Effect of multifactorial intervention on diabetic macular edema.

betle flower may exert sympathomimetic effects (4), which might elevate blood pressure leading to increased UAER. However, because the effect was independent of blood pressure, other mechanisms should have been in play. Reactive oxygen species and N-nitroso compounds can be formed in the oral cavity during betel nut chewing, and in vitro studies also demonstrated that betel nut components increased the release of inflammatory mediators including prostanoids, interleukin-6, and tumor necrosis factor(1). Increased oxidative stress and inflammation are also associated with glomerular damage and increased UAER (2). Therefore, the inflammatory mediators produced with betel nut chewing could be responsible. In conclusions, betel nut chewing is independently associated with increased UAER and albuminuria in Taiwanese type 2 diabetic male patients in this crosssectional observation. However, future prospective longitudinal studies are warranted for confirmation.