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Last update: February 2013

Retinopathy

1.   UKPDS trial

  • Intensified diabetes treatment in T2DM reduces the risk of retinal laser therapy requirement by 29%, vitreous hemorrhage by 23%, retinopathy progression by 17%, and blindness by 16% [UKPDS 33].
  • Reduction of blood pressure by 10 / 5 mmHg (to a mean 144/82 mmHg) was associated with a significant reduction of first appearance / progression of retinopathy (44%), laser treatment (35%), and decrease in visual acuity (47%) [Matthews 2004, UKPDS 38].
  • UKPDS – United Kindom Prospective Diabetes Trial.

2.   DCCT trial

  • Intensified insulin treatment in T1DM was associated with a significant reduction of first appearance / progression of retinopathy (76% / 54%), incidence of severe non-proliferative/proliferative retinopathy (47%), clinical significant macular edema (23%), and the need for laser therapy (56%) [DCCT Study group 1995].
  • The absolute risk of retinopathy was proportional with the mean HbA1c [DCCT/EDIC Study group 2002].
  • There is no lower threshold for HbA1c as regards microvascular T1DM complications [DCCT Study group 1996].
  • A reduction in HbA1c of 10% was associated with a significant nonlinear reduction of first appearance (43%) and progression (39%) of retinopathy, which is higher at higher levels of HbA1c [DCCT Study group 1996].
  • Intensified insulin treatment in T1DM was associated with a significant initial deterioration of retinopathy in 13.1% of cases, but the long term benefits were important [DCCT Study group 1998 pp. 874].
  • Pregnancy in T1DM was independently associated with retinopathy progression, especially in the context of poor metabolic control before conception, and rapid improvement of blood sugar following the discovery of pregnancy [DCCT Study group 2000 pp. 1084].
  • Retinopathy progression during pregnancy in T1DM does not persist after delivery [DCCT Study group 2000 pp. 1084].
  • DCCT – Diabetes Control and Complication Trial.

3.   EDIC trial

  • The beneficial effects of intensive insulin treatment in T1DM subjects from the DCCT trial on diabetes microvascular complications were preserved at 4 and 9 years after DCCT closure, despite the convergence of both arms as regards metabolic control [DCCT/EDIC Study group 2002, DCCT Study group 2000 pp. 381, Nathan 2005].
  • EDIC – Epidemiology of Diabetes Intervention and Complications (follow-up of DCCT).

4.   WESDR trial

  • Cumulative incidence of diabetic proliferative retinopathy in T1DM patients was 67% after 35 years of follow-up [Klein 1984].
  • WESDR – Wisconsin Epidemiologic Study of Diabetic Retinopathy.

5.   DRS trial

  • Laser pan-photocoagulation for diabetic proliferative retinopathy was associated with 50% reduction in severe visual acuity loss after 5 years of follow-up [DRS Study group 1978].
  • DRS – Diabetic Retinopathy Study.

6.   ETDRS trial

  • Laser focal photocoagulation for clinical significant macular edema was associated with 50% reduction in the 5 years risk of moderate decrease in visual acuity [ETDRS Study group 1985, ETDRS Study group 1987, Chew 1995].
  • Laser pan-photocoagulation for high risk diabetic proliferative retinopathy was associated with 50% reduction in the 5 years risk of severe visual acuity or vitrectomy [ETDRS Study group 1985, ETDRS Study group 1987, Chew 1995].
  • Laser pan-photocoagulation before the development of high risk diabetic proliferative retinopathy was associated with 50% reduction in the 5 years risk of severe visual acuity or vitrectomy in T2DM, but not T1DM patients [ETDRS Study group 1985, ETDRS Study group 1987, Chew 1995].
  • Aspirin use was not associated with retinopathy progression, vitreous haemorrhage, or cataract development [ETDRS Study group 1985, ETDRS Study group 1987, Chew 1995].
  • High blood lipids level was associated with macular exudate, and moderate reduction in visual acuity [Chew 1996].
  • ETDRS – Early Treatment Diabetic Retinopathy Study.

References

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