ReviewPrevention of Visual Loss From Diabetic Retinopathy
Section snippets
Glycemic Control
Epidemiological data from the population-based Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) showed a strong step-wise relation between glycosylated hemoglobin measured at baseline and the 10-year incidence and progression of retinopathy in persons with diabetes (Fig. 1).23, 26, 28 The Diabetes Control and Complications Trial (DCCT) was “designed to compare intensive with conventional diabetes therapy with regard to their effects on the development and progression of the early
Blood Pressure Control
Epidemiological data regarding an association of hypertension with diabetic retinopathy have been inconsistent.27 In the UKPDS, the incidence of retinopathy was associated with systolic blood pressure. For each 10 mm Hg decrease in mean systolic blood pressure, a 13% reduction was found for microvascular complications and no threshold was found for any endpoint.12 In the WESDR, diastolic blood pressure was a significant predictor of progression of diabetic retinopathy and the incidence of
Lipid Lowering
Elevated triglycerides and lipids have been shown to be associated with retinal hard exudate in patients with diabetes. In the 1960s, clinical trials of clofibrate showed that treatment with this drug reduced the incidence of hard exudate but failed to restore vision to eyes with established macular edema at the onset of the trial.17 Clofibrate was associated with liver toxicity and is no longer used. In the WESDR, higher total serum cholesterol was associated with higher prevalence of retinal
Conclusions
Primary prevention of diabetes remains an important goal in reducing the complications and costs of this disease. Data from a recent clinical trial on physical activity and weight reduction showed that primary prevention of type 2 diabetes may be possible in some persons with impaired glucose tolerance.29, 30 Other studies are investigating new approaches to early detection and treatment for primary prevention of type 1 diabetes. Until approaches for primary prevention become available,
Methods of Literature Search
A systematic medline search was conducted initially using the following keywords: diabetic retinopathy, macular edema, clinical trials, hyperglycemia, glycemic control, hypertension, blood pressure control, dyslipidemia, lipid control. Relevant abstracts and computer links to these abstracts were reviewed and a preliminary list of possible articles from this search was compiled. Next, the original articles from the list were retrieved and evaluated. Only English-based abstracts were used. From
Acknowledgements
This research was supported by National Institutes of Health grants EYO3083, EY12198, and HL59259. The author reported no proprietary or commercial interest in any product mentioned or concept discussed in this article.
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(1995) - ___: The effect of intensive treatment of diabetes on the development and progression of long-term complications in...
- ___: Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of...
- ___: Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2...
- ___: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS...
- ___: Lifetime benefits and costs of intensive therapy as practiced in the diabetes control and complications trial. The...
The absence of a glycemic threshold for the development of long-term complicationsthe perspective of the Diabetes Control and Complications Trial
Diabetes
(1996)- ___: Progression of retinopathy with intensive versus conventional treatment in the Diabetes Control and Complications...