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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 beta-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 +/- 0.70% vs. 7.50 +/- 1.50%; P = 0.002). During the follow-up visit, the A1C level was still better in the insulin group (6.78 +/- 1.21% vs. 7.84 +/- 1.74%; P = 0.009). All parameters regarding beta-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 beta-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 beta-cell function in new-onset type 2 diabetic patients with severe hyperglycemia. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Topic: To systematically compare the effectiveness of conventional phacoemulsification surgery (CPS) and low-energy femtosecond laser-assisted cataract surgery (FLACS) in patients with cataract., Clinical Relevance: Cataract surgery is a common procedure, and comparing different techniques such as CPS and low-energy FLACS is crucial for optimizing patient outcomes., Methods: The PubMed, Web of Science, MEDLINE, EMBASE, and Cochrane library databases were searched for clinical trials. Outcomes of procedure time, effective phacoemulsification time, balanced salt solution usage, cumulative dissipated energy, mean change of best-corrected visual acuity, endothelial cells reduction, central corneal thickness, and aqueous cytokine level were evaluated. The effect measures were weighted mean differences with 95% confidence interval. The protocol was registered at the Prospective Register for Systematic Reviews (PROSPERO, registration number CRD42023420173)., Results: 11 studies were included in the present meta-analysis, of which 1680 eyes were analyzed (637 eyes in the low-energy FLACS group, and 1043 eyes in the CPS group). Low-energy FLACS demonstrated significantly fewer reductions in endothelial cell count at six months (p<0.001) compared to CPS. It also exhibited a shorter effective phacoemulsification time (p<0.001) and less balanced salt solution usage (P<0.001). However, there were no differences in cumulative dissipated energy, corrected distance visual acuity, central corneal thickness changes, or aqueous cytokine levels between the two groups., Conclusion: Both low-energy FLACS and CPS are effective in treating cataracts, but low-energy FLACS may offer advantages such as reduced phacoemulsification time and less endothelial cell loss., (Copyright © 2024 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Objectives: Severe hyperglycemia is associated with increased morbidity and mortality in a variety of patients. We undertook this study to identify prognostic factors of mortality among patients experiencing severe hyperglycemia in the emergency department (ED)., Study Design: Longitudinal observation study., Methods: We recruited patients who visited the ED with blood glucose levels higher than 500 mg/dL between July 2008 and September 2010. The primary outcome was death from any cause within 90 days. Outcome analysis was first performed with Pearson's χ(2) test. Any characteristic with suspected significance (P < .1) was then used in a univariate Cox regression model. The variables found to be statistically significant were then subjected to multivariate analysis for further investigation., Results: Among 733 patients with severe hyperglycemia, the 90-day mortality rate was 14.6% (n = 107). Independent prognostic factors for increasing 90-day mortality included elevated absolute neutrophil count (hazard ratio [HR], 7.34), elevated C-reactive protein (HR, 4.48), elevated blood urea nitrogen (HR, 3.04), elevated respiratory rate (HR, 2.91), decreasing body temperature (HR, 2.68), decreasing systolic blood pressure (HR, 2.65), elevated potassium (HR, 2.54), decreasing blood glucose (HR, 2.46), elevated creatinine (HR, 2.40), elevated white blood cell count (HR, 2.30), and elevated ratio of blood urea nitrogen to creatinine (HR, 2.23)., Conclusions: The 90-day mortality rate among patients with severe hyperglycemia in the ED was 14.6%. Sepsis, renal impairment with electrolyte imbalance, and lower blood pressure were independent prognostic factors.

Objectives: To compare the effects of a 6-month course of insulin therapy versus oral antidiabetic drugs (OADs) on long-term (5-year) glycemic control in patients newly diagnosed with type 2 diabetes mellitus (T2DM) with severe hyperglycemia., Study Design: 5 years’ follow-up of a randomized controlled trial., Methods: Newly diagnosed patients with T2DM and severe hyperglycemia were hospitalized and treated with intensive insulin injections for 10 to 14 days. Fifty patients were randomized to receive either insulin injections or OADs for an additional 6 months. Subjects were followed for 5 years to evaluate long-term glycemic control. We compared the glycated hemoglobin (A1C) levels of the treatment groups and the proportion of patients in each group who reached the treatment targets. We also examined the remission rate (A1C ≤6.5% without antidiabetic medication) at the end of the 5 years. The mechanisms of improved glycemic control and possible mechanism of remission were also investigated., Results: At 5 years, A1C levels remained lower in the insulin group than in the OAD group (6.49 ± 0.72% vs 7.72 ± 1.06%; P = .012). The proportion of subjects with A1C levels ≤6.5% was significantly higher in the insulin group than in the OAD group (63.6% vs 23.5%; P = .013). The remission rate was 27.3% in the insulin group and 5.9% in the OAD group (P = .048)., Conclusions: This randomized trial demonstrated that a 6-month course of insulin therapy led to better 5-year glycemic control, reflected by lower A1C levels, than did oral antidiabetic agent therapy. Moreover, the insulin-treated group had a significantly higher rate of remission from diabetes.

Purpose: Because pupillary dilation caused by muscarinic antagonists is a predisposing factor for glaucoma, we examined the effects of long-term atropine treatment for myopia on intraocular pressure (IOP) and studied the risk factors of elevated IOP among myopic children., Methods: A retrospective chart review was conducted in 621 myopic children (aged 6 to 15 years) whose spherical equivalent refractive error ranged from -1.00 to -6.00 D in each eye and who had received atropine therapy. For all children, we collected their complete ocular examination data and IOP measurements beginning in 2008. We then calculated the cumulative dose and the duration of atropine therapy in the 3 years before the date of recruitment to quantitatively assess the effects of atropine therapy on IOP., Results: Four hundred eighty-nine children who received atropine therapy were classified as the "treatment" group, whereas 132 children who did not receive atropine therapy were classified as "reference" group. Statistical analyses did not find any relation between the dose or duration of atropine therapy and the risk of having elevated IOP. However, the age of the myopic children and the spherical equivalent values were positively associated with the risk of having elevated IOP irrespective of whether they had been treated with atropine or not., Conclusions: Topical atropine therapy for up to 3 years seemed to be safe in myopic children; neither the cumulative dose nor the duration of atropine therapy was statistically associated with the risk of having elevated IOP. However, the safety of longer atropine therapy still needs more study. Clinicians should be careful to monitor the changes in IOP among older myopic children or myopic children with more severe myopia.

Heat shock protein 60 (HSPD1) plays a critical role in myocardial protection. Its reduced expression may lower myocardial protection against ischemic injury in the diabetic state. This study was conducted to investigate the natural course of fructose-fed insulin-resistant rats, define changes in myocardial HSPD1 expression, and determine the effects of thiazolidinedione or anti-hypertensive treatment. Results showed that insulin resistance with hyperinsulinemia and hypertension developed after 6 weeks of fructose feeding. This time-course study also showed that myocardial HSPD1 expression was mildly increased in week 6 (P=0.05) and significantly increased in week 8. Rosiglitazone-treated rats had restored systolic blood pressure (BP) and normalized plasma insulin level during oral glucose tolerance tests, whereas amlodipine-treated rats restored only systolic BP. Both amlodipine and rosiglitazone treatments normalized the abundance of myocardial HSPD1 expression in fructose-fed rats. When these rats received streptozotocin injection and diabetes developed, myocardial HSPD1 expression decreased despite persistent hypertension. In conclusion, this is the first study to report that myocardial HSPD1 expression is increased in high-fructose-fed rats, which may be due to increased BP. Once the high-fructose-fed rats developed diabetes with insulin deficiency, the myocardial HSPD1 expression decreased in spite of persistent hypertension.

Morning glory disk anomaly (MGDA) is a congenital malformation of the optic disk that is usually unilateral. It has characteristic fundus findings, including enlarged optic disk opening and funnel-shaped excavation of the peripapillary fundus. Optical coherence tomography (OCT) with micrometer resolution and cross-sectional imaging capabilities can provide detailed information about the structure of the living eye. Some reports have used OCT to demonstrate the structure of the disk in older patients with MGDA but, to our knowledge, no quantitative OCT report concerning a child with MGDA has been published previously.

Objective: To investigate whether the effects of regular diabetes health education or a holiday-specific pamphlet before the Chinese New Year holiday period could improve glycemic control during the winter holidays among patients with type 2 diabetes mellitus., Study Design: Randomized controlled trial., Methods: The study was conducted from October 2004 to December 2005 in Taipei Veterans General Hospital. Subjects were randomized to program 1 (receipt of regular diabetes education between October 20 and November 25, 2004, and then every 3-4 months) or to program 2 (receipt of a special reminder pamphlet during the holidays). The patients were seen and blood samples obtained on 4 occasions during the holidays and then every 4 months through December 2005., Results: Ninety-three subjects completed the first 4 visits during the Chinese New Year holidays, and 89 subjects completed 12 months of the study. Fructosamine levels in program 1 increased more during the preholiday period than those in program 2 (mean [standard deviation] 7.4 [5.2] vs -5.3 [8.3] mumol/L, P = .03) during the preholiday period. Changes in fructosamine levels during the holiday and postholiday periods were similar in the 2 groups. At the end of the holidays, changes in glycosylated hemoglobin (A1C) levels were 0.34% (95% confidence interval, 0.03%-0.85%) in program 1 and 0.09% (95% confidence interval, -0.23% to 0.42%) in program 2. After the Chinese New Year holidays, the groups had similar changes in A1C levels, with a slight downward decline thereafter., Conclusion: A special educational reminder pamphlet for the holidays led to improvements in glycemic control during the Chinese New Year holidays.