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Boston, MA, United States

Joslin Diabetes Center is the world’s largest diabetes research center, diabetes clinic, and provider of diabetes education. It is located in the Longwood Medical and Academic Area in Boston, Massachusetts, USA. Among the Harvard Medical School Affiliated institutions, Joslin is unique in its sole focus on diabetes. Joslin has the world’s largest team of board-certified physicians treating diabetes and its complications, as well as the largest staff of Certified Diabetes Educators anywhere in the world.Since its inception, Joslin has focused on aggressive, comprehensive care of the patient. Over 23,000 active patients receive specialty care for their eyes, hearts, kidneys, pregnancies and feet.Joslin supports the world’s largest diabetes research team with more than 40 faculty level investigators for a total of more than 300 researchers.Joslin has 46 clinical care affiliates in the US and two in other countries. Wikipedia.

Patti M.-E.,Joslin Diabetes Center | Patti M.-E.,Harvard University | Corvera S.,University of Massachusetts Medical School
Endocrine Reviews | Year: 2010

The pathophysiology of type 2 diabetes mellitus (DM) is varied and complex. However, the association of DM with obesity and inactivity indicates an important, and potentially pathogenic, link between fuel and energy homeostasis and the emergence of metabolic disease. Given the central role for mitochondria in fuel utilization and energy production, disordered mitochondrial function at the cellular level can impact whole-body metabolic homeostasis. Thus, the hypothesis that defective or insufficient mitochondrial function might play a potentially pathogenic role in mediating risk of type 2 DM has emerged in recent years. Here, we summarize current literature on risk factors for diabetes pathogenesis, on the specific role(s) of mitochondria in tissues involved in its pathophysiology, and on evidence pointing to alterations in mitochondrial function in these tissues that could contribute to the development of DM. We also review literature on metabolic phenotypes of existing animal models of impaired mitochondrial function.Weconclude that, whereas the association between impaired mitochondrial function and DM is strong, a causal pathogenic relationship remains uncertain. However, we hypothesize that genetically determined and/or inactivity-mediated alterations in mitochondrial oxidative activity may directly impact adaptive responses to overnutrition, causing an imbalance between oxidative activity and nutrient load. This imbalance may lead in turn to chronic accumulation of lipid oxidative metabolites that can mediate insulin resistance and secretory dysfunction. More refined experimental strategies that accurately mimic potential reductions in mitochondrial functional capacity in humans at risk for diabetes will be required to determine the potential pathogenic role in human insulin resistance and type 2 DM. Copyright © 2010 by The Endocrine Society. Source

Objective To evaluate whether intensive treatment (INT) with the goal of achieving blood glucose levels as close to the nondiabetic range as safely possible reduced the risk of onset and progression of diabetic retinopathy (DR) in subjects with type 1 diabetes (T1D) compared with conventional therapy (CON). Research Design And Methods The Diabetes Control and Complications Trial (DCCT) (1982-1993) was a multicenter, controlled clinical trial comparing INT with CON for onset and progression of DR. The Epidemiology of Diabetes Interventions and Complications (EDIC) study (1994-present) is an observational follow-up of the DCCT cohort. Results Of the 1,441 DCCT subjects, 726 had no DR (primary prevention cohort) and 715 had mild DR (secondary intervention cohort) at baseline. Subjects were followed for a mean of 6.5 years. INT median HbA1c was 7% compared with CON median of 9%. INT reduced the adjusted mean risk for the development of DR by 76% and slowed progression of DR by 54% compared with CON. Following DCCT, the HbA1c levels in the original INT and CON groups converged (year 8, INT 7.98%; CON 8.07%); nevertheless, the groups continued to have a durable effect of initial assigned therapy with significantly lower incidence of further DR progression in the INT group (hazard reduction 53-56%). Severe retinal outcomes and procedures to treat them were reduced by 50% in the original INT group. Conclusions INT delays the onset and slows the progression of DR. Furthermore, the early effects of metabolic control continue to accrue over many years despite subsequent comparable glycemic control (metabolic memory). These results emphasize the need for optimizing glycemic control as early as possible in patients with diabetes. © 2014 by the American Diabetes Association. Source

Soliman A.Z.,Joslin Diabetes Center
Seminars in ophthalmology | Year: 2012

Current ultra-wide field (UWF) retinal imaging systems utilize scanning laser ophthalmoscope technology combined with an ellipsoidal mirror to capture up to 200 degrees of the retina in a single image. When compared with mydriatic ETDRS-protocol, 7 standard field photographs and clinical examination, nonmydriatic UWF images appear to have excellent agreement in allowing the detection and classification of diabetic retinopathy (DR), although larger, definitive validation studies are still forthcoming. UWF imaging and angiography allow visualization of peripheral retinal nonperfusion, vascular leakage and neovascularization in patients with DR that may not be captured on 7 standard fields. Prospective randomized controlled trials are needed to evaluate whether modified laser treatment algorithms based on improved visualization of the retinal periphery might improve patient outcomes. Nonmydriatic UWF imaging has potential applications for ocular diabetic telehealth programs, but validation of newer, more portable, and more affordable UWF imaging models is needed. Source

Stanton R.C.,Joslin Diabetes Center
American Journal of Kidney Diseases | Year: 2014

Diabetic kidney disease (DKD) is a major and increasing worldwide public health issue. There is a great need for implementing treatments that either prevent or significantly slow the progression of DKD. Although there have been significant improvements in management, the increasing numbers of patients with DKD illustrate that current management is not wholly adequate. The reasons for suboptimal management include the lack of early diagnosis, lack of aggressive interventions, and lack of understanding about which interventions are most successful. There are a number of challenges and controversies regarding the current management of patients with DKD. Understanding of these issues is needed in order to provide the best care to patients with DKD. This article describes some of the clinically important challenges associated with DKD: the current epidemiology and cost burden and the role of biopsy in the diagnosis of DKD. Treatment controversies regarding current pharmacologic and nonpharmacologic approaches are reviewed and recommendations based on the published literature are made. © 2014 by the National Kidney Foundation, Inc. Source

Williams M.E.,Joslin Diabetes Center | Garg R.,Brigham and Womens Hospital
American Journal of Kidney Diseases | Year: 2014

The management of hyperglycemia in patients with kidney failure is complex, and the goals and methods regarding glycemic control in chronic kidney disease (CKD) are not clearly defined. Although aggressive glycemic control seems to be advantageous in early diabetic nephropathy, outcome data supporting tight glycemic control in patients with advanced CKD (including end-stage renal disease [ESRD]) are lacking. Challenges in the management of such patients include therapeutic inertia, monitoring difficulties, and the complexity of available treatments. In this article, we review the alterations in glucose homeostasis that occur in kidney failure, current views on the value of glycemic control and issues with its determination, and more recent approaches to monitor or measure glycemic control. Hypoglycemia and treatment options for patients with diabetes and ESRD or earlier stages of CKD also are addressed, discussing the insulin and noninsulin agents that currently are available, along with their indications and contraindications. The article provides information to help clinicians in decision making in order to provide individualized glycemic goals and appropriate therapy for patients with ESRD or earlier stages of CKD. © 2014 by the National Kidney Foundation, Inc. Source

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