OBJECTIVE -To evaluate whether treatment with insulin is advantageous compared with oral antidiabetes agents in newly diagnosed type 2 diabetes with severe hyperglycemia after short-term intensive insulin therapy.RESEARCH DESIGN AND METHODS -Newly diagnosed type 2 diabetic patients with severe hyperglycemia were hospitalized and treated with intensive insulin injections for 10 -14 days. The oral glucose tolerance test (OGTT) was performed after intensive insulin treatment. After discharge, the patients were randomized to receive either insulin injections or oral antidiabetes drugs (OADs) for further management. The OGTT was repeated 6 months later, and -cell function and insulin sensitivity were evaluated again. These subjects were continually followed up for another 6 months to evaluate their long-term glycemic control.RESULTS -At the 6th month of the study, the A1C level was significantly lower in the insulin group than in the OAD group (6.33 Ϯ 0.70% vs. 7.50 Ϯ 1.50%; P ϭ 0.002). During the follow-up visit, the A1C level was still better in the insulin group (6.78 Ϯ 1.21% vs. 7.84 Ϯ 1.74%; P ϭ 0.009). All parameters regarding -cell function measured in the OGTT were improved significantly in both groups after 6 months of treatment. Compared with the OAD group, the homeostasis model assessment of -cell function index, insulin area under the curve, and insulinogenic index were better in the insulin group. CONCLUSIONS -A 6-month course of insulin therapy, compared with OAD treatment, could more effectively achieve adequate glycemic control and significant improvement of -cell function in new-onset type 2 diabetic patients with severe hyperglycemia.
Atropine is a common treatment used in children with myopia. However, it probably affects intraocular pressure (IOP) under some conditions. Our research aims to analyze clinical data by using machine learning models to evaluate the effect of 19 important factors on intraocular pressure (IOP) in children with myopia treated with topical atropine. The data is collected on 1545 eyes with spherical equivalent (SE) less than −10.0 diopters (D) treated with atropine for myopia control. Four machine learning models, namely multivariate adaptive regression splines (MARS), classification and regression tree (CART), random forest (RF), and eXtreme gradient boosting (XGBoost), were used. Linear regression (LR) was used for benchmarking. The 10-fold cross-validation method was used to estimate the performance of the five methods. The main outcome measure is that the 19 important factors associated with atropine use that may affect IOP are evaluated using machine learning models. Endpoint IOP at the last visit was set as the target variable. The results show that the top five significant variables, including baseline IOP, recruitment duration, age, total duration and previous cumulative dosage, were identified as most significant for evaluating the effect of atropine use for treating myopia on IOP. We can conclude that the use of machine learning methods to evaluate factors that affect IOP in children with myopia treated with topical atropine is promising. XGBoost is the best predictive model, and baseline IOP is the most accurate predictive factor for endpoint IOP among all machine learning approaches.
Isolated inferior division oculomotor nerve palsy (ONP) is rare. Acquired cases have been associated with neurologic or systemic disease. To our knowledge, congenital inferior division ONP is previously unreported. We present a case of congenital inferior division ONP in which magnetic resonance imaging demonstrated the structural neuropathy.A 21-year-old woman presented with lifelong largeangle exotropia and diminished vision acuity in her right eye (OD). She denied diplopia, periocular pain, cephalgia, migraine, head trauma, or prior surgery. Birth history was unremarkable. She had no history of diabetes mellitus, hypertension, systemic vasculopathy, or thyroid disease. She has three unaffected brothers and four unaffected sisters. General physical and neurologic examinations were normal. Cranial nerves were normal except for ocular motility. Cycloplegic refraction was ϩ4.00 ϩ 2.75 ϫ 150 OD and ϩ0.50 ϩ 0.50 ϫ 90 left eye (OS). Corrected visual acuity was 20/80 OD and 20/25 OS. Ptosis was absent. Both pupils were 7 mm in diameter with slight peaking toward 9:00 OD and were normally reactive to light and accommodation. The ocular versions are shown in Figure 1. At near with correction, there was 100 ⌬ exotropia with 10 ⌬ right hypertropia. Head tilt did not appreciably alter the hypertropia, but dissociated vertical deviation was present bilaterally. Abducting and vertical saccades were normal for both eyes (OU), while adducting saccades were bilaterally slow. Convergence was absent. There was bilateral optic disk pallor with cup-to-disk ratio of 0.5 OD and 0.3 OS. There was incyclotorsion OU on fundus examination.High-resolution magnetic resonance imaging (MRI) performed with orbital surface coils identified a smaller inferior division of the oculomotor nerve (OMN) OD than OS, with no identifiable motor nerve to the right medial (MR) and inferior rectus (IR) muscles, both of whose deep portions exhibited marked atrophy and abnormal internal bright signal on T1 imaging (Figure 2). The abducens nerve was readily demonstrable OU. The inferior oblique muscle was present bilaterally, but both lateral rectus muscle paths were superiorly displaced relative to the MR muscles ( Figure 2). Just posterior to the globe, right and left optic nerve diameters were 3.07 and 3.05 mm, respectively (Figure 2), both subnormal compared with published values. 1 Imaging with a head coil demonstrated bilateral OMN hypoplasia in the skull base region, with the right OMN too small to resolve in any of the 1 mm thickness contiguous image planes obtained in the plane of its path (Figure 3). These anatomic findings indicate bilateral but asymmetrical OMN abnormality. DiscussionThe OMN divides into superior and inferior divisions just before entering the superior orbital fissure. Classical signs of inferior division OMP were evident here, including large exotropia, hypertropia, incyclotropia, and discoria. Although pupillary light responses were spared, Good and coworkers have postulated that early embryologic damage could partially spare th...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.