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ACE inhibitors delay progression of diabetic retinopathy
The aims of the St Vincent Declaration to reduce blindness from diabetic retinopathy by half by the year 2000 are being addressed in a series of clinical trials and basic science studies sponsored by EURODIAB, a confederation of European diabetes associations. Interim results of the EUCLID trial (EURODIAB controlled trial of linisopril in insulin dependent diabetes) indicate some interesting effects of the ACE inhibitor linisopril which appears to delay the progression of retinopathy in normotensive diabetics who do not have renal impairment. Progression of retinopathy was reduced by 50% during the 2 year trial period as assessed by standard photographic grading methods. How ACE inhibitors exert their effect in retinopathy is as yet unclear but they do appear to have a ‘renoprotective’ effect mediated by reduction in capillary pressure. Angiotensin has also been proposed as an endothelial cell activating compound possibly involved in increased cell motility. Whatever the mechanism, the possible beneficial effects are promising for reducing the sight threatening effects of diabetic retinopathy.
The BDA points to a funding crisis in diabetes research
Despite the problem of diabetes and its complications, research programmes in diabetes and particularly in diabetic retinopathy are not sufficiently well supported, according to the British Diabetic Association. Since 1990 there has been a 48% increase in research applications and it appears that the rise is set to continue. The BDA’s annual research fund amounts to approximately £4.5 million to investigate a condition which health economists estimate amounts to a £1.4–1.8 billion cost to the NHS. While there are other sources of funding for diabetes research from more broad based funding bodies such as the MRC and the Wellcome Trust, there still remains a very large shortfall. A major problem in generating funds has been identified by the BDA as lack …