A five-year follow-up study on diabetic retinopathy with intensive glucose control in outpatients with type 2 diabetes

Abstract

Objective To observe effects of long-term intensive glucose control therapy on diabetic retinopathy in outpatients with type 2 diabetes mellitus (72DM) . Methods Forty-nine patients with T2DM, aged 58 to 70 years with illness course length of 0. 6 to 12.0 years, were randomly assigned to groups receiving either intensive (24 patients) or standard glucose control (25 patients) . They were all under management with hypoglycemic treatment in the outpatient department of Beijing Tongren Hospital for five years during 2002 to 2007. Serum level of glycosylated hemoglobin Ale ( HbA1c) were measured for the patients in intensive-therapy group every three months targeting at it controlled below 6. 5% with any drugsneeded. For the patients in standard glucose control group aged 60 years or over, with history of myocardial infarction, but without other complications, serum level of HbA 1 c was measured every a half year and should be controlled under 7.0%. Their visual acuity, lens, vitreous body and fundus oculi were examined after dilatation of the pupil by ophthalmologists to identify any new diabetic retinopathy ( DR) , including micro-aneurysm, fundus hemorrhage, edema of the macula lutea, or diabetic associated blindness. Results Serum level of HbAlc had been significantly lower in intensive glucose control group [ (6. 3±0. 6 ) % ] than that in standard glucose control one [ ( 7. 1±2. 0) % ] since the second year of therapy (P < 0. 05), which could be maintained in the next four years of therapy. No new case of fundus hemorrhage or diabetic associated blindness could be found in intensive glucose control group during the five-year period of therapy.Number of new episodes of lowering in visual acuity ( 15 cases), occurrence of micro-aneurysm (five cases), edema of the macula lutea (one case), as well as those who needed retinal laser photocoagulation (four cases) , were significantly less in intensive glucose control group than that in standard glucose control one (25, 10, three and 23 cases, respectively) during five-year follow-up (P<0. 05). Conclusions Long-term intensive glucose control in patients with T2DM can significantly reduce new occurrence of diabetic retinopathy in them, which is feasible in outpatient clinics. Key words: Diabetes mellitus,type 2; Blood glucose; Diabetic retinopathy