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Br J Ophthalmol 2004;88:436-437 doi:10.1136/bjo.2003.024760
  • Controversy

Overview

  1. E Chew
  1. Lead clinician, Building 31, Room 6A52, 31 Center Drive, MSC 2510, Bethesda, MD 20892-2510, USA; echew@nei.nih.gov

      This patient has both medical and ocular conditions that need to be addressed. It is important to emphasise the need to improve his glycaemic control. This information should be communicated to his primary care physician to initiate tighter control of his glycaemia. In the UK Prospective Diabetes Study (UKPDS), the largest and longest randomised study of intensive v conventional glucose control in patients with type 2 diabetes, there was a 25% reduction in the risk of the “any diabetes related microvascular end point,” including the need for retinal photocoagulation in the intensive treatment group compared with the conventional treatment group.1 After 6 years of follow up, a smaller proportion of patients in the intensive treatment group than in the conventional group had a two step progression (worsening) in diabetic retinopathy (p<0.01). Epidemiological analysis of the UKPDS data showed a continuous relation between the risk of microvascular complications and glycaemia, such that for every percentage point decrease in HbA1c (for example, 9% to 8%), there was a 35% reduction in the risk of microvascular complications.

      Although the data from the Diabetes Control and Complications Trial (DCCT) are from patients with type 1 diabetes, the results showed the importance as well as the persistent effects of glucose control in preventing the progression of the severity of diabetic retinopathy and the development of macular oedema.2 Following the completion of the controlled …

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