***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 
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    Input: Aims /hypothesisThe aim of the present study was to investigate the effect of blood pressure lowering and intensive glucose control on the incidence and progression of retinopathy in type 2 diabetic patients . Methods The Action in Diabetes and Vascular Disease : Preterax and Diamicron MR Controlled Evaluation ( ADVANCE ) Retinal Measurements study , a sub study of ADVANCE , is a r and omised ( using a central , computer-based procedure ) controlled 2 × 2 factorial trial comprising a double-blind comparison of blood pressure lowering with perindopril – indapamide vs placebo , and an open comparison of st and ard vs intensive glucose control targeting a HbA1c of ≤ 6.5 % in 1,602 diabetic patients from ADVANCE centres with access to retinal cameras conducted from 2001 to 2008 . At baseline and the final visit , seven-field stereoscopic retinal photographs were taken and grade d by blinded readers ( grade able baseline and final photographs from 1,241 patients ) . Progression of ≥2 steps in the Early Treatment of Diabetic Retinopathy Study classification ( using the eye with worst grading ) was the primary outcome . Results Retinopathy progressed in 59 ( 4.8 % ) patients and developed in 128 ( 10.3 % ) patients over 4.1 years . Fewer patients on blood pressure-lowering treatment ( n = 623 ) experienced incidence or progression of retinopathy compared with patients on placebo ( n = 618 ) , but the difference was not significant ( OR 0.78 ; 95 % CI 0.57–1.06 ; p = 0.12 ) . Blood pressure-lowering treatment reduced the occurrence of macular oedema ( OR 0.50 ; 95 % CI 0.29–0.88 ; p = 0.016 ) and arteriovenous nicking compared with placebo ( OR 0.60 ; 95 % CI 0.38–0.94 ; p = 0.025 ) . Compared with st and ard glucose control ( n = 611 ) , intensive glucose control ( n = 630 ) did not reduce ( p = 0.27 ) the incidence and progression of retinopathy ( OR 0.84 ; 95 % CI 0.61–1.15 ) . Lower , borderline significant risks of microaneurysms , hard exu date s and macular oedema were observed with intensive glucose control , adjusted for baseline retinal haemorrhages . These effects of the two treatments were independent and additive . Adverse events in the ADVANCE study are reported elsewhere . Conclusions /interpretationBlood pressure lowering or intensive glucose control did not significantly reduce the incidence and progression of retinopathy , although consistent trends towards a benefit were observed , with significant reductions in some lesions observed with both interventions .Trial registration : Clinical Trials.gov ID no. NCT00145925 . Funding : Grants from Servier and the National Health and Medical Research Council of PURPOSE To examine the 4-year incidence and risk factors for diabetic retinopathy ( DR ) among black participants with diabetes in the Barbados Eye Studies ( BES ) . DESIGN Population -based incidence study . SETTING AND PARTICIPANTS Four hundred ten persons with diabetes mellitus ( DM ) from the BES cohort , which was based on a simple r and om sample of Barbadians , 40 to 84 years of age at baseline . MAIN OUTCOME MEASURES Development of DR , assessed by independent gradings of 30 degrees color stereo fundus photographs  of the disc and macula . Associations were evaluated by logistic regression analyses . RESULTS After 4 years , DR developed in 92 of 306 ( 30.1 % ; 95 % confidence interval , 25.0 % , 35.5 % ) persons unaffected at baseline . The incidence of DR was 31.9 % in those with known DM at baseline and 20.9 % in newly diagnosed DM . Clinical ly significant macular edema developed in 16 ( 4.5 % ) of 353 individuals at risk . Seven ( 6.9 % ) of the 101 persons with minimum or moderate DR at baseline progressed to proliferative DR . Age-specific incidence declined from 36.2 % at age 40 to 49 years to 28.8 % and 24.2 % over the subsequent two decades , increasing to 38.2 % among those > /=70 years . Risk factors for DR were increased systolic blood pressure ( relative risk [ RR ] , 1.16 [ 1.03 , 1.31]/10 mmHg increase ) ; use of oral hypoglycemics ( RR , 2.4 [ 1.3 , 4.2 ] ) ; and use of insulin ( RR , 6.1 [ 1.7 , 22.1 ] ) ( vs. no treatment or diet only ) ; and elevated glycated hemoglobin ( GHb ; RR , 6.4 [ 2.5 , 16.0 ] ) ; GHb > 11.5 % vs. GHb < /=8 % ) . CONCLUSIONS High rates of incident DR were evident in the black BES population , also known to have high rates of DM . Prevention of visual loss caused by DR in this population has high priority , including optimal glycemic and blood pressure control BACKGROUND Diabetes mellitus is a strong risk factor for cardiovascular and renal disease . We investigated whether the angiotensin-converting-enzyme ( ACE ) inhibitor ramipril can lower these risks in patients with diabetes . METHODS 3577 people with diabetes included in the Heart Outcomes Prevention Evaluation study , aged 55 years or older , who had a previous cardiovascular event or at least one other cardiovascular risk factor , no clinical proteinuria , heart failure , or low ejection fraction , and who were not taking ACE inhibitors , were r and omly assigned ramipril ( 10 mg/day ) or placebo , and vitamin E or placebo , according to a two-by-two factorial design . The combined primary outcome was myocardial infa rct ion , stroke , or cardiovascular death . Overt nephropathy was a main outcome in a sub study . FINDINGS The study was stopped 6 months early ( after 4.5 years ) by the independent data safety and monitoring board because of a consistent benefit of ramipril compared with placebo . Ramipril lowered the risk of the combined primary outcome by 25 % ( 95 % CI 12 - 36 , p=0.0004 ) , myocardial infa rct ion by 22 % ( 6 - 36 ) , stroke by 33 % ( 10 - 50 ) , cardiovascular death by 37 % ( 21 - 51 ) , total mortality by 24 % ( 8 - 37 ) , revascularisation by 17 % ( 2 - 30 ) , and overt nephropathy by 24 % ( 3 - 40 , p=0.027 ) . After adjustment for the changes in systolic ( 2.4 mm Hg ) and diastolic ( 1.0 mm Hg ) blood pressures , ramipril still lowered the risk of the combined primary outcome by 25 % ( 12 - 36 , p=0.0004 ) . INTERPRETATION Ramipril was beneficial for cardiovascular events and overt nephropathy in people with diabetes . The cardiovascular benefit was greater than that attributable to the decrease in blood pressure . This treatment represents a vasculoprotective and renoprotective effect for people with diabetes BACKGROUND Post-trial monitoring of patients in the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) examined whether risk reductions for microvascular and macrovascular disease , achieved with the use of improved blood-pressure control during the trial , would be sustained . METHODS Among 5102 UKPDS patients with newly diagnosed type 2 diabetes mellitus , we r and omly assigned , over a 4-year period beginning in 1987 , 1148 patients with hypertension to  tight or less-tight blood-pressure control regimens .  The 884 patients who underwent post-trial monitoring  were asked to attend annual UKPDS clinics for the first 5 years , but no attempt was made to maintain their previously assigned therapies . Annual question naires completed by patients and general practitioners were used to follow patients who were unable to attend the clinic in years 1 through 5 , and question naires were used for all patients in years 6 to 10 . Seven prespecified aggregate clinical end points were examined on an intention-to-treat basis , according to the previous r and omization categories . RESULTS Differences in blood pressure between the two groups during the trial disappeared within 2 years after termination of the trial . Significant relative risk reductions found during the trial for any diabetes-related end point , diabetes-related death , microvascular disease , and stroke in the group receiving tight , as compared with less tight , blood-pressure control were not sustained during the post-trial follow-up . No risk reductions were seen during or after the trial for myocardial infa rct ion or death from any cause , but a risk reduction for peripheral vascular disease associated with tight blood-pressure control became significant ( P=0.02 ) . CONCLUSIONS The benefits of previously improved blood-pressure control were not sustained when between-group differences in blood pressure were lost . Early improvement in blood-pressure control in patients with both type 2 diabetes and hypertension was associated with a reduced risk of complications , but it appears that good blood-pressure control must be continued if the benefits are to be maintained . ( UKPDS 81 ; Current Controlled Trials number , IS RCT N75451837 . OBJECTIVE To determine the prevalence and factors associated with diabetic retinopathy in the Australian population and to estimate the time difference between disease onset and clinical diagnosis of type 2 diabetes . RESEARCH DESIGN AND METHODS The Australian Diabetes , Obesity and Lifestyle study ( AusDiab ) included 11,247 adults aged > or = 25 years in 42 r and omly selected areas of Australia . Retinopathy was assessed in participants identified as having diabetes ( based on self-report and oral glucose tolerance test ) , impaired fasting glucose , and impaired glucose tolerance and in a r and om sample with normal glucose tolerance . Data were available for 2,177 participants . RESULTS Overall , 15.3 % of those with diabetes had retinopathy . The prevalence of retinopathy was 21.9 % in those with known type 2 diabetes ( KDM ) and 6.2 % in those newly diagnosed ( NDM ) . The prevalence of proliferative diabetic retinopathy ( PDR ) was 2.1 % in those with KDM . No cases of PDR were found in those with NDM . Untreated vision threatening retinopathy ( presence of PDR or macular edema ) was present in 1.2 % ( n = 4 ) . Factors associated with retinopathy were duration of diabetes , HbA(1c ) , and systolic blood pressure . Using linear extrapolation of the prevalence of retinopathy with diabetes duration , the onset of diabetes in this population was approximately the time of diagnosis . CONCLUSIONS This is one of the first national studies of diabetic retinopathy in a developed country . The prevalence of retinopathy was similar to that in other population -based studies . Vision threatening retinopathy was relatively rare ; however , four untreated cases were identified . Regular screening for diabetic retinopathy and more aggressive management of modifiable risk factors could reduce the numbers of people who develop vision-threatening retinopathy To assess whether angiotensin-converting enzyme inhibitors and third-generation dihydropyridine calcium channel blockers ameliorate diabetic complications , we compared glomerular filtration rate ( GFR ; primary outcome ) , cardiovascular events , retinopathy , and neuropathy in 380 hypertensive type 2 diabetics with albuminuria < 200 mg/min included in a multicenter , double-blind , placebo-controlled trial ( DEM AND [ Delapril and Manidipine for Nephroprotection in Diabetes ] ) and r and omized to 3-year treatment with manidipine/delapril combination ( 10/30 mg/d ; n=126 ) , delapril ( 30 mg/d ; n=127 ) , or placebo ( n=127 ) . GFR was central ly measured by iohexol plasma clearance . Median monthly GFR decline ( interquartile range [ IQR ] ) was 0.32 mL/min per 1.73 m2 ( IQR : 0.16–0.50 mL/min per 1.73 m2 ) on combined therapy , 0.36 mL/min per 1.73 m2 ( IQR : 0.18–0.53 mL/min per 1.73 m2 ) on delapril , and 0.30 mL/min per 1.73 m2 ( IQR : 0.12–0.50 mL/min per 1.73 m2 ) on placebo ( P=0.87 and P=0.53 versus combined therapy or delapril , respectively ) . Similar findings were observed when baseline GFR values were 
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However , the lack of evidence to support such intervention to slow progression of diabetic retinopathy or to prevent other outcomes considered in this review , along with the relatively modest support for the beneficial effect on incidence , weakens the conclusion regarding an overall benefit of intervening on blood pressure solely to prevent diabetic retinopathy