The effects of vitamin E on non-proliferative diabetic retinopathy in type 2 diabetes mellitus: Are they sustainable with 12 months of therapy

Abstract

Introduction: Prolonged uncontrolled hyperglycaemia has shown to cause oxidative stress, inflammation, thrombosis and upregulation of angiogenesis in diabetics, which all contributes to diabetic retinopathy development and progression. Vitamin E is found to have anti-inflammatory, anti-oxidative, anti-thrombogenic and anti-angiogenesis which could play an important role in early treatment of diabetic retinopathy. This study aims to investigate the effect of Tocotrienol-rich vitamin E (Tocovid) on the progression of retinal microhaemorrhages and diabetic macular oedema in patients with diabetic retinopathy. Method: This is a multi-centred, randomized, double-blinded, placebo-controlled trial which involved 55 eligible participants. The participants in the treatment group ( n = 22) received Tocovid 200 mg twice daily while those in the placebo group ( n = 23) would receive placebo twice daily. Both groups will be on the treatment for a total duration of 12 months. Both retinal signs will be assessed at baseline, 2 months, 6 months and 12 months of treatment to determine the progression of diabetic retinopathy. Serum vascular endothelial growth factor which reflects on the angiogenesis process in the eye was analysed as well at similar time points as the retinal findings. Results: After 12 months of treatment, the placebo group had a significant increase of 23.42% in retinal microhaemorrhages ( p < 0.05), but the Tocovid group had no significant changes. Moreover, the Tocovid group showed a significant decrease of 48.38% in area of diabetic macular oedema over the 12 months period ( p < 0.05), but the placebo group had no significant changes. Meanwhile, there was no significant difference in serum vascular endothelial growth factor level when comparing between both groups. Conclusion: These findings could indicate that Tocovid has an important role in preventing early diabetic retinopathy progression.

The Roles of Vitamins in Diabetic Retinopathy: A Narrative Review

“…The area of DME, on the other hand, was significantly decreased, by 48.38% in the vitamin group, while there was no significant change in the placebo group. For serum VEGF level at 12 months, there was no significant difference between the two groups, or when compared with baseline in each group [ 67 ].…”

“…Assessment of retinal hemorrhage, one of many retinal lesions in DR, alone might not be a good surrogate for assessment of DR progression. In addition, assessment of DME from retinal photographs may not be as reliable as from optical coherence tomography (OCT) [ 67 ]. In the pilot study, the authors aimed to study vitamin B, which was found to lower the risk of cardiovascular diseases and nephropathy, in the treatment of DR.…”

Oxidative Stress and Diabetic Retinopathy: Evidence from Epidemiological Studies

“…Secondly, optimal oxidative balance protects against micro-and macrovascular complications of diabetes through shared endpoints of endothelial dysfunction, low-grade in ammation and accelerated atherosclerosis [4,21]. Diabetic nephropathy, cardiovascular disease, stroke and related complications that are more prevalent in those with poorer antioxidant status could contribute to higher mortality [36,37].Finally, beyond diabetes, higher overall antioxidant exposure has been associated with lower risks of cancer, lung disease, [41,44]. However, direct evidence on the effects of lifestyle changes and antioxidant supplements on hard clinical outcomes like diabetic retinopathy remains limited [45,46].…”

The Role of Natural Factors that Optimize Redox Status in Combating Type 2 Diabetes

“…A recent study by Ho, et al [68] showed that TRF (200 mg twice daily for 12 months) was effective in preventing early diabetic retinopathy compared to placebo. Diabetic retinopathy is a very common microvascular complication of T2D and makes a major contribution to blindness and vision loss in adults [68].…”