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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-2\u0022\u003EThis article discusses new insights on the diabetic eye, assessing and managing ocular complications of diabetes, as well as diabetic kidney disease.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ERetinal Diseases\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes \u0026amp; Kidney Disease Diabetes Mellitus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERenal Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ERetinal Diseases\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes \u0026amp; Kidney Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EEndocrinology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes \u0026amp; Metabolic Syndrome\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERenal Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ENEW INSIGHTS ON THE DIABETIC EYE\u003C\/h2\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EAccording to Jennifer K. Sun, MD, MPH, Joslin Diabetes Center, Boston, Massachusetts, USA, the 7-standard field color fundus photography protocol established by the Early Treatment Diabetic Retinopathy Study [ETDRS], which captures 90\u00b0 of the posterior retina and 30% of the entire retinal surface, is the gold standard currently used to evaluate the eye complications of diabetes [Garg S, Davis RM \u003Cem\u003EClin Diabetes\u003C\/em\u003E 2009]. This procedure requires pharmacologic pupil dilation and a skilled retinal photographer. However, a less extensive evaluation can be performed with nonmydriatic ultrawide field imaging (UWFI), which can capture up to 200\u00b0 and 82% of the entire retinal surface in a single image [Soliman AZ et al. \u003Cem\u003ESemin Ophthalmol\u003C\/em\u003E 2012] and requires no pupil dilation.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003ETelemedicine is an important element of screening for diabetic retinopathy. However, the official standard of the American Telemedicine Association (ATA) for validating retinal images is the ETDRS protocol [ATA \u003Cem\u003ETelehealth Practice Recommendations for Diabetic Retinopathy\u003C\/em\u003E 2011]. As ETDRS requires a skilled operator, however, it is not always accessible to remote clinics.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EEvidence suggests that the wider range of UWFI can capture more cases of diabetic retinopathy than ETDRS, as well as detect more hemorrhages and intraretinal abnormalities [Silva PS et al. \u003Cem\u003EOphthalmology\u003C\/em\u003E 2013]. One study suggests that compared with ETDRS, UWFI could identify more severe retinopathy, reduce the rate of ungradable diabetic retinopathy by 71%, and reduce the time to image evaluation [Silva PS et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2014]. According to Dr. Sun, UWFI may become a new standard in clinical, research, and teleophthalmology settings if these findings are confirmed in trials across all severity groups.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EMANAGING OCULAR COMPLICATIONS\u003C\/h2\u003E\n         \u003Cp id=\u0022p-6\u0022\u003ELloyd Paul Aiello, MD, PhD, Joslin Diabetes Center, Boston, Massachusetts, USA, spoke about assessing and managing ocular complications of diabetes. He emphasized that proliferative diabetic retinopathy is the leading cause of severe visual loss in people with diabetes and that severe retinopathy can exist with good vision. Therefore, appropriate care mandates that clinicians be proactive, as patients with diabetic eye complications often remain unaware of their eye disease [Huang OS et al. \u003Cem\u003EAnn Acad Med Singapore\u003C\/em\u003E 2009]. As well, lack of patient awareness is a major factor in nonadherence to eye care guidelines and poor visual outcomes [Schoenfeld ER et al. \u003Cem\u003EOphthalmology\u003C\/em\u003E 2001].\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EAccording to guidelines published by the American Diabetes Association (ADA), adults with type 1 diabetes mellitus should undergo an initial ophthalmic exam within 5 years of onset or shortly after the diagnosis of type 2 diabetes (T2DM) [ADA. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2014]. Dr. Aiello reinforced 6 elements composing state-of-the-art diabetes care: (1) identification; (2) lifelong evaluation and education; (3) optimization of systemic factors, such as blood glucose, blood pressure (BP), and lipids; (4) identification of complications; (5) timely and appropriate intervention; and (6) novel therapies and treatment approaches.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EDiabetic macular edema (DME), caused by retinal microvascular changes, is an important cause of vision loss. An injection of intravitreal ranibizumab, followed by prompt (within 1 week of initial injection) or deferred laser photocoagulation, was more effective through \u2265 1 year compared with prompt laser alone for treating central DME [Diabetic Retinopathy Clinical Research Network et al. \u003Cem\u003EOphthalmology\u003C\/em\u003E 2010]. An algorithm for the treatment and follow-up of center-involved DME with antivascular endothelial growth factors is provided in \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/19\/29\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Treatment Scheme for Center-Involved DME With Anti-VEGF Agents\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-557317160\u0022 data-figure-caption=\u0022Treatment Scheme for Center-Involved DME With Anti-VEGF Agents\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/19\/29\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/19\/29\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/19\/29\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14661\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-9\u0022 class=\u0022first-child\u0022\u003ETreatment Scheme for Center-Involved DME With Anti-VEGF Agents\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EDME = diabetic macular edema; VEGF = vascular endothelial growth factors.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EDIABETIC KIDNEY DISEASE\u003C\/h2\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EDiabetes is the leading cause of end-stage renal disease (ESRD). Ian H. de Boer, MD, MS, University of Washington, Seattle, Washington, USA, stated that diabetic kidney disease (DKD) has not decreased in people with diabetes despite an increased use of medications to control BP and glucose levels [de Boer IH et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2011]. The biomarker cystatin C, alone or in combination with creatinine, improves the estimation of glomerular filtration rate (eGFR) [Shlipak MG et al. \u003Cem\u003EAm J Kidney Dis\u003C\/em\u003E 2013; Inker LA et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2012] and the classification of cardiovascular risk [Shlipak MG et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2013]. However, cystatin C may not significantly improve the tracking of eGFR [de Boer IH et al. \u003Cem\u003EJ Am Soc Nephrol\u003C\/em\u003E 2014.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EStrategies to reduce the progression of DKD and reduce cardiovascular risk focus on 6 targets: BP, glycemia, albuminuria, weight loss and exercise, nephrotoxins, and novel therapies. Dr. de Boer reviewed various published BP targets (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E) and data suggesting that while intensive BP control had no benefit on kidney disease progression, it may benefit patients with baseline proteinuria [Appel LJ et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2010].\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14662\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14662\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14662\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-12\u0022 class=\u0022first-child\u0022\u003EBlood Pressure Targets Recommended by Professional Societies\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-16\u0022\u003EAlthough calcium channel blockers (CCBs), angiotensin-receptor blockers (ARBs), and ACE inhibitors all effectively lower BP, there are differences among them. ACE inhibitors have demonstrated greater cardiovascular benefit than that of ARBs (Cheng J et al. \u003Cem\u003EJAMA Intern Med\u003C\/em\u003E 2014). Among patients with DKD and T2DM, ARBs have demonstrated more renal benefit than have CCBs (Lewis EJ et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2001]. However, the use of an ARB plus an ACE inhibitor is likely to provide no additional benefit and may increase the risks of hypotension, hyperkalemia, and acute kidney injury [Hsu TW et al. \u003Cem\u003EJAMA Intern Med\u003C\/em\u003E 2014; Hou FF et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2006]. There are also data suggesting the benefit of taking at least 1 BP medication at night to prevent clinical cardiovascular events [Hermida RC et al. \u003Cem\u003EJ Am Soc Nephrol\u003C\/em\u003E 2011; Hermida RC et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2011].\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section fn-group\u0022 id=\u0022fn-group-1\u0022\u003E\u003Ch2\u003EArticle Notes\u003C\/h2\u003E\u003Cul\u003E\u003Cli class=\u0022fn-other\u0022 id=\u0022fn-1\u0022\u003E\n               \n               \u003Cp id=\u0022p-1\u0022\u003E\u003Ca class=\u0022rev-xref\u0022 href=\u0022#xref-fn-1-1\u0022\u003E\u21b5\u003C\/a\u003E\u003Cspan class=\u0022fn-label\u0022\u003E*\u003C\/span\u003E On September 4, 2014, the article author was changed from Mary Mosley to Jill Shuman.\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/19\/29.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzp35p\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzp35p\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzp35p\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}