A Randomized Controlled Trial of an Internet-Based Mentoring Program for Type 1 Diabetes Patients with Inadequate Glycemic Control

BACKGROUND: To determine whether an internet-based mentoring program can improve glycemic control in subjects with type 1 diabetes mellitus (T1DM). METHODS: Subjects with T1DM on intensive insulin therapy and with hemoglobin A1c (HbA1c) > or =8.0% were randomized to mentored (glucometer transmission with feedback from mentors) or control (glucometer transmission without feedback) groups and were examined for 12 weeks. Five mentors were interviewed and selected, of which two were T1DM patients themselves and three were parents with at least one child diagnosed with T1DM since more than 5 years ago. RESULTS: A total of 57 T1DM adult subjects with a mean duration after being diagnosed with diabetes of 7.4 years were recruited from Samsung Medical Center. Unfortunately, the mentored group failed to show significant improvements in HbA1c levels or other outcomes, including the quality of life, after completion of the study. However, the mentored group monitored their blood glucose (1.41 vs. 0.30) and logged into our website (http://ubisens.co.kr/) more frequently (20.59 times vs. 5.07 times) than the control group. CONCLUSION: A 12-week internet-based mentoring program for T1DM patients with inadequate glycemic control did not prove to be superior to the usual follow-up. However, the noted increase in the subjects' frequency of blood glucose monitoring may lead to clinical benefits.

The Effect of the Nd:YAG Laser on the Rabbit Retina

The effect of the Nd:YAG laser on the rabbit retina was evaluated with fundus photography, light microscopy and transmission electron microscopy(TEM), and compared with the effect of the Argon laser. Fundus photography was performed at 2 days, 4 days, 7 days, 14 days, 29 days and 49 days after treatment. The enucleated retina was examined by light microscopy and TEM. In YAG treated eye, laser reaction was not found at 0.5mJ level but laser reaction(G2-3) was found at 1.5mJ level. Laser reaction(G3-4) with expulsive bleeding was found at 2.5 and 3.5mJ level. Bleeding was seemed to be originated from the choroidal layer. 2 days after treatment, hemorrhage was sustained but bleeding was not continued. 7 days after treatment, hemorrhage was completely absorbed. In Argon treated eye, photocoagulation burns was well formed without and bleeding. In pathologic examination of YAG treated eye, full thickness disruption of the retina amd Bruch's membrane and replacement of these layers with fibrous scar tissue were revealed at 2.5 and 3.5mJ level. In 1.5mJ energy level of the YAG laser and Argon laser irradiation, the outer half of the retina, RPE and Bruch's membrane appeared to be pridominantely affected than the inner half of the retina. The extent and character of his to pathology in Argon treated lesion was not so different from that of the YAG laser 1.5mJ lesion.