Systemic Factors associated with Diabetic Retinopathy
Emily Y. Chew, Epidemiology & Clinical Applications, National Eye Inst/NIH, Bethesda, Maryland, United States
DisclosureBlock: Emily Y. Chew, None
Description
In both type 1 and type 2 diabetes, the role of intensive glycemic control, with or without the combination of therapy for dyslipidemia and intensive blood-pressure control has been studied in randomized controlled clinical trials over the decades (Diabetes Control and Complications Trial [DCCT], Action to Control Cardiovascular Risk in Diabetes [ACCORD], and others). The importance of tight or intensive glycemic control has been proven to reduce the risk of progression of diabetic retinopathy in both types of diabetes and in persons with diabetes and with or without diabetic retinopathy at the time of initiation of tight glycemic control. Furthermore, the metabolic memory or the legacy effect of this tight glycemic control endured for over two decades. Tight glycemic control may also have beneficial effects on other diabetic complications.
The treatment of hypertension has been proven in the United Kingdom Prospective Diabetes Study (UKPDS) to be effective in reducing diabetic retinopathy progression and the development of diabetic macular edema. More recent studies have not demonstrated a beneficial effect partly because the standard arm is only 20 mmg Hg lower than the intensive treatment arm. However, lower blood pressure has been advocated by other studies such as SPRINT.
Two studies of fenofibrate were designed to reduce elevated triglycerides to test the effect on cardivoascular risk as well as progression of diabetic retinopathy. The Fenofibrate Intervention & Event Lower in Diabetes (FIELD) study using 200 mg daily and the ACCORD study using 160 mg daily showed a beneficail effect in reducing progression of diaetic retinopathy, especially in persons with existing diabetic retinopathy. This treatment has not been adopted as standard medical practise because of the lack of efficacy for the systemic disease of cardivoascular events. Further discussion will be presented on this medical therapy.
In summary, the control of glycemia, blood pressure and dyslipidemia has an important role in reducing the risk fo diabetic retinopathy progression.
