Articles: disease.
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Diabetic retinopathy (DR), the primary retinal vascular complication of diabetes mellitus, is a progressive disease and a major cause of impaired vision and blindness, especially among individuals who are of working age. Early detection and treatment of DR can prevent 50% to 70% of its associated blindness. However, fewer than half of all US adults with diabetes adhere to guideline-recommended eye-screening schedules. ⋯ These delays in diagnosis and treatment may result in visual impairment that is permanent and cannot be reversed. Although the direct medical costs of DR are substantial, the indirect costs of visual impairment with respect to loss of productivity, increased nursing home admissions, and decreased quality of life are far more copious. Greater adherence to eye screening guidelines among patients with diabetes is required to facilitate prompt diagnosis and early treatment of DR, and in doing so, reduce the resulting vision loss and economic burden associated with DR.
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Before 2016, safety concerns limited metformin use in patients with kidney disease; however, the effectiveness of metformin on clinical outcomes in patients with reduced kidney function remains unknown. ⋯ Among patients with diabetes and reduced kidney function persisting with monotherapy, treatment with metformin, compared with a sulfonylurea, was associated with a lower risk of MACE.
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Although the Hospital Readmission Reduction Program (HRRP) has reduced the 30-day readmission rates for patients with chronic obstructive pulmonary disease (COPD) across hospitals, the effect of HRRP on hospital mortality remains unknown. Therefore, we examined the association between hospital readmissions and mortality rates for patients discharged with acute exacerbation of COPD (AECOPD). ⋯ This hospital-level analysis of AECOPD showed that although the 30-day all-cause readmission rates declined, the mortality rates increased. Hospitals with lower readmission rates had higher mortality rates over time.