***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A three-year trial of Atromid treatment in exudative diabetic retinopathy was carried out in twenty-three patients and twenty-five controls . In comparison with those of the controls the eyes of the Atromid-treated patients showed a highly significant decrease in hard waxy exu date s ( p = < 0.0001 ) which was not , however , accompanied by appreciable improvement in visual acuity . No improvement in the vascular retinal lesions occurred . The initial severity of the exudative lesions was not related to the fasting serum cholesterol or triglyceride levels ; there was also no correlation between the effect of Atromid on the exu date s and on these serum lipids . The way in which Atromid might influence exu date deposition and its possible use in the treatment of exudative diabetic retinopathy are discussed One hundred and forty nine diabetic patients were ophthalmologically assessed seven years after r and omisation to a low carbohydrate or modified fat diet ( rich in linoleic acid ) .  Glycaemic control , regardless of the type of diet , was a major determinant of the development of retinopathy . Poorly controlled patients ( haemoglobin A1c greater than 8 % ) with low levels of linoleic acid in cholesterol ester had a significantly greater frequency of retinopathy than well controlled patients or patients with similarly unsatisfactory control but higher levels of linoleic acid . The findings support an earlier suggestion that linoleic acid might protect against diabetic retinopathy BACKGROUND Laser treatment for diabetic retinopathy is often associated with visual field reduction and other ocular side-effects . Our aim was to assess whether long-term lipid-lowering therapy with fenofibrate could reduce the progression of retinopathy and the need for laser treatment  in patients with type 2 diabetes mellitus . METHODS The Fenofibrate Intervention and Event Lowering in Diabetes ( FIELD ) study was a multinational r and omised trial of 9795 patients aged 50 - 75 years with type 2 diabetes mellitus . Eligible patients were r and omly assigned to receive fenofibrate 200 mg/day ( n=4895 ) or matching placebo ( n=4900 ) . At each clinic visit , information concerning laser treatment for diabetic retinopathy-a prespecified tertiary endpoint of the main study -was gathered . Adjudication by ophthalmologists masked to treatment allocation defined instances of laser treatment for macular oedema , proliferative retinopathy , or other eye conditions . In a sub study of 1012 patients , st and ardised retinal photography was done and photographs grade d with Early Treatment Diabetic Retinopathy Study ( ETDRS ) criteria to determine the cumulative incidence of diabetic retinopathy and its component lesions . Analyses were by intention to treat . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N64783481 . FINDINGS  Laser treatment  was needed more frequently in participants with poorer glycaemic or blood pressure control than in those with good control of these factors , and in those with a greater burden of clinical microvascular disease , but the need for such treatment was not affected by plasma lipid concentrations . The requirement for first laser treatment for all retinopathy was significantly lower in the fenofibrate group than in the placebo group ( 164 [ 3.4 % ] patients on fenofibrate vs 238 [ 4.9 % ] on placebo ; hazard ratio [ HR ] 0.69 , 95 % CI 0.56 - 0.84 ; p=0.0002 ; absolute risk reduction 1.5 % [ 0.7 - 2.3 ] ) . In the ophthalmology sub study , the primary endpoint of 2-step progression of retinopathy grade did not differ significantly between the two groups overall ( 46 [ 9.6 % ] patients on fenofibrate vs 57 [ 12.3 % ] on placebo ; p=0.19 ) or in the subset of patients without pre-existing retinopathy ( 43 [ 11.4 % ] vs 43 [ 11.7 % ] ; p=0.87 ) . By contrast , in patients with pre-existing retinopathy , significantly fewer patients on fenofibrate had a 2-step progression than did those on placebo ( three [ 3.1 % ] patients vs 14 [ 14.6 % ] ; p=0.004 ) . An exploratory composite endpoint of 2-step progression of retinopathy grade , macular oedema , or laser treatments was significantly lower in the fenofibrate group than in the placebo group ( HR 0.66 , 95 % CI 0.47 - 0.94 ; p=0.022 ) . INTERPRETATION Treatment with fenofibrate in individuals with type 2 diabetes mellitus reduces the need for laser treatment for diabetic retinopathy , although the mechanism of this effect does not seem to be related to plasma concentrations of lipids A double blind controlled trial has been made of clofibrate in the treatment of diabetic retinopathy . Fifty-six patients completed one year in the trial and form the basis for this paper . At the end of one year there was a significant reduction in the area of retina involved by hard exudation in the treated group . There were no significant effects on other retinal lesions . The improvement in retinal exu date s was not associated with any significant improvement in visual acuity The Early Treatment Diabetic Retinopathy Study ( ETDRS ) , a multicenter collaborative clinical trial supported by the National Eye Institute , was design ed to assess whether argon laser photocoagulation or aspirin treatment can reduce the risk of visual loss or slow the progression of diabetic retinopathy in patients with mild-to-severe nonproliferative or early proliferative diabetic retinopathy . The 3711 patients enrolled in the ETDRS were assigned r and omly to either aspirin ( 650 mg per day ) or placebo . One eye of each patient was assigned r and omly to early argon laser photocoagulation and the other to deferral of photocoagulation . Both eyes were to be examined at least every 4 months and photocoagulation was to be initiated in eyes assigned to deferral as soon as high-risk proliferative retinopathy was detected . Examination of a large number of baseline ocular and patient characteristics indicated that there were no important differences between r and omized treatment groups at baseline PURPOSE To determine the risk factors for retinopathy progression in type 1 ( insulin-dependent ) diabetes mellitus in a prospect i ve cohort study . SUBJECTS AND METHODS Subjects were 485 participants in the Sorbinil Retinopathy Trial , a r and omized trial of aldose reductase inhibition among patients aged 18 to 56 years with type 1 diabetes mellitus ( duration of 1 to 15 years ) and no or only mild retinopathy . Retinopathy progression , assessed by seven-field stereoscopic fundus photography , was defined as worsening by two or more levels on a st and ardized grading scale at the end of follow-up ( median , 41 months ) . RESULTS The relative risks for retinopathy progression according to successively greater quintiles of total glycosylated hemoglobin level at baseline , after adjusting for age , diabetes duration , sorbinil assignment , and other variables , were 1.0 , 2.0 , 1.6 , 3.7 , and 4.4 ( P trend < 0.0001 ) . Risk increased with greater baseline diastolic blood pressure : 1.0 for < 70 mm Hg , 1.2 for 70 to 79 mm Hg , and 1.8 for > or = 80 mm Hg ( P for trend = 0.04 ) . Diastolic blood pressure was a significant risk factor for progression in participants with mild baseline retinopathy ( P for trend < 0.02 ) but not in those without retinopathy at entry . Systolic blood pressure , by comparison , was not associated with progression . Baseline total cholesterol level was a marginally significant predictor of retinopathy progression when examined as a categorical variable ( relative risks for increasing quartiles ; 1.0 , 1.6 , 1.8 , 1.9 ; P for trend = 0.03 ) but not when it was examined as a continuous variable or when hypercholesterolemic patients were compared with those with normal levels . Furthermore , when cholesterol levels were up date d in subsequent visits , it was not a significant predictor of progression , and low density lipoprotein ( LDL ) cholesterol levels did not predict progression no matter how analyzed . Smoking was not associated with progression of retinopathy . CONCLUSIONS Levels of hyperglycemia and diastolic blood pressure predicted progression of retinopathy in type 1 diabetes mellitus . We found only a suggestion of an association between total cholesterol level ( but not of LDL cholesterol level ) and progression of retinopathy ; resolution of this issue will require additional studies with larger sample sizes and longer follow-up 
    Output:
    
Intensive glucose control and lowering blood pressure and lipids are mechanisms that protect macrocirculation in diabetic patients .