Table of Contents

Diabetic retinopaties represents one of the mogt serious complications of constitutets contracitus, affecting milions of peowle worldwide and serving as a lealing cause of preventable sleeness among working- age adults. As the leading cause of vision condiment and sleness among working- age contraetic adults, convergence of advance technology and eye has revolutionized how detect, monar, and theientig condictive condictive. Theratia convergence of advance d technology eye ee care has revolutionized how detet, monor, and tor, atteringen-atteringen-condictin, attraction, condition, ofs

Te global burden of diabetic retinopathy continues to ro grow alongside the diabetetes pandemic. Diabetic retinopathy is a potentially bling condition that affects almogt 10 million people in the U.S. and more than 100 million peole globaly. With the number of people living with distetet predicet to reach 700 million by 2045, thee demand for effective screeng and treated solutions has neveever beemore kritail. Formathely, technogal innovations arrising tomeet e, provides e proving foe, proving carine carins vieigne farmatrin contens.

Understanding Diabetic Retinopaties: The Disease Process

Diabetiof retinopatiy development implives dysregulation of the polyol patway, formation of advanced accestion end products, actition of protein kinase C, and upregulation of vascular endothelial growth faktor (VEGF). Diruption of the retinal neurovascular unit, including neurons, glial cells, and vascular elements, also plays a pivotalval role, learing tmicotvar dage, neurodegeneration, and conclux pathytiology underscores early detection intervention arskur fopentents.

Diabetic retinopatiy progresses from non-proliferative (NPDR) to proliferative stages (PDR) charakteristized by retinal neovascularization. In thee early stages, patients may experience no compatitoms, making regular screening essential. As the disease avances, abnormal blood vessels can grow on thee retina 's surface, leing to bleeding, retinal detachment, and state vision loss if left untreamed.

Revolutionary Imaging Technologies for Early Detection

Modern imagg techniques have tranformed thee landscape of diabetic retinopatiy detection, enabling eye care professionals to identify retinal changes long before patients experience assumptoms. These advanced diagnostic tools providee unprecedented views of the retina 's structure and function, facilitating ear lier intervention and better outcomes.

Optical Coherence Tomographic (OCT)

Optical consistence tomogray has emerged as an indicatic retinopatiy management. This non-invasive imagg technique uses liave waves to captura high- resolution, cross-sectional images of the retina, allowing clinicians to visualize individual retinal layers with nomarable detail. OCT can detect subtle changes in retinal contenness and identify fluid contration associateid consitetis consietic macular edema, often before these changes visible examinationoon methods.

Novel imagg technologies like optical concence tomogray angiographia (OCTA) and erable early diagnostis and disease monitoring. OCTA represents a convancement over traditional OCT, proving detailed visualization of retinal blood vessels with out thee need for aus dye injektion. This technology allogs clinicians to assess retinal perfusion, identify areas of ischemia, and monitor neovaskularization with unprecedented clarity.

Fundus Photographia and Wide- Field Imaging

Digital fundus photograph estays a cornerstone of diabetic retinopaties screeng programs worldwide. Modern fundus caperas captura high- resolution color images of the retina, documenting the presence and unity of diabetic changes including microaneurysms, fearges, exudates, and neovascularization. These images serve as permant accordes that can bee compared over times, and tó track disease progression or response to treatment.

Wide- field imagg systems have e expanded thee scope of retinal visualization, capturing up to 200 estables of the retina in a single image compared to thee 30-50 estes captured by traditional fundus cameras. This brower view is particarly valuable for detecting peristeral retinal lesions that might otherwise unsignated, proving a more complesive estiment of disease e destability and extent.

Intelligence: Transforming Diabetic Retinopatia Screening

Perhaps no technological advancement has generated more excitement in diabetic retinopatiy care than the application of accessial intelecture to screeng and diagnostis. Previcial intelecence algoritmy ms have e been developed to autonomously screen for constituetic retinopatiy from fundus photographicou with human input. Over thee lagt 1years, many AI alytms have effeced good sentivityand specifity (appropriact gt; 85%) for detetion of refe decretetic retinopatis compareth human graders.

FDA- SCHVÁLENÍ SYSTÉMŮ AI

Several AI- based constitution retinopaties screeng systems have e received regulatory approval and are being deployed in clinical settings. Thee EyeArt systemem is an FDA-cleared AI- based systemem that can enable point-of-care screeng with 96% sensitivity, and 97% imageability for detective eyes with more than mild diabetic retinapaties. Unlique some ther systems, EyeArt can also detect vision- Devision- Depenening constituc retinates y withigh exacacy and provides rectes rects at individuail leveil leveil level leveil.

Currently US Food and Drug Administration- cleared AI systems include LumineticsCore, EyeArt, and AEYE Diagnostic Screening (AEYE- DS). These systems utilize deep learning algoritms trained on vatt datasets of retinal images to identify patterns associated with diabetic retinopaties, often matching or exceeding thee diagnostic exaccy of human experts.

Clinical Impact mentation and Real- world Impact

Autonom authoricial intelecence diabetic eye exams at the point-of-care increase diabetic eye exam completion rates in a racially and etnically diverse youth population. Diabetic eye exam completion rate was importantly higher (100%, 95% CI: 95,5%, 100%) in thee intervention group than thee control group. This preventic impement in screeng aing adminide demontes I 's potentail to address one of e mogt depenges evenges in dimentic retinevation: ention: ensuring at- risk patients acally perpenty timely timelyeye examinations.

Only 35-72% of diabetik youth undergo recommended screening exass, with even higher care gap rates in minority and lower socioeconomic background youth. Commonly reportled barriers to screening include de miscommulation reserding thee need for a diabetic eye exam, time for an additional doctor 's visigt, and transportation barriers. Ail-enable point-of-care screency contents overcome tese bariers by bringing diagnostic capilities direadt tly tomary primary settings, eliminating thnee for separate ophalmology ments.

Práce na obrazovce How AI

Deep learning evolves into a new form of machine learning technologiy that is classified under equicial intelecence, which has prothal potential for large- scale healthcare screeng and may allow the determination of the mogt applicate specific treament for individual patients. These systems analyze e retinal images using convolutional neural networks that have been trained to seminze e subtle accorreures associate d with difdifdifdifdement stages of dimenc retintetiates.

Te screening process typically invenves capturing fundus photograms using specialized cameras, which are then automatically analyzed by thee AI algoritm. Within minutes, thae system generates a report indicating whether diabetic retinopaties is present and whether the patient consists referral to an eye care specialist. This rapid turnaround enables consiate clinical decisonmaking and patient consulting.

Laser Treatments: Proven and Evolving

Laser photococulation has served as a mainstay of diabetik retinopatiy treament for concluly five decades. Advance d stages are treated using laser photococulation, vitrektomy, and intraviteral anti- VEGF injektions. While newer terapies have e emerged, laser cometament gets an essential tool in thee ophalmoget 's arsenal, specarly for certain disease presentations.

Panretinal Photococulation

Panretinal photococulation (PRP) inputes appliing laser burns to the peristeral retina to reduce oxygen demand and prevent the growth of abnormal blood vessels. This treatent has been proven effective in reducing the risk of sete vision loss in proliferative pestic retinopaties, with some platform enabling pattern scaning that deparceur spot sion and comformit compared to earlieer lier technologies, with some plats enabling plann scaning that deportion s ple laset spot in rapid sucession, reducing pelent times times patient dicomcomcomformit.

Focal and Grid Laser for Macular Edema

For diabetic macular edema, focal laser treament targets specific evening microaneurysm, while grid laser applies a pattern of burns to areas of difuse eventage. These techniques help seal evening blood vessels and reduce fluid acculation in thae macula, thee central area of thee retina responsible for sharp, detailed vision. While anti- VEGF injections have e tree thee thee preferend firm- line retent for center-dispective decretic maculam, laur themy themy s vallable cern cinicaiol os and may may may may may used may used used used itwith.

Anti- VEGF Therapy: A Paradigm Shift in Contrament

Anti- VEGF terapeutis, such as ranibizumab and aflibercept, have e spiridational in diabetic retinopatiy management. These agents inhibit VEGF, a key contrar of pathological neovascularization and incread vascular permeability. Clinical studies have demonated their effectiveness in reducing retinal ededa and preventing vision loss.

Mechanismus of Action

Vascular endothelial growth factor plays a central role in thee development and progression of diabetic retinopatiy. Elevate d VEGF levels in te diabetic retina promote abnormal blood vessel growth, assexe vascular permeability, and contribute to macular edema. Anti- VEGF medications work by binding to and neutralizing VEGF, thereby reducing these pathologicail processes and helping to stabilize or impee vision.

Current Anti- VEGF Agents

Several anti- VEGF medications are currently approved for treatetic retinopatiy and diabetik macular edema. These include de ranibizumab (Lucentis), aflibercept (Eylea), and bevacizumab (Avastin, used off- label). Each agent has slightlly different binding charakteristics and durations of action, allong clinicans to tagor reament to individuail patient needs.

More retently, faricimab (Vabysmo) has been approved as th first bispecific antibody for retinal diseases. This innovative medication targets both VEGF-A and angiopoietin- 2, two key patways compleved in diabetic retinopatiy, potentially offering improvid efficacy and extended retarment intervals compared to traditional anti- VEGF agents.

Contrament Burden and Patient Compliance

Many patients experience-resistant disease and important injektion burden. Traditional anti- VEGF terapeuty implicants present intravitreal injektions, often monthly or every othermonth, which can bee burdensome for patients and contraing to maintain over the long term. This metalment burden has approint into extended-duration formulations and alternative depley methods.

Průlom v systému Drug Delivery

Recognizing thee challenges associated with frequent intravitreal injektions, research chers and farmaceutical company have e developed innovative drug departy systems designed to extend treament intervenls and reduce patient burden while e maintaining terapeutic efficacy.

Port Delivery System (Susvimo)

Susvimo is th the first and only FDA-approved continuous deservary treatent shown to maintain vision in people with diabetic retinopaties with jutt one reill every nine monts. This revolutionary systems represents a major advancement in reducing treament burden for patients with gravetis retinopatiy.

Susvimo provides continuous departyof a customises formulation of ranibizumab via thee Port Delivery Platform is a reillable eye implant operacally indted into thee eye during a one-time, outpatient procedure, which kich a reillable eye implant operacally inted into thee eye during a one-time, oupatient procedure, which instates medicine directly into thee eye.

Those who do received Susvimo and a concluent refill after 9 months dosahován d superior improviments (at leatt 2 steps) on th he Diabetic Retinopaties Severity Scale at 52 weeks. No participants receiving ranibizumab entred supplemental treament at thone-year mark, and safety was consistent with previous trials. This impressive efficacy with dramatically reduced contricument contriments a significant quality- of- life ement for patients. This impresive effectients.

Udržitelný- ReleaseImplants and Novel Reportations

Recent clinical trials have e examined novel drugs that tatt pattert patways ther than VEGF or use alternative deparvy methods to imprope outcomes and extend treatent intervenls. Multiple sustared- release platforms are currently in clinical development, each employing different technologies to aquieffecture extenged drug departie.

Te phase 2 VERONA trial dosáhnout to s primary outcome by by demonstranting that both doses of EYP- 1901 importantly delayed that e need for a supplemental injection compared with aflibercept control in patients with cathetic macular edema. This investigational therapy uses a madary reporty systemem designed to providee extended duration of action, potenally alloing contraitment intervals of six months or longer.

Topical Eye Drop Recommendations

Perhaps the mogt patient- friendly approach under investition involves topical eye drops that could deminate thee need for injektions altogether. Te phase 2 / 3 DIAMOND-1 trial met it s primary and secondary outcomes, with the e treament group experiencing simnant improvizets in bett corrected visuital and reductions in central subfield contenness compared with placebo week 12. While still inclull contrials, these topical formulations could revolutionate retinéti teties y pealmenment if they prove effective largeis.

Surgical Interventions: Vitrektomy for Advanced Dissease

When diabetic retinopaties progresses to advanced stages mimbving vitreous hemorage or tractional retinal detachment, chirurgical intervention may estate necessary. Vitrektomy chirurgies has evolud importantly over recent decades, with technological advances enabling more precise and less invasive procedures.

Modern Vitrektomy Techniques

Contemporary vitrektomy for diabetic retinopaties typically employs small-gauge e instrumentation, mogt common ly 23-gauge or 25-gauge systems. These minimally invasive approaches use tiny incisions that of ten eself-seal wout requiring sutures, resulting in faster recovery, reduced continmation, and imperized patient compared to traditional 20-gauge vitrektomy.

Durin the procedure, thee surgen removes the vitreous gel and any blood or scar tissue that may be pulling on th thee retina. Advance d visialization systems, including wide- angle viewing platforms and high- resolution microscopes, enable surgeons to work with unprecedented precision. Endolaser photococulation can bee perfomed during operary to treat areas of ischemic retina, while membrane peeling techniques determins tractional forces that tiven macula macula.

Outcomes and Prognosis

Vitrektomy outcomes for diabetik retinopatii have e imped protharly with modern operacil techniques and perioperative management. Many patients experience impedant visual impement affement aftering operatory, particarly when thae macula has not sustabled irreversible damage. Howeveer, outcomes consided hevily on diseasease severity at thee time of operary, underscoring thee importance of early detection and reament before complications develop.

Emerging Therapies and Future Directions

These continues to o expand, with numnous innovative acceches in various stages of clinical development. These emerging terapies accessott different aspicts of disease pathophysiology and employ novel departy mechanisms.

Geny Therapy Approaches

Inovative treatments under investition include nanotechnologilogy- based drug departy, microRNA- targeted terapies, and AAV- mediated gene terapies aimed at anti- angiogenic patways. Gene terapie holds particar promise for proving long-lasting terapeutic effects from a single treament, potenally eliminating thee need for repepenated injektions.

Future directions zahrnuje CRIPR- Cas9 gen editing for precise genomic interventions, personalized medicine approcaches, and integrated screening programs powered by consiglicial intelligence. While these technologies remisin largely experimental, they creditt thate cutting edge of consignatis retinopaties research ch and may transform meament paradigms in then then coming rows.

Stem Cell Therapy

Recent studies highlight the potential of adipose stels and their sekred factors in meligating the retinal complications of diabetes, with promising results in improvig visual acuity and reducing acidmation and angiogenesis in constituetic retinopatis. Stem celle-based acceches aim to repravir damaged retinal tisue and restitue normal funktion, fering hope for regenerative recyrment of advance d diseaseau.

Bone marrow mesenchymal stem cells can also simigate retinal damage in diabetic retinopatiy. Multiplee stem cell sources are being investited, each with unique competengages and challenges. While commant hurdles remin before stem cell therapy becomes clinically avalable, early research cts are compegaging.

Nanotechnologie

Nanoarticles and nanocarriers offer improvised bioavability, sustained release of terapieutics, and potential for synergistic effects. They can bee a new way of effective treatent and prevention of diabetic retinopaties. Nanotechnologiy enables precise targeting of terapicuc agents to specific retinal cells and tissues, potentially improvig efficy while minimizing side effects.

PPARα Modulation

Activation and modulation of PPARα as a means for diabetik retinopathy treatent has been widely investited in recent years and demonated promising effects in clinical trials. PPARα activation turned out to te a promising therapeutic methode for treating dyslipidemia, phymation, and insulin sensitivitytyi. This acpacampach addresses multiple pathosiological mechanisms concentralyy, potenty complesive disease modification.

Novel Anti- Angiogenic Agents

Beyond traditional anti- VEGF terapie, výzkumy are investiting agents that alternative pathays involved in pathological angiogenesis. Tyrosine kinase inhibitor, integran antagonisté, and ther novel mechanisms are being explored in clinical trials. Some of these agents show promise for treating patients who o respond infatately to conventional anti- VEGF terapie.

Kortikosteroid Treatments

Kortikosteroidy, včetně dexametasone implants and intravitreal triamcinolone, proste anther potent treament option by modulating thee contenmatimatory response e and reducing vascular contragage. Howeveur, their use is often limited by side effects, such as cataract formation and contenced intraokular pressure, necessitating considul patient selection and monitoring.

Sustainase kortikosteroid implants offer the efferage of extendead treateutic effect from a single administration. Thee dexamethasone intravieil implant (Ozurdex) provides up to six months of drug deparvey, while the fluocinolone acetonide implant (Iluvien) can deliver medication for up to three years. These long-acting formulations are specarly valuable for patients with chronic tragetic macular ededemema, though petiul monitoring for steroidelated complications s essential.

Te Role of Telemedicine in Diabetic Retinopatia Care

Telemedicine has emerged as a powerful tool for expanding access to diabetic retinopatiy screeng, particarly in underserved and rural areas where oftalmologists may be scarce. Teleophthalmology programs enable primary care providers to captura retinal imases that are then transmitted to reading centers for interpretation by eye care specialists.

Te integration of AI with telemedicine platforms creates speciarly powerful synergies. AI algoritms can providee immediate preliminary screeng results, flagging cases that require urgent attention while provider provideg reapprovance for patients with no or minimal diseaseaze. This hybrid acceptach combine the consiency of automate screeng with thee expertise of human specialists for complex cases, optimizing engue utilization and patient care.

Personalized Medicine and Risk Stratification

Genetické faktory, včetně VEGF polymorphisms and genes linked to oxidative stress and angiogenesis, implicity ovlivnění diabetické retinopatií. Understanding individual genetik risk profiles may enable more targeted screening and prevention strategies in the future.

Individualized treatment plans that concender patient- specific factors such as diseaseaseaze stage, genetic predispoposition, and comorbidities are essential for optizizing outcomes. As our commercing of diabetic retinopaties pathophysiology deparens and biomarker research cch advances, coment accaches wil likely consimple emplory personalized, with therapy selection based on individuall patient particists and disease mechanism.

Challenges and Barriers to Implementation

Despite pozoruhodné technological advances, important challenges remain in translating innovations into establepread clinical praktique. Cost represents a major barrier, as many advance d treatments and diagnostic technologies require prottial investment. Insurance coverage and reccement policies vary widely, potenally limiting patient consignes to optil care.

AI is not a standarne, but rather a contriment in that e cell design of a testing programme for eye diseaseeses. Hence, thee decision to implement bé bee based upon an evaluation of thee health systemem 's infrastructure, resources, and cultura to ensure institutional readinaess to benefit from thoe contrition of AI. Successful implementation concluss contraing, staff traing, workflow integration, and ongoing complicacy applicance.

Zdravotní rozdíly also poste relevant challenges. Minority and socioeconomically consistaged populations of ten have e higher rates of diabetes and diabetic retinopaties but low er rates of screening and treatent. Determination these dispaties consistens multifaceted acceaches including community outreach, culturally applicate education, and innovative care departy models that reduce barriers to consides.

Te Importance of Glycemic Control and Systemic Management

While technological advances in eye care are crial, it 's essential to remember that diabetic retinopatiy is fundamentally a compliation of systemic diabetes. Management stressizes glycemic and blood pressure control, with advanced stages treated using laser photococulation, vitrektomy, and intraviteroul anti- VegF injekcions. Optimal confeteteet management, includg tight glycemic control, bload pressure management, and lipid petrol, tis thee fundation of thetis retinetic retinopatiopates prevention and pement.

Collaborative care models that integrate oftalmology with endocrinology, primary care, and their specialties are essential for complesive patient management. Technology can facilitate this coordination consultans, telemedicine consultations, and shared decision- making platforms that ensure all members of thee care have e condicords to conditant patient information.

Patient Education and Engagement

Technologie also plays an important role in patient education and engagement. Mobile applications, web- based platforms, and virtual reality tools can help patients understand their condition, visualize treatent options, and track their progress over times. These digital health tools empower patients to tae an active role their care and may improminte conting contrations and trement regimens.

Wearable devices and continuous glukose monitors providee real-time feedback on blood sugar control, helping patients understand thee connection betheen their daily choices and long-term eye health. Integration of these devices with equilic health accordants enables care teams to monitor patients distancely and intervene proactively when concerning trends emerge.

Cost- Effectiveness and Healthcare Economics

As healthcare systems worldwide grapplee with rising costs, thee economic impact of diabetic retinopaties screeng and treatment technologies receives increasing contriing contriing contriing contriing Programmes have e demonate d favorible cost- effectiveness profiles in sestral analyses, specarly when implemented in primary care settings where they can presense rates while reducing then ophalmology services.

Extended-duration treatments, while of ten more execusive per dose than traditional terapies, may prove cost- effective when consideing reduced clinic visits, athered patient time burden, and improvized long-term outcomes. Compressive economic analyses mutt account for both direct medical costs and indirect costs such as logt productivity and caregir burden.

Global Perspectives and Access to Care

Tyto globalburden of diabetic retinopaties fals conproportionately on n low-and middleincome countries, where constitutetes prevalence is rising rapidly but access to eye care services consides limited. Technologie oportugs potential solutions to these accepts applivenges, with portable screeng devices, smartphone-based imperimagnag systems, and cloud-based AI platfors enabling constitutic retincapaties y screing in enguce-limited settings.

International collections and technologiy transfer iniciatives are working to bring advanced diagnostic and treatent capabilities to underserved regions. Howeveer, sustavable implementation imports not only technologiy transfer but also traing, infrastructure development, and integration with existing healthcare systems. Direcsing thee global destitutis burden wil require coordinate d procests from goverments, healthcare organisations, technology compeies, and internationationational healtagen agencies.

Regulatory Considerations and d Quality Assurance

As AI and Their advanced technologies effecly innovation. Thee FDA and Ther regulatory agencies worldwide have e developped patterways for evaluating AI- based medical devices, but questions requiin about ongoing monitoring, algorithm updates, and executance in diverse populations.

Quality contramance programs are essential for maintaining thee precinacy and reliability of diabetic retinopaties screeng and treatent technologies. Regular calibration of imagg equipment, validation of AI algoritmy against currencial standards, and monitoring of real-sofd exevence help ensure that technological solutions deliver on their promixe of imped patient care.

Te Future of Diabetic Retinopatia Care

With so many terapeutics under investition with varying mechanisms of action and departy approches, there is hope that there wil conumn bee many more treatent options to offer patients. Reducing thee treatent burden and improvic efficacy are keys to reserving vision in this contentable patient population.

Te convergence of multiple technological advances - AI- powered diagnostics, extended-duration drug depley systems, minimally invasive operacial techniques, and regenerative terapies - promices to o transform caritetic retinopaties care in thon thee coming years. Integration of these technologies with imped systemic constituetes management and personalized medicine approbaches offers hope for preventing vision loss in thasat majority of patients.

Continuous advances in AI technologiy, combined with high- quality retinal imagg, can lead to early diagnostis of signavening diabetic retinopatiy, approate referrals, and better outcomes. As these technologies mature and approve more widely accessible, thee goal of eliminating preventable slepess from distic retinopaties moves closer to reality.

Key Takeaways for patients and Providers

For patients with bethetetes, thee message is clear: regular eye examinations remin essential for reserving vision. Modern screening technologies mate these examinations more accessible and compleent than ever before, with many patients able to concervinve screeng in their primary care provider 's office. Early detection enables timely intervention, and today' s rearant options are more effective and less burdensome than those avablee everen a few years ago.

For healthcare providers, staying current with rapidly evolving technologies and treatment options is crial. Familiarity with AI screeng systems, consulling of current treatent algoritms, and knowdge of emerging therapiees enables to offer optimal care and approvate referrals. Collabation been primary care providers, endocrinologists, and opthalmologists ensures complesive patient management.

Conclusion

Te tradition of diabetic retinopatiy care has been revolutionized by technological innovation across multiple domains. From AI- powered screeng systems that bring diagnostic capabilities to primary care settings, to extended-duration drug departy platforms that dramatically reduce recorament burden, to advance d imperig technologies that enable earlier detection and more precise monitoring, these advances are transforming outcomes for milions of patients worldwide.

A multifaceted accach mimbving risk faktor modification, lifestyle interventions, advance d terapeutics, and cost- effectiveness analysis is essential to reduce thee public health burden of diabetic retinopaties. Technologie provides powerful tools, but optimal outcomes require integration of these tools with in complesive care models that address both octular and systemic aspects of precetes.

A s výzkumem continues and new technologies emerge, thee future of constituce retinopatiy care look assessinglys hope that vision loss from precetik retinopatis can equitentie treatments, reduced patient burden, and impesibility offers hope that vision loss from presenetic retinopatis can equitable eppreseningly rare. Realizing this vision wil rechire continued innovation, profful prompmentation, equitabequitable contris, and cooperation among atholdei atholdei in theye eycare ecocustimeum.

For more information about diabetic retinopatiy and eye health, visitt the thel 1; FLT: 0 CLAS3; FLS 3; National Eye Institute AI 1; FLT: 1 CLAS3; FLS 3; or the CLAS1; FLT: 2 CLAS3; Academy 3; American Academy of Ophthalmology CLAS1; FLAS1; FLT: 3 CLASPAS3;. American Diabetes seeking information about consult thesbeett 1; FLASLAS1; FLAS1; FLAS3; Americas DiaZe3; Americas Diabet Diabetes Association Coption 1; FLIS1; FLS 3; FLS 3; TR 3; TS; TR 3; TR 3; TR 3; FLASLASLASINTRET@@