Glycaemic control and control of risk factors in diabetes patients in an ophthalmology clinic: what lessons have we learned from the UKPDS and DCCT studies?

Abstract

. Purpose: The Diabetes Control and Complications Trial (DCCT) and UK Prospective Diabetes Study (UKPDS) have studied glycaemic control as well as other risk factors in preventing the progression of diabetic end‐organ disease, including diabetic retinopathy. We wished to determine to what extent a cross‐section of diabetes patients attending our eye clinic met the targets laid down by recent landmark studies. Methods: We prospectively assessed 44 consecutive diabetes patients attending outpatient clinics for assessment of diabetic retinopathy. Each patient had HbA1c levels, serum cholesterol and blood pressure checked. A proforma was completed for each patient. Results: Of the 44 patients studied, 11 had type 1 diabetes mellitus (DM) and 33 had type 2 DM (11 insulin‐dependent DM [IDDM], 22 non‐insulin‐dependent DM [NIDDM]). The mean age of type 1 DM patients was 43 years; that of type 2 DM patients was 62 years. Five of 11 (46%) type 1 DM patients had poorly controlled diabetes (HbA1c > 9%) compared with four of 33 (12%) type 2 DM patients. Overall, 27 of 44 (62%) patients were on antihypertensive medication. The prevalence of poorly controlled blood pressure (> 150/85 mmHg treated; > 160/90 mmHg untreated) was 16 of 44 (36%) patients overall, and was higher for type 2 DM patients (13/33, 39%) than for type 1 DM patients (3/11, 27%). Random serum cholesterol levels > 5.2 were found in 10 of 44 (23%) patients overall (4/11 [36%] type 1 and 6/33 [18%] type 2 DM patients). Conclusions: Control of HbA1c, hypertension and hypercholesterolaemia can slow progression of retinopathy and other DM end‐points. Many of our patients were poorly controlled in terms of these risk factors. More attention should be addressed to these primary preventative factors in the management of diabetes patients.

Association analysis of genetic variations of eNOS and α2ß1 integrin genes with type 2 diabetic retinopathy

“…Further, the present study showed that fasting blood sugar and HbA 1c levels were significantly higher in the DR group compared with the DWR group; however, those levels did not differ between NPDR group PDR group, which is in agreement with the findings of Lecaire et al,30 Axer-Siegel et al,31 Higgins et al,32 and Longo-Mbenza et al,29 who all observed higher levels of blood glucose and HbA 1c in diabetic patients with DR compared with those without DR.…”

Physiology of vitreous surgery

“…Arterial hypertension tends to increase the hydrostatic pressure in the capillaries and is a well-known risk factor for diabetic macular edema (91,92). Diabetic macular edema tends to improve if arterial hypertension is successfully treated (93,94).…”

Endothelial cell inhibitory autoantibodies are associated with laser photocoagulation in adults from the Veterans Affairs Diabetes Trial

“…Those possible risk factors were a set of clinical risk variables that based upon published literature [15,16] (age, diabetes duration, antibody group ≤90% vs N90%, history of hypertension, LDL cholesterol concentration, baseline hemoglobin A 1c [HbA 1c ]) are known or likely to be associated with retinopathy or laser treatment. Backward elimination was used to determine those variables that contributed significantly (P ≤ .05) to the model.…”