabetes because this condition is one of the leading causes of death in the United States, Zong said.

By the end of the study, nearly 16,000 particIpants had developed Type 2 diabetes. The researchers found that those who ate the most gluten had a 13 percent lower risk of developing Type 2 diabetes during the study period than the people who ate the least gluten.

These findings suggest that there might be a link between gluten consumption and risk of diabetes, the researchers said. However, it is not clear why the people who ate more gluten were less likely to be diagnosed with Type 2 diabetes than those who ate less gluten, the researchers said.

One possible explanation is that the people who consumed more gluten also ate more fiber, which, as previous research has suggested, may help to lower a persons diabetes risk. However, more research is needed to examine the relationship between gluten consumption and diabetes, the researchers said.

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Gluten-free diets may be tied to an increased risk of Type 2 diabetes - Washington Post

Diabetes can pose a number of challenges to those with the diagnosis.

With a heavy emphasis on foods, content and the impacts of those choices, understanding nutrition labels can be a daunting task.

Theres a lot of label confusion, so were here to help, said Patricia Zimmerman, a registered dietitian and a certified diabetes educator with the Diabetes Support Group through Monongahela Valley Hospital.

Tomorrow, the group is hosting a Health Eating Supermarket Tour at the Willow Pointe Shop & Save in Belle Vernon.

Learn how to choose foods at the supermarket to manage a healthier lifestyle, the program reads. Health care professionals from Monongahela Valley Hospitals Center for Diabetes and Endocrinology will conduct the tours and discuss how to live a healthier lifestyle.

Zimmerman said a diabetes educator will accompany the group through aisles as they highlight and analyze different carbohydrates, fiber sources and sugar content. Those in attendance also learn about meal planning and shopping on a budget.

The free program requires advanced registration, Zimmerman said, adding that people can call 724-258-1483 for more information.

Well do whatever we can to improve food choices and selections, she said. And our biggest highlight is making sure theyre comfortable with reading a nutrition label.

A lot of people have questions about better choices, said Zimmerman. We also have questions from people about whether they need supplements.

Zimmerman said a common misconception is associated with sugar-free items.

Sugar-free doesnt mean lower carbs. They forget theres other forms of carbs, she said. We want to steer them in the right direction.

Heidi McClain, a registered dietician and certified diabetes educator with Highlands Hospital Diabetes Center, agreed. McClain, who is the only registered dietician in Fayette County that deals with outpatient care, added that she advises diabetics to steer clear of sweetened, sugary drinks.

Free up the limited number of calories you have save them for eating. There are so many calorie-free drinks to chose from, McClain said. She also suggested adding more whole grains and foods with higher fiber content.

As for trips to the supermarket, McClain said one of the keys to success is going with, and sticking to, a shopping list.

Dont shop when youre hungry, McClain said. And stick to the perimeter of the store. Theres where the dairy, meats, fruits and veggies are located.

If you have to go into the inner aisles, get what you need and get out, she added with a laugh. Itll also cut back on impulse buying.

McClain also stressed the importance of understanding labels, noting that basic label reading can help people eat less, lose weight and focus on the foods contents to help blood sugar controls.

Most of us eat on autopilot. We eat because its there in front of us, whether we need it or not, she said. Label reading will make you more aware. Its the first step.

McClain added that there are several classes dealing with nutrition labels and food in general at the diabetes center. More information can be found by calling 724-628-8008.

The American Diabetes Association has a number of resources for those interested in learning more about what they can and cant eat.

In particular, there is information on diabetes superfoods that are chalk-full of vitamins, minerals and fibers, information on grains, starchy and non-starchy vegetables, and on what to eat, or drink, when going out.

They go as far as to provide a sample shopping list with refrigerated items including yogurt, skim milk, cottage cheese, fresh meat or poultry, and fruit/vegetables.

Pantry items include canned vegetables, rice, tuna, pasta and nuts.

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Nutrition label confusion poses problems for those with diabetes - Uniontown Herald Standard

KNOXVILLE (WATE) The frequency of people being diagnosed with type 2 diabetes has tripled in the past 20 years in the United States, according to Tennova Healthcare. March 28 is Diabetes Alert Day.

Diabetes affects nearly 30 million people in the United Statesa stunning 10 percent of the overall population, said Cheri Johnston, M.D., a family medicine physician with Tennova Primary Care Farragut. And recent research reveals that diabetes is now the third leading cause of death and not the seventh, as was previously thought. Perhaps the most alarming statistic is that one in four people living with diabetes is unaware that he or she even has the disease.

Tennova says the prevalence is due to an increase in sugary diets and sedentary lifestyles. One-third of Americans will have diabetes by 2050, according to researchers.

The disease can cause kidney failure, blindness, limb amputations and death if left untreated.

People with a family history of type 2 diabetes are at risk. Also, above-average body weight can lead to an increase. The disease is more common in Native Americans, African-Americans, Hispanics and Asian Americans.

On the positive side, diabetes is almost always avoidableeven reversiblewith appropriate lifestyle changes, Dr. Johnston said. Early diagnosis and treatment are critical to preventing significant damage to your health and longevity. Awareness and access to quality medical care are key.

Tennova suggests five ways to help reduce the risk of getting the disease:

As part of your annual physical, talk to your doctor about the results of your fasting blood sugar test and A1C test, which provides information about your average glucose levels over a three-month period, Dr. Johnston said. If your numbers are heading in the wrong direction, acting quickly may get things back on the right track.

For more information, call 1-855-TENNOVA or visit Tennovas website.

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Tennova brings awareness to Diabetes Alert Day | WATE 6 On Your ... - WATE 6 On Your Side

Positive Outcomes in Type 2 Diabetes Treatment Intensification Endocrinology Advisor HealthDay News For patients with type 2 diabetes, not delaying intensification of oral antidiabetic drugs is associated with greater reductions in hemoglobin A1c (HbA1c), and with reduced risks of cardiovascular events and amputations, according to ...

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Positive Outcomes in Type 2 Diabetes Treatment Intensification - Endocrinology Advisor

Lisa Miller and Sanford Miller enrolled in a Methodist Hospital's diabetes prevention program each loosing over 20 pounds after Sanford was diagnosed prediabetic and both registered high cholesterol.(Photo: Jim Weber, The Commercial Appeal)Buy Photo

Construction worker Sanford Miller rarely ate a midday mealthat didn't include a fast-food burger andfries because, as he says, "that's what you did for lunch."

Not any more.

With his weight, cholesteroland blood-sugar levels surging, Miller, 56, decided to make a change. He and his wife Lisa joined a diabetes-prevention class at Methodist Le Bonheur Germantown Hospitaland began taking walks and eatinga more healthful diet. TheMemphis native and Olive Branch resident not only shed nearly 30 pounds, but lowered hisblood-sugar levels from the pre-diabetes range to normal.

Much like Miller, Michelle Norman says she was"absolutely" destined fordiabetes, what with her family history and struggles to manage weight. But that was before she became an exercise devotee, bicycling up to 150 miles at a time and leading a regular Zumba class.Although still considered pre-diabetic, the 49-year-old Whitehaven resident has reversed the steady increase in her glucose levels, which now are dropping toward the normal range.

Miller and Norman are among a growing number of people acrossGreater Memphis and Tennessee who are eludingone of the region's most widespread and devastatinghealth problems diabetes without prescription drugs.Under the National Diabetes Prevention Program, local hospitals and healthcare providers are targeting pre-diabetic residents for intervention efforts focused mostly on diet, exercise and behavioral changes.

There are early, but tantalizing signs that the effort is helpingbluntwhat area health officials have described as an epidemic. The number of new diabetes cases diagnosed in Shelby County fell nearly 19 percent, from a peak of 7,918 in 2008 to 6,439 in 2013, the most recent year for which the Centers for Disease Control and Prevention has statistics.

Other urban counties in Tennessee have experienced similar drops. In Davidson County, new cases fell from a high of 5,201 in 2007 to 4,032 in 2013, while Knox County experienced a decline from 3,964 to 2,642 during the same period.

Not eventhose declines, however, change the fact that Type 2 or "adult" diabetes remains a major scourge. Greater Memphis,along with most of Tennessee, lies within what the CDC calls the "diabetes belt,"a 644-county region stretching from eastern Texas to West Virginia and the Carolinas in which 11 percent or more of the adult population has been diagnosed with the disease.

In Shelby County alone, more than 82,000 people, or 12.2 percent of the adult population, had diabetes in 2013, according to CDC data. Although thatfigurerepresentsa leveling-off from the previous twoyears, it'ssignificantly higher than2004, when fewer than 60,000residents, 9.4 percent of the adult population, had the disease. In Davidson and Knox counties, the percentage of adults with diabetes in 2013 was 10.6 and 11.2, respectively.

Characterized by an excess of glucose in the blood, diabetes is an incurable disease that can lead to nerve damage, blindness, kidney disease, heart trouble and death. It kills nearly 250 people in Shelby County each year.

The disease also presents a crushing cost burden. People diagnosed with diabetes at age 50 will spend up to $135,600 more in lifetime medical costs than those without it, according to a 2014 study.Nationally, the disease produces an annual$245billion drain on the economy, including$5.8 billion in Tennessee.

But while it may not be curable, diabetes is clearly preventable, even among those who are especially at-risk because theirblood-sugar levels have reached the pre-diabetic stage.

Dr. Sam Dagogo-Jack, professor of medicine and chief of the division of endocrinology, diabetes and metabolism at the University of Tennessee Health Science Center in Memphis, helped lead a major studyshowing that lifestyleand diet changes can reduce by up to 58 percent the occurrence of diabetes amongpeople who are pre-diabetic. Lifestyle and diet, the study showed, wasalmost twice as effective as medication in preventing the transition from pre-diabetes to diabetes.

"We can prevent the progression from pre-diabetes to diabetes, and even sweeter still, we can observe remission from pre-diabetes back to normal glucose levels," Dagogo-Jack told The Commercial Appeal in a 2015 interview.

While 29.1 million Americans have been diagnosed with the disease, 86 million others have pre-diabetes. Because it typically takes five to 10 years for pre-diabetes to turn intoto diabetes, specialattention should be focused on that lattergroup, Dagogo-Jack said.

"Very few diseases give you that much of a window of opportunity for intervention."

People at-risk for diabetes include those who are obese, overweight and sedentary, orhave a family history of the disease. Also, certain ethnic groups, including African-Americans, are more predisposed to diabetes.

Jennifer Reed, diabetes program manager at the Baptist Medical Group Outpatient Care Center, said just the loss of 5-10 percent of body weight can have a "tremendous effect" on blood-sugar levels. She citessugary drinks, particularly thatSouthern favorite, sweet tea, asa good place to start cutting back.

Kristy Merritt,diabetes education coordinator, Methodist Le Bonheur Germantown, instructs at-risk people how to eat healthier, become more active and manage their stress. She said that among arecent class of nine participants, the average weight loss was 7.65 percent, and, by the end of the program,all had reduced blood-sugar levels to the point they were no longer pre-diabetic.

At Church Health, at-risk patients are assigned health coaches help thembecome more active and improve their diets and behavior. It's led to significant reductions in blood-sugar levels, said Dr. Scott Morris, CEO, and the effort should become even more successful with the organization's imminent move to Crosstown Concourse, where the Church Health YMCA is opening.

Preventing diabetes has become a major focus of private-practice physicians in the city. Patients of Dr. Beverly Williams-Cleaves benefit fromthe workout room and learning kitchen at her practice on Lamar. "Between the exercise and nutrition, I have several (pre-diabetic patients)who have totally corrected" their blood-sugar levels, she said.

David Sweat, chief of epidemiology for the Shelby County Health Department, said the key to controlling diabetes is reducing the area's high rate of obesity. There are some hopeful signs in that regard, as well. CDC figures show a slight dip in the county's obesity rate, from 34.7 percent in 2011 to 32.3 percent two years later.

Sweat said the recent addition of walking and bicycling trails is having an effect.

"It's very heartening. If you're out on the (Shelby Farms) Greenline, or atShelby Farms, you see a lot of people walking, biking and hiking," he said.

Reach Tom Charlier by email at thomas.charlier@commercialappeal.com, by phone at (901) 529-2572, or on Twitter at @thomasrcharlier.

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Programs help blunt Memphis' diabetes epidemic - The Commercial Appeal

Diabetes mellitus is a huge concern in Lancaster County and the surrounding areas; roughly 15 percent of people in Lancaster have diabetes. Diabetes is a multifocal problem. Patients are more likely to have high blood pressure, a stroke, heart disease, blindness, poor circulation to the lower extremities, and even mortality.

Per 100,000 people in Lancaster, 362 will die as a result of diabetes. When diabetes is poorly managed, the risks for complications greatly increase. It is extremely important for diabetics to always have the supplies they need to control their blood sugars.

As your article mentioned, supplies are often too costly to buy. This leaves patients buying cheaper, expired supplies that may be faulty.

Nationally, we spend $174 billion annually on diabetic care. This number will continue to rise as more people are diagnosed with diabetes. I urge you to continue to write well-informed articles on diabetes, obesity and high blood pressure. We can bring more awareness to the disease by sharing these alarming statistics.

Rather then just writing on the cost of the disease, I encourage you to increase the knowledge of Lancaster residents. The newspaper is a prime opportunity to educate people who are at high risk for diabetes and how they can decrease their risk. We must try to decrease our rates of countywide diabetes or we will continue to see these problems.

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Educate the public about diabetes - LancasterOnline

Mike Golic was 42 years old when he first learned he had Type 2 diabetes, the same age his father was diagnosed with the disease. Thats where the similarity of their experience ended.

The way he chose to deal with it is to keep it to himself, Golic, the former NFL defensive lineman who has become a signature voice on ESPNs morning radio show, Mike & Mike. When I was diagnosed with it, I decided Im not going to go down that road. Im going to include everybody.

Golic likened it to playing on a football team.

My coach is going to be my doctor, and hes going to game plan what Im going to do, said Golic, whose father lived until age 84. My wife and my three kids are going to be my teammates.

Golic, now 54, has gotten his condition under control and has now become a spokesman for a pharmaceutical manufacturer which manufactures the diabetes drug, Invokana, that Golic uses. I want to be very public with this and help other people. If this is what youre diagnosed with, you need to get your family involved and see what game plan with your doctor works.

Golic, who played nine NFL seasons, including six with the Eagles, is especially interested in making sure other former players who may be diagnosed with the disease are made aware of treatment options.

I catch up to a lot of my former teammates at Super Bowls, and I see what guys are dealing with, said Golic. Were used to dealing with sprains, breaks and strains, but Type 2 diabetes is something different. We all need an education on it. I think in this day and age, Im happy to find out in talking to guys that Ive played with and against is that theyre communicating and its not something thats hidden. Today, people are so much more open, and Im happy to see that . . .

My whole thing is to get out there and be a voice and say, Listen, this is what youve been diagnosed with. Get your game plan down, and get your teammates involves.

Golic has lost weight in recent years, even before being diagnosed with the disease.

When I was finished playing (in 1993), I was 300 pounds, he said. I hated working out so I stopped. One day, I literally walked out of the shower and caught my reflection in the mirror. I looked like a vanilla milkshake. I was probably 320. I lost weight over the years, and I dropped down to about 260. Now Im about 240. Between the meds that are working incredibly well and exercising, I feel as good as Ive felt in years.

Golic plans to continue doing his morning show, despite reports that co-host Mike Greenberg is about to leave for a new television venture at ESPN. He hopes his son, Mike Jr., who has been a regular on the show, will continue to have a major role.

Nothing is in stone at this point, but I would imagine I will continue doing this show, whoever it would be with, Golic said. Im been doing the show forever. Greenie is looking to do something else. Its been a long time with the show. Everything changes. Its been fun working with my son. Just to continue possibly doing something with him would be good.

Golic, who started the show in 1998 and has been with Greenberg since 2000, isnt worried about any potential lack of chemistry once Greenberg leaves.

We went through 13 different people from October of 1999 and January of 2000, Golic said. Greeny wasnt even a candidate at that point, but it all worked out. Now we move on.

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Mike Golic tackles Type 2 diabetes issue | Newsday - Newsday

Diabetes and high blood pressure are prevalent in the African-American community in the United States, and with idea of supersize meals and processed fast foods catching on everywhere, these non-communicable diseases are becoming an even bigger problem in other parts of the world the Caribbean being one of those regions.

The Caribbean Community published a statistic from a study by the University of the West Indies that showed that 1 in 4 adults in the Caribbean nations have diabetes or are pre-diabetic. It also found that some are struggling with high blood pressure.

Furthermore, the study shows the risk to women of contracting the diseases is about 60 percent higher because they tend to be more obese. There has also been an increase in obesity among children and adolescents, which could result into diabetes within those age groups.

This is very concerning to government and health care officials.

Diabetes develops when the body cannot produce enough insulin or effectively use the insulin that it produces. The harmful effects include damage to the major organs and increase risk of heart attack, stroke, kidney failure or nerve damage.

Other studies indicate that the epidemic of noncommunicable diseases is the worst in the Americas. This is an eye opener because deaths have continued to increase over the last two decades.

Why? Because of the lifestyle choices and people not taking their medication as prescribed.

The universitys study describes the health care system in these Caribbean countries as fragile and under-resourced as they struggle to ensure effective delivery of health care interventions.

Many of our family and friends, in the United States and on the islands, who have been diagnosed with one or more of these ailments have accepted the reality of their situation. However, they have not taken the time to educate themselves on how to manage these diseases.

For those who are elderly, they are quick to say that they are set in their ways and are too old to change their diet. They feel as if cutting back or eliminating certain foods from their diet is robbing themselves of the simple pleasures of life.

One family friend said eventually something is gonna kill you so it might as well enjoy myself while I can.

It is surprising how many people respond with that attitude.

My grandmother Delrose (Gran-gran) died several years ago, (God rest her soul) from complications linked to diabetes. I can hear her voice just as if it was yesterday, Mi live long enough mi can eat anything mi want.

She had a sweet tooth and would always make room for some cake, sweet potato pudding, or some syrup sweet chocolate tea flavored with coconut milk and fresh cinnamon. Yes we all have our favorite dishes whether it is fried dumplings, coconut bread, bun and cheese or grater cakes BUT as we get older it is wise to make a change to our diets and eat these delicious meals in moderation.

The CARICOM report noted that researchers from Kings College London, England; the University of Guyana; Ross University, Dominica and the University of the West Indies hope to come up with a non-traditional approach that will prove to be more effective. They plan to train members of religious congregations to offer educational classes in their communities and give participants much needed tools to manage their disease.

The goal is to recruit more than 100 people to become health advocates. These trainees will be supervised by a nurse as they promote physical activity, healthy food choices and patient care. Locals agree that this approach will increase the reach of health services and should therefore reduce the number of deaths.

Aptly called Congregations Taking Action Against NCDs, the project will be rolled out in Guyana, Jamaica and Dominica before being expanded to other locations.

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Diabetic-tied ailments require dietary sea change - The Philadelphia Tribune

Improvements in assessment and treatment of diabetic retinopathy position statement

Diabetic retinopathy (DR) is a complication of diabetes that affects vision. High blood sugar levels can damage the blood vessels starving the retina of vital nutrients and oxygen resulting in blurry vision. Without appropriate treatment this condition may lead to complete vision loss. A recent update on diabetic retinopathy by American Diabetes Association (ADA) has considerably improved in terms of diagnosing and treating this complication since the 2002 Position Statement.

The statement was comprised of natural history of diabetic retinopathy with associated risk factors and different stages categorized by the growth of new blood vessels on the retina and posterior surface of the vitreous. The four stages ranged from mild non-proliferative diabetic retinopathy (NPDR) to moderate NPDR, to severe NPDR, to the most advanced stage proliferative diabetic retinopathy (PDR). It evaluated the general acceptance of optical coherence tomography to assess retinal thickness, along with intraretinal pathology and wide-angle fundus photography to expose clinically silent microvascular lesions. Moreover, it summarized the recent data on screening and treatment with recommendations and discussed about cost-effectiveness.

DR is explicitly a neurovascular complication of both type 1 and type 2 diabetes and its rate of occurrence depends on the level of glycemic control and the duration of diabetes. Other risk factors associated with DR include hyperglycemia, nephropathy, hypertension, and dyslipidemia. Studies have proven that reduction in blood pressure (BP) decreases the progression of retinopathy in people with type 2 diabetes, but strict BP targets (systolic blood pressure of 120 mmHg vs. 140 mmHg) do not provide additional benefits. In another study, retinopathy progression was slowed in patients with dyslipidemia by adding fenofibrate, mainly in NPDR at baseline. In addition, several studies propose that pregnant patients with type 1 diabetes may exacerbate retinopathy with poor glycemic control during conception and may threaten their vision.

Optimization of blood glucose, blood pressure, and serum lipid levels in conjunction with appropriately scheduled dilated eye examinations can decrease the risk of vision loss from DR complications, but a substantial amount of those affected with diabetes develop diabetic macular edema (DME) or proliferative changes that require intervention. Large prospective randomized studies have shown that the use of intensive therapy could possibly prevent or delay DR with the goal of attaining near-normoglycemia. Although, intravitreal injection of antivascular endothelial growth factor agents may treat DME and PDR, it may threaten reading vision.

A meta-analysis study, conducted worldwide from 19802008 and consisting of 35 studies, predicted the global prevalence of DR to be 35.4% and PDR to be 7.5%. In developed countries, DR is mostly the cause of new cases of blindness among those 20 to 74 year old and eye disorders, such as glaucoma and cataracts, are frequently seen in diabetes patients. However, recent advancements in systemic therapy of diabetes have helped patients to improve their metabolic control. The statement incorporates these medical developments for the use of physicians and patients to aid in diagnosis and treatment of DR. It also provides an opportunity to improve glucose management and avoid or delay potential progression of the retinopathy.

The statement includes that screening recommendations for patients with diabetes depend on the rates of appearance and progression of DR and the associated risk factors. Ophthalmologist or optometrist examinations in patients with type 1 and 2 diabetes should be within 5 years after onset of diabetes and at the time of diabetes diagnosis, respectively. Women planning for pregnancy or who are pregnant with pre-existing diabetes should be examined before pregnancy or in the first trimester. In diabetes patients where no evidence of retinopathy is found, follow-up eye exams can be scheduled every two years. If any retinopathy is identified, then subsequent dilated-pupil retina exams are advised at least yearly, but more frequently if progressive retinopathy is diagnosed.

Fortunately, the cost-effectiveness of screening and traditional laser treatment for DR has been established with no more disputes. It is focused on telemedicines impact on the detection and eventual management of DR that appears to be most effective with lower ratio of providers to patients, with prohibitive distance to reach a provider, or when the alternative is no patient screening. The latest advancement in retinopathy treatment, anti-VEGF therapy has been taken into consideration, as they are more cost-effective than laser monotherapy for DME. Also, having retinopathy is not contraindicated with aspirin therapy for cardioprotection because studies suggest that aspirin does not increase the risk for retinal hemorrhage. Nonetheless, future studies are needed to determine the cost-effectiveness of anti-VEGF as a first-line treatment option for PDR.

Practice Pearls:

Reference:

Javitt JC, Canner JK, Sommer A. Cost effectiveness of current approaches to the control of retinopathy in type I diabetics. Ophthalmology 1989;96:255264 42

Pasquel FJ, Hendrick AM, Ryan M, Cason E, Ali MK, Narayan KMV. Cost-effectiveness of different diabetic retinopathy screening modalities. J Diabetes Sci Technol 2015;10:301307

Solomon SD, Chew E, Duh EJ, Sobrin L, Sun JK, VanderBeek BL, Wykoff CC, and Gardner TW. Diabetic Retinopathy: A Position Statement by the American Diabetes Association. Diabetes Care. Mar 2017; 40(3): 412-418.https://doi.org/10.2337/dc16-2641

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American Diabetes Association Updates on Diabetic Retinopathy - Diabetes In Control