9. Microvascular Complications and Foot Care

,

doi:10.2337/dc16-s012

Cited by 112 publications

(50 citation statements)

References 68 publications

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“…All major guidelines (American Diabetes Association (ADA), 4 American Academy of Ophthalmology, 26 UK National Institute for Health and Care Excellence (NICE) 30 ) recommend retinopathy screening for all patients newly diagnosed as having type 2 diabetes. They concur on the need for a dilated pupil and comprehensive examination by a specialist.…”

Section: Frequencymentioning

confidence: 99%

“…4 NICE guidelines emphasize that a quality assured digital retinal photography program should be used by appropriately trained staff. 30 Although the gold standard for retinal evaluation is by a retinal specialist under mydriasis, concerns exist about access, costs, and patients' safety.…”

Section: Measurementmentioning

confidence: 99%

“…54 The 2016 ADA guidelines mention that diabetic retinopathy progression may be slowed by fenofibrate but do not consider it a strong recommendation. 4 A forthcoming study will assess the effect of fenofibrate on circulating endothelial progenitor cells, 55 which may enhance our knowledge on its potential role for primary and secondary prevention of diabetic retinopathy. The study was estimated to be completed by December 2015, but results have not yet been published.…”

Section: Peroxisome Proliferator Activated Receptor α Agonist: Fenofimentioning

confidence: 99%

“…As highlighted by the ADA guidelines, 4 it is a diagnosis of exclusion. Screening includes 10 g monofilament testing and at least one of pinprick, temperature, or vibration sensation at onset of type 2 diabetes and then annually.…”

Section: Screeningmentioning

confidence: 99%

“…Detecting and treating complications of diabetes are major components for these interventions. [3][4][5] Strong evidence supports the need to achieve and maintain proper glycemic control to prevent the incidence (primary prevention) or progression (secondary prevention) of microvascular complications.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

How to prevent the microvascular complications of type 2 diabetes beyond glucose control

Valencia

Flórez

2017

BMJ

158

109

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Section: Frequencymentioning

confidence: 99%

Section: Measurementmentioning

confidence: 99%

Section: Peroxisome Proliferator Activated Receptor α Agonist: Fenofimentioning

confidence: 99%

Section: Screeningmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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How to prevent the microvascular complications of type 2 diabetes beyond glucose control

Valencia

Flórez

2017

BMJ

158

109

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Cardiovascular Outcomes According to Urinary Albumin and Kidney Disease in Patients With Type 2 Diabetes at High Cardiovascular Risk

et al. 2018

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Efficacy of Oral Mixed Tocotrienols in Diabetic Peripheral Neuropathy

Hor¹,

Fung

Ang

et al. 2018

JAMA Neurol

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The Vitamin E in Neuroprotection Study (VENUS) Investigators IMPORTANCE Management of painful diabetic peripheral neuropathy remains challenging. Most therapies provide symptomatic relief with varying degrees of efficacy. Tocotrienols have modulatory effects on the neuropathy pathway and may reduce neuropathic symptoms with their antioxidative and anti-inflammatory activities.OBJECTIVE To evaluate the efficacy of oral mixed tocotrienols for patients with diabetic peripheral neuropathy. DESIGN, SETTING, AND PARTICIPANTSThe Vitamin E in Neuroprotection Study (VENUS) was a parallel, double-blind, placebo-controlled trial that recruited participants from January 30, 2011, to December 7, 2014, with 12 months of follow-up. This trial screened 14 289 patients with diabetes from 6 health clinics and ambulatory care units from 5 public hospitals in Malaysia. A total of 391 patients who reported neuropathic symptoms were further assessed with Total Symptom Score (TSS) and Neuropathy Impairment Score (NIS). Patients 20 years or older with a TSS of 3 or higher and an NIS of 2 or higher were recruited.INTERVENTIONS Patients were randomized to receive 200 mg of mixed tocotrienols twice daily or matching placebo for 12 months. Patients with hyperhomocysteinemia (homocysteine level Ն2.03 mg/L) received oral folic acid, 5 mg once daily, and methylcobalamin, 500 μg thrice daily, in both groups. MAIN OUTCOMES AND MEASURESThe primary outcome was patient-reported neuropathy TSS (lancinating pain, burning pain, paresthesia, and asleep numbness) changes at 12 months. The secondary outcomes were NIS and sensory nerve conduction test result. RESULTSOf 391 eligible patients, 300 were recruited (130 [43.3%] male; mean [SD] age, 57.6 [8.9] years; mean [SD] duration of diabetes, 11.4 [7.8] years) and 229 (76.3%) completed the trial. The TSS changes between the tocotrienols and placebo groups at 12 months (−0.30; 95% CI, −1.16 to 0.56; P = .49) were similar. No significant differences in NIS (0.60; 95% CI, −1.37 to 2.65; P = .53) and sensory nerve conduction test assessments were found between both groups. In post hoc subgroup analyses, tocotrienols reduced lancinating pain among patients with hemoglobin A 1C levels greater than 8% (P = .03) and normohomocysteinemia (homocysteine level <2.03 mg/L; P = .008) at 1 year. Serious adverse events in both groups were similar, except more infections were observed in the tocotrienols group (6.7% vs 0.7%, P = .04). Results reported were of modified intention-to-treat analyses.CONCLUSIONS AND RELEVANCE Supplementation of oral mixed tocotrienols, 400 mg/d for 1 year, did not improve overall neuropathic symptoms. The preliminary observations on lancinating pain among subsets of patients require further exploration.

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9. Microvascular Complications and Foot Care

Cited by 112 publications

References 68 publications

How to prevent the microvascular complications of type 2 diabetes beyond glucose control

How to prevent the microvascular complications of type 2 diabetes beyond glucose control

Cardiovascular Outcomes According to Urinary Albumin and Kidney Disease in Patients With Type 2 Diabetes at High Cardiovascular Risk

Efficacy of Oral Mixed Tocotrienols in Diabetic Peripheral Neuropathy

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