Teleretinography into diabetes integrated care: an Italian experience.

INTRODUCTION: Integrated care, by allowing information exchange among health professionals, improves outcomes and favours a reduction in hospital admission in diabetes. Retinal complications can be sight-threatening, and diabetic patients often miss the suggested yearly clinical examination. METHODS: Teleretinography can be easily performed in patients attending Diabetes Clinics: images are sent to a remote ophthalmologist, grading and instructions are received and forwarded to General Practitioners by a dedicated software. RESULTS: We here report the results of teleretinography performed in our Diabetes Clinic in 362 patients missing the yearly fundus examination: 253 patients showed no diabetic retinopathy, 86 a mild form, and 23 needed referral to hospital settings. CONCLUSIONS: Teleretinography is a user-friendly, time-saving and cost-effective technique, easily integrable into integrated care, allowing a better adherence to guidelines.

[Towards evidence-based medicine: large-scale intervention trials with glucagon-like peptide-1 receptor agonists]. / Verso la medicina basata sull'evidenza: i grandi trial di intervento con gli agonisti recettoriali del glucagon-like peptide-1.

The primary goal of antihyperglycemic therapy in type 2 diabetes mellitus is to reduce cardiovascular morbidity and mortality. As a consequence, drugs used for the treatment of diabetes must be safe with respect to cardiovascular risk. It would be ideal if antidiabetic drugs could also promote cardiovascular protection mechanisms independent of improved glucose control. Glucagon-like peptide-1 (GLP-1) receptor agonists might indeed be such drugs. Experimental studies in animal models as well as preliminary results in man have provided evidence that GLP-1 receptor agonists may have protective effects on the cardiovascular system. In addition, registration trial data have demonstrated that treatment with liraglutide is associated with a significant improvement in several cardiovascular risk factors. However, definite confirmation of both absolute cardiovascular safety and potential cardiovascular protective effects of GLP-1 receptor agonists can only be provided by large, randomized, controlled intervention trials specifically designed to answer these questions. The design of such ongoing trials is described in this article.

[Protective effects of glucagon-like peptide-1 on beta-cells: preclinical and clinical data]. / Effetti protettivi del glucagon-like peptide-1 sulle beta-cellule: dati preclinici e studi clinici.

Dipartimento di Medicina Interna e Scienze dell'Invecchiamento, Università degli Studi "G. d'Annunzio", Chieti Continuing b-cell mass and function loss represents the key mechanism for the pathogenesis and the progression of type 2 diabetes mellitus. Drugs capable of arresting b-cell loss and eventually able to bring b-cell function close to be back to normal would then be a formidable help in type 2 diabetes mellitus treatment. The glucagon-like peptide-1 (GLP-1) receptor agonists exenatide and liraglutide can stimulate in vitro neogenesis and prevent apoptosis in b-cell-like cell lines. Consistently, treatment with GLP-1 receptor agonists ameliorates glucose metabolism, preserves b-cell mass and improves b-cell function in several animal models of diabetes. For instance, in the db/db mice, liraglutide protects the b-cell from oxidative stress and endoplasmic reticulum stress-related damage. Data in humans, in vivo, are less definitive and often based on scarcely reliable indexes of b-cell function. However, short-term treatment (14 weeks) with liraglutide increased b-cell maximal response capacity in a dose-response fashion. A longer (1 year) exenatide treatment also was able to increase b-cell maximal response capacity, but the effect was no longer there after a 4-week washout period. However, a marginal, although significant as compared to glargine treatment, improvement in another b-cell function index (disposition index) was observed after a 4-week washout period following 3-year exenatide treatment. Finally, although no clinical trials with a long enough follow-up period are presently available, durable glucose control has been obtained during 2 years of liraglutide treatment in monotherapy. Since the durability of good control is strictly dependent upon a lack of further b-cell function deterioration, these clinical data may foster hope that GLP-1 receptor antagonist treatment might help preserving b-cell function also in individuals affected by type 2 diabetes mellitus.