Progression Of Retinopathy In Patients Research Articles

Correlation of MMP-2, TIMP-1, β2-MG and hs-CRP with the progression of retinopathy in patients with type 2 diabetes.

This study aimed to investigate the relationship between MMP-2, TIMP-1, β2-MG, hs-CRP and the progression of type 2 diabetic retinopathy (T2DM). For this purpose, 68 patients with T2DM retinopathy treated in our hospital were selected as the retinopathy group (REG), and 68 T2DM patients without retinopathy were selected as the control group (CDG). The serum levels of MMP-2, TIMP-1, β2-MG and hs-CRP were compared between the two groups. According to the international clinical classification of T2DM non-retinopathy (NDR), the patients were divided into non-proliferative T2DM retinopathy group (NPDR) (n=28) and proliferative T2DM retinopathy group (PDR) (n=40). The levels of MMP-2, TIMP-1, β2-MG and hs-CRP in patients with different conditions were compared. In addition, the Spearman method was used to analyze the correlation between the levels of MMP-2, TIMP-1, β2-MG, hs-CRP and glucose and lipid metabolism and the course of disease in patients with T2DM retinopathy (DR). Logistic multiple regression was used to analyze the risk factors of DR. Results showed that the levels of serum MMP-2, β2-MG and hs-CRP in PDR groups were raised than those in NPDR and NDR, while the serum TIMP-1 level was reduced. The levels of MMP-2, β2-MG and hs-CRP were positively correlated with the levels of HbA1c, TG and the course of disease in DR patients, while the levels of TIMP-1 in DR patients were negatively correlated with the levels of HbA1c, TG and the course of disease. The results of multivariate Logistic regression model showed that MMP-2, β2-MG and hs-CRP were independent risk factors for DR, and TIMP-1 was the protective factor for DR. In conclusion, the changes of peripheral blood MMP-2, TIMP-1, hs-CRP and β2-MG levels are closely related to the progression of T2DM retinopathy.

Diabetic retinopathy progression in patients under monitoring for treatment or vision loss: external validation and update of a multivariable prediction model

IntroductionThe number of people with diabetes mellitus is increasing globally and consequently so too is diabetic retinopathy (DR). Most patients with diabetes are monitored through the diabetic eye screening programme...

Addition of fenofibrate to statins is associated with risk reduction of diabetic retinopathy progression in patients with type 2 diabetes and metabolic syndrome: A propensity-matched cohort study

AimThis study aimed to determine the association between fenofibrate added to statin therapy and diabetic retinopathy progression. MethodsIn this propensity-matched study using the Korean National Health Insurance Service cohort (2002–2019), patients with type 2 diabetes and metabolic syndrome (≥ 30 years) receiving statin therapy were matched 1:2 by propensity score into the statin plus fenofibrate group (n = 22,395) and statin-only group (n = 43,191). The primary outcome was a composite of diabetic retinopathy progression including vitreous hemorrhage, vitrectomy, laser photocoagulation, intravitreous injection therapy and retinal detachment. ResultsThe median (quartiles) follow-up duration was 44.0 (27.6–70.6) months. For the primary outcome, the incidence rate per 1,000 person-years was 9.66 in the statin-only group and 8.68 in the statin-plus-fenofibrate group. The risk of the primary outcome was significantly lower (hazard ratio [HR]=0.88; 95% confidence interval [0.81;0.96] P = 0.005) in the statin-plus-fenofibrate group than in the statin-only group. Only patients with pre-existing retinopathy showed benefits from fenofibrate treatment (HR=0.83 [0.73;0.95] P = 0.006). In addition, the statin plus fenofibrate group exhibited significantly lower risks of vitreous hemorrhage (HR= 0.86 [0.75;0.995] P = 0.042), laser photocoagulation (HR=0.86 [0.77;0.96] P = 0.009) and intravitreous injection therapy (HR=0.73 [0.59;0.90] P = 0.003) than those in the statin-only group. There was no significant interaction between the different characteristics at baseline and the treatment effect. ConclusionThe addition of fenofibrate to statins was associated with significantly lower risk of diabetic retinopathy progression than statin therapy alone in patients with type 2 diabetes and metabolic syndrome.

Natural History and Rate of Progression of Retinopathy in Patients with Sickle Cell Disease: An 11-Year Retrospective Follow-up Analysis

Background: Sickle cell disease (SCD) is characterized by chronic hemolysis and recurrent vaso-occlusion, resulting in tissue ischemia and organ damage. The retina is very sensitive to ischemic damage, which can result in sickle cell retinopathy (SCR). SCR can be divided into non-proliferative SCR (NPSCR) and proliferative SCR (PSCR). The proliferative form can be complicated by severe visual impairment due to vitreous haemorrhage and retinal detachment. With respect to retinopathy, different opinions exist about the necessity of regular screening. Knowledge of the natural history and risk factors for progression of SCR and subsequent complications is limited. Therefore, it would be helpful to determine the cumulative incidence of SCR in a large population of adult patients and to identify risk factors for progression and vision threatening complications. Aims: The aim of our study is to describe the natural history of SCR in a systematically analysed cohort of patients with SCD and to identify risk factors for the development of PSCR. Methods: In our retrospective cohort study, we recruited all patients with SCD (HbSS, HbSC, HbSβ0 and HbSβ+) attending the departments of Haematology and Ophthalmology of our tertiary academic hospital between 2006 and 2011. Patients lost to follow-up were excluded. Clinical, ophthalmologic and laboratory data were systematically collected and retrospectively analysed. Univariate and multivariate binary logistic regressions were used to identify associations between clinical and laboratory variables and progression to PSCR. Results: 129 SCD patients were included with a median follow-up of 11 years (IQR = 8.5-12). The median age at the end of follow-up was 34 years (IQR = 28-45). HbSS/HbSβ0/HbSβ+ genotype was present in 64.3% (83/129) of the patients and HbSC genotype was present in 35.7% (46/129). Progression of SCR during follow-up was seen in 28.7% (37/129) of the patients. Male sex was the only predictor for progression of SCR (aOR: 2.535, 95% CI: 1.152-5.579, p = 0.021). Age (aOR: 1.073, 95% CI: 1.024-1.125, p = 0.003) and HbSC genotype (aOR: 35.796, 95% CI: 7.444-172.125, p <0.001) were associated with PSCR at end of follow-up. Hb level and microalbuminuria were no independent risk factors for PSCR or progression to PSCR (p > 0.05). Lack of any SCR at end of follow-up was associated with female sex (aOR: 3.440, 95% CI: 1.523-7.774, p = 0.003) and HbSS/HbSβ0/HbSβ+ genotype (aOR: 6.419, 95% CI: 2.352-17.519, p = <0.001). Conclusion: Progression of SCR was seen in more than a quarter of the patients. Age and HbSC genotype were associated with progression to PSCR at end of follow-up. Female SCD patients and patients with HbSS/HbSβ0/HbSβ+ genotype were at significant lower risk of developing SCR than other patients. Given the high rate of progression of SCR, screening of SCR remains important, but differentiated strategies for screening and follow-up of SCR could be considered for low-risk or high-risk patients. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Irrational Responses to Risk Preference Questionnaires by Patients with Diabetes with or without Retinopathy and Comparison with Those without Diabetes.

PurposeThe risk preferences of patients with diabetes have profound effects on the progression of complications. The present study aimed to clarify whether the preferences of patients with diabetes and retinopathy are deliberately risk-seeking or irrational and whether this propensity is specific to those with retinopathy or is also found in patients without retinopathy compared with those without diabetes.Patients and MethodsA total of 394 patients with diabetes (264 without retinopathy and 130 with retinopathy) and 198 patients without diabetes agreed to participate in this survey. The questions were modified versions of those from the Japan Household Survey on Consumer Preferences and Satisfaction, which sought to determine the participants’ personal socioeconomic status and risk preferences. In the questionnaires, responses were analyzed by determining the participants’ willingness to pay for a lottery ticket and for an insurance policy. Irrational responses were defined as violations of two axioms of the Expected Utility Theory: completeness and transitivity.ResultsThe incidence of irrational responses increased with age and was associated with educational level. The incidence of irrational responses was significantly higher in patients with retinopathy than in those without retinopathy after adjusting for age and educational level. There was no significant difference in the incidence of irrational responses between patients with diabetes but without retinopathy and those without diabetes.ConclusionThe risk-seeking behavior of patients with diabetes and retinopathy was not deliberate but was irrational under uncertainty. Medical professionals should be aware of their patients’ propensity to make irrational decisions, which is an important risk factor for the progression of retinopathy in patients with diabetes regardless of age and educational level.

Screening for Diabetic Retinopathy with Extended Intervals, Safe and Without Compromising Adherence: A Retrospective Cohort Study.

IntroductionScreening for diabetic retinopathy (DR) prevents blindness through the early detection of sight-threatening retinal microvascular lesions that respond to timely local treatment. However, the provision of easy and regular access to DR screening programs is currently being challenged by the increasing prevalence of diabetes. One proposed solution is to extend the screening interval for patients at low risk for progression of retinopathy. To date, most providers of screening programs have hesitated to implement a strategy of extended intervals due to the lack of data on whether adherence and safety are compromised when retinal examinations occur less frequently. In the study reported here, we investigated adherence to the screening program and progression of retinopathy in patients with type 2 diabetes participating in a DR screening program with extended intervals.MethodsThis was a retrospective study that included 1000 patients with type 2 diabetes mellitus who attended a screening program for DR. The patients were consecutively placed into a low-risk patient cohort with no retinopathy or into an intermediate-risk patient cohort with mild retinopathy (each cohort n = 500). Screening intervals were 36 months for the low-risk cohort and 18 months for the intermediate-risk cohort.ResultsThe 1000 subjects enrolled in the study had a median age of 68 (interquartile range 12) years and 60.4% were men. At the follow-up screening visit, data on 102 subjects were not included in the analysis of adherence rate due to death, severe systemic illness, other concurrent eye disease or migration. Among the 898 remaining subjects, adherence to the screening program was 93.7% (413/443) in the 36-month group and 98.3% (449/455) in the 18-month group (p < 0.0001). Non-adherence decreased with increasing age (odds ratio 0.92, 95% confidence interval 0.888–0.954, p = 0.0005). At follow-up, 65 subjects showed progression of retinopathy; none had worse than moderate retinopathy. Risk factors for DR and treatment for hyperglycemia, hypertension and hyperlipidemia were compared among subjects in the low-risk cohort: non-adherent subjects did not differ from their adherent counterparts without progression of DR, but the former had a shorter duration of diabetes and higher diastolic blood pressure than adherent subjects with progression of DR (4.5 vs. 7.5 years, p = 0.007; and 80 vs. 75 mmHg, p = 0.02, respectively).ConclusionThe results suggest that screening DR at extended intervals can be achieved with high adherence rates without compromising patient safety. However, younger subjects and those at higher risk of progression may require extra attention.

MON-LB112 Socioeconomic Status, Literacy, and Sex Differences in the Progression of Retinopathy in Patients With Type 2 Diabetes in Tokyo, Japan

Socioeconomic status has profound effects on glycemic control and diabetic complications in patients with type 2 diabetes. Sex differences are one of the most important factors in socioeconomic status and may vary among countries or areas. The study aim was to determine if sex differences are associated with glycemic control and diabetic complications in Tokyo, Japan, one of the most educated countries in the world. This study initially enrolled 3307 patients treated from 2017 to 2019 at the medical school hospital located in Tokyo. All enrolled patients were asked to complete behavioral and socioeconomic surveys. A total of 276 type 2 diabetic patients (175 males, age 64.1 ± 0.88 y, disease duration 15.2 ± 0.78 y, mean ± SE y; 101 females, age 64.0 ± 1.1 y, disease duration 15.6 ± 1.01 y) agreed to participate in the study. The survey questionnaire has been previously reported in detail (Patient Preference and Adherence, 10:2151-2162, 2016). The questionnaire attempted to determine estimations of risk preference regarding things like lottery gambling and accident insurance. After reviewing the patients’ answers, however, it became clear that some were illogical, which suggested that these patients did not understand the context of the questions, the hypothetical economical situations, or even the instructions, probably because of lower literacy skills. Thus, we labeled these patients as the unreasonable (UR) group (n = 81), and the patients who provided appropriate answers, even if extremely risk averse or risk loving, were labeled as the reasonable (R) group (n = 195). The prevalence of UR answers generally increased with age (<50 y, 16%; 50-64 y, 10%; 65-74 y, 37%; ≥75 y, 64%) (p < 0.0001). After age adjustment, there was a significant correlation between the UR answers and educational attainment in both sexes. The prevalence of UR answers was significantly higher in females (38.6%) than in males (24%) (p < 0.01), which may be partly because the average number of educational years was lower for females than for males (males, 13.8 y; females, 12.9 y; p < 0.05), but both averages are very high among all countries. The prevalence of retinopathy was significantly higher in the UR than the R group in males (p < 0.05), but not in females. Job and economic status were not associated with prevalence of retinopathy. These results suggest that effects of literacy skills on progression of diabetic retinopathy may be sex dependent. Although the mechanism underlying this finding is unknown, sex may be an important biological factor beyond socioeconomic status in highly educated high-income countries.

Molecular Docking Interaction Between Carotenoids and Curcumin and RAGE Receptor Prevents Diabetic Retinopathy Progression (P06-044-19)

ObjectivesDiabetic Retinopathy is the leading cause of blindness, stimulating the rise in 20,000 cases in the United States per year, and leaving over 3 million individuals vulnerable at risk. During the early stages of Diabetic Retinopathy, inflammatory and innate immune responses are derived from pattern-recognition receptors (PRRs) expressed as Advanced Glycation End-products (AGEs). It has been observed that AGEs increase the progression of retinopathy in patients enduring the early stages of retinopathy. The reason behind the complication progression induced by AGEs is the ligand – receptor binding with the Receptor Advanced Glycation End-products. Therefore, by instituting macular carotenoids and curcumin bind with RAGE, may prevent the ligand-receptor binding between RAGEs and AGEs. The following study analyzes carotenoids and polyphenols interacting with the RAGE receptor utilizing computational docking simulations. MethodsA docking program, AutoDock Tools and AutoDock Vina, were used to determine the binding affinity and rmsd (root mean square deviation) values of the carotenoids and curcumin. ResultsIt was found that Lutein, Curcumin and Zeaxanthin were able to bind to the RAGE receptor with a strong binding affinity. Lutein had the strongest binding affinity interaction with the RAGE receptor followed by zeaxanthin compared with control [RAP, Receptor associated protein]. ConclusionsRAGE may be of importance in the prevention and management of diabetes complications, and by instituting carotenoids and curcumin as a treatment, this may potentially decrease the progression of diabetes complications. Funding SourcesNone. Supporting Tables, Images and/or Graphs▪

The effect of hyperbaric oxygen therapy on retinal thickness and progression of retinopathy in patients with Type 2 diabetes: a prospective cohort study

Purpose: Evaluation of the effect of hyperbaric oxygen therapy (HBOT) on the progression of retinopathy, choroidal and retinal thickness in patients with type 2 diabetes mellitus (DM).Materials and methods: This prospective non-randomized cohort study consisted of 60 eyes of 30 patients who received 30 sessions of HBOT for a diabetic foot ulcer (DFU). The participants were divided into three groups; group 1: mild-moderate non-proliferative diabetic retinopathy (DRP) (n = 14), group 2: severe non-proliferative DRP (n = 20) and group 3: DRP without active proliferative findings with the applied laser for at least 2 years (n = 26). The cases were examined on base-line (measurement-1), after the 10th session of HBOT (Measurement-2), after the 20th session of HBOT (Measurement-3), after the 30th session of HBOT (Measurement-4), and after 10 days of the last session of HBOT (Measurement-5). The changes in central macular thickness (CMT; subfoveal point [CMT-SF], nasal point [CMT-N] and temporal point [CMT-T]), central choroidal thickness (CCT; subfoveal point [CCT-SF], nasal point [CCT-N] and temporal point [CCT-T]), and the stage of DRP were compared.Results: There was no significant difference between groups in terms of change ratio (CR%) in CMT-SF and CMT-N values. However, in Measurement-3, CR% in CMT-T was significantly higher in group 1 (p = 0.019). A significant increase in CMT-N and CMT-T parameters over time was observed in Group 1 (p < 0.05). There was a significant decrease in CCT-SF, CCT-N, and CCT-T values with time in each of the three groups (p < 0.05). At the end of HBOT, there was no progression or regression in the stage of DRP in any group.Conclusions: HBOT has both a thinning effect on the choroid layer in all three groups and a thickening effect on the macula in the mild-moderate non-proliferative diabetic eyes.

Dipeptidyl peptidase‐4 inhibitors and risk of diabetic retinopathy progression in patients with type 2 diabetes: a population‐based cohort study

Dipeptidyl peptidase‐4 inhibitors and risk of diabetic retinopathy progression in patients with type 2 diabetes: a population‐based cohort study

Predictors of Development and Progression of Retinopathy in Patients with Type 2 Diabetes: Importance of Blood Pressure Parameters

Diabetic retinopathy (DR) is a chronic microvascular complication associated a worse prognosis. We aimed to evaluate the predictors of development/progression of DR in a cohort of 544 high-risk patients with type 2 diabetes who had annual ophthalmologic examinations over a median follow-up of 6 years. Ambulatory blood pressure (BP) monitoring and aortic stiffness by carotid-femoral pulse wave velocity were performed. Multivariate Cox survival analysis examined the independent predictors of development or progression of DR. During follow-up, 156 patients either newly-developed or worsened DR. Patients who developed/progressed DR had longer diabetes duration, higher ambulatory and clinic BP levels, higher aortic stiffness, and poorer glycemic control than patients who did not developed/progressed DR. After adjustments for baseline retinopathy prevalence, age and sex, a longer diabetes duration (p < 0.001), higher baseline ambulatory BPs (p = 0.013, for 24-hour diastolic BP), and higher mean cumulative exposure of HbA1c (p < 0.001), clinic diastolic BP (p < 0.001) and LDL-cholesterol (p = 0.05) during follow-up were the independent predictors of development/progression of DR. BP parameters were only predictors of DR development. In conclusion, a longer diabetes duration, poorer glycemic and lipid control, and higher BPs were the main predictors of development/progression of DR. Mean cumulative clinic diastolic BP was the strongest BP-related predictor.

Structure based drug design with Diabetic Retinopathy and Rage

ObjectiveDiabetic Retinopathy is the leading cause of blindness, stimulating the rise in 20,000 cases in the United States per year, and leaving over 3 million individuals vulnerable at risk. During the early stages of Diabetic Retinopathy, inflammatory and innate immune responses are derivative from pattern‐recognition receptors (PRRs) expressed as Advanced Glycation End‐products (AGEs). It has been observed that AGEs increases the progression of retinopathy in patients enduring the early stages of retinopathy. The reason behind the complication progression induced by AGEs is the ligand ‐ receptor binding with the Receptor Advanced Glycation End‐products. Therefore, by instituting a drug to bind with RAGE, may prevent the ligand‐receptor binding between RAGEs and AGEs. The following study analyzed drug targets based on their hydrophobicity, as to whether they will be able to bind with RAGE.MethodsA docking program, AutoDock Tools and AutoDock Vina, were both used to determine the binding affinity, rmsd values, and Log P values of the drug targets.ResultsIt was found that Statin drugs and Fibric Acid drugs are the types of drugs that were able to bind with RAGE with a high hydrophobicity and affinity, while a very popularly marketed drug, Metformin, wasn't able to bind with RAGE.ConclusionRAGE may be of importance in the prevention and management of diabetes complications.Support or Funding Informationnone

A socioeconomic and behavioral survey of patients with difficult-to-control type 2 diabetes mellitus reveals an association between diabetic retinopathy and educational attainment.

BackgroundWe have recently reported that the attitude of patients toward risk could be a factor in the progression of diabetic complications. In general, risk preference is closely related to socioeconomic status (SES), which includes factors such as age, sex, income, and educational attainment.ObjectiveWe aimed to determine the effect of SES and behavioral propensity on the progress of diabetic complications in patients with type 2 diabetes mellitus (T2DM).MethodsWe conducted a survey of 238 patients with difficult-to-control T2DM treated at a hospital in Japan using a modified behavioral economics questionnaire that included questions related to SES. The patients had been referred by general practitioners or other departments in the hospital because of poor metabolic control or unstable complications.ResultsEducational attainment was significantly associated with progression of retinopathy in patients <65 years of age. Educational attainment of a high school diploma (12 years of education) or lower was a significant risk factor, but there were no differences among levels of attainment beyond high school (13–16 years or more of education). Behavioral propensities were also weakly associated with complications, but not as much as educational attainment. Personal income level and economic status did not show an association with the retinopathy levels.ConclusionLower educational attainment is a strong risk factor for diabetic retinopathy, and it is independent of the economic status. The result suggests that cognitive function may play an important role in the progression of diabetic retinopathy in patients with T2DM.

Cognitive function may be a predictor of retinopathy progression in patients with type 2 diabetes.

Microvascular and macrovascular complications of diabetes, such as retinopathy and nephropathy, progress over time and may be associated with cognitive decline. In this article, we aim to gain further insight into the association between cognitive function and retinopathy in type 2 diabetes. In this observational 8-year prospective study of 498 outpatients, demographic and clinical variables were monitored, along with retinopathy, depression, anxiety, and cognitive function. Baseline fundus photographs were available in 477 patients, 240 with no retinopathy, 110 with mild retinopathy, and 127 with moderate/more severe retinopathy. Of the first 2 groups, 279 patients were reevaluated after 8 years, of whom 181 still had no/mild retinopathy and 98 had progressed to more severe stages. On multivariate analysis, retinopathy progression was associated with being insulin-treated (p = 0.036), and worse cognitive function (p = 0.025) at baseline. Cognitive function may be an independent predictor of retinopathy progression.

Effect of Doxycycline vs Placebo on Retinal Function and Diabetic Retinopathy Progression in Patients With Severe Nonproliferative or Non–High-Risk Proliferative Diabetic Retinopathy

Inflammation may contribute to the pathogenesis of diabetic retinopathy (DR). To investigate, in a proof-of-concept clinical trial, whether low-dose oral doxycycline monohydrate can (1) slow the deterioration of, or improve, retinal function or (2) induce regression or slow the progression of DR in patients with severe nonproliferative DR (NPDR) or non-high-risk proliferative (PDR), and to determine the potential usefulness of visual function end points to expedite the feasibility of conducting proof-of-concept clinical trials in patients with DR. We conducted a randomized, double-masked, 24-month proof-of-concept clinical trial. Thirty patients (from hospital-based retina practices) with 1 or more eyes with severe NPDR or PDR less than Early Treatment Diabetic Retinopathy Study-defined high-risk PDR. Patients were randomized to receive 50 mg of doxycycline monohydrate or placebo daily for 24 months. Change at 24 months compared with baseline in functional factors (frequency doubling perimetry [FDP], Humphrey photopic Swedish Interactive Thresholding Algorithm 24-2 testing, contrast sensitivity, dark adaptation, visual acuity, and quality of life) and anatomic factors (Early Treatment Diabetic Retinopathy Study DR severity level, area of retinal thickening, central macular thickness, macular volume, and retinal vessel diameters). From baseline to month 24, mean FDP foveal sensitivity decreased in the placebo group (-1.9 dB) and increased in the doxycycline group (+1.8 dB) (P = .02). A higher mean FDP foveal sensitivity in the doxycycline group compared with the placebo group was detected at 6 months (P = .04), and this significant difference persisted at 12 and 24 months. A difference between the groups was not detected with respect to the other visual function outcomes and all anatomic outcomes assessed. To our knowledge, this is the first observation suggesting a link between a low-dose oral anti-inflammatory agent and subclinical improvement in inner retinal function. Oral doxycycline may be a promising therapeutic strategy targeting the inflammatory component of DR. Furthermore, study results suggest that FDP, which primarily measures inner retinal function, is responsive to intervention and may be a useful clinical trial end point for proof-of-concept studies in patients with DR. clinicaltrials.gov Identifier: NCT00511875.

Применение статинов и фибратов как стабилизаторов прогрессирования диабетической ретинопатии у больныгх сахарным диабетом II типа

<p style="text-align: left;"><span style="color: #800000;"><span style="font-size: 13.008px; line-height: 1.538em;"><span style="color: #800000;">https://doi.org/10.31288/oftalmolzh201353440</span></span></span> <p style="text-align: left;"><span style="color: #800000;"><strong><span style="font-size: 13.008px; line-height: 1.538em;">Using statins and fibrates for stabilization of diabetic retinopathy progression in patients with diabetes type 2</span></strong></span> <strong>Bezdetko PA, Ajaj SM, Ilyina YN</strong>

Evaluation of the relationship between background factors and sleep-disordered breathing in patients with proliferative diabetic retinopathy

To clarify the relationship between sleep-disordered breathing (SDB) and background factors in patients with proliferative diabetic retinopathy (PDR). One hundred fifty-one consecutive PDR patients were included in this study. These patients' SDB parameters, including the mean and lowest SpO(2), sleeping 4% oxygen desaturation index (ODI), and cumulative percentage of time spent at SpO(2) < 90% (CT90%), were measured. Simple linear regression analyses were conducted to investigate whether the SDB parameters correlated with systemic factors for PDR, including age, duration of diabetes, HbA1c value, incidence of hypertension, estimated glomerular filtration rate (eGFR), body mass index (BMI), and insulin therapy. Logistic regression analysis was also conducted to investigate whether the SDB evaluation items were factors independently associated with the incidence of hypertension. Hypertension and BMI were statistically correlated with all of the parameters. The eGFR was statistically correlated with 4% ODI and insulin therapy with the lowest SpO(2). Logistic regression analysis revealed 4% ODI and eGFR as factors independently contributing to the incidence of hypertension. The results of our study confirmed the relationship between SDB and background factors reported to be risk factors for diabetic retinopathy progression in patients with PDR.

Vergleich der Risikoparameter der diabetischen Retinopathie und der leitliniengerechten Prävention für Patienten einer diabetischen Schwerpunktambulanz und eines Lasertherapiezentrums

The purpose of this study was the comparison of risk factors for development or progression of diabetic retinopathy in patients with type 2 diabetes between patients of a laser therapy center and a diabetes outpatient clinic. Furthermore, the implementation of the guidelines of the German Diabetic Association for the prevention and therapy of diabetic retinopathy was analysed. In a prospective study, patients with type 2 diabetes and diabetic retinopathy of the laser therapy center at the ophthalmology department, Leipzig University, were interviewed and examined. Patients of the reference group without diabetic retinopathy were recruited from the diabetes outpatient clinic Leipzig University. Between August 2004 and May 2008, a total of 180 patients with type 2 diabetes were included (48 patients with non-proliferative diabetic retinopathy (NPDR), 59 patients with proliferative diabetic retinopathy (PDR) and 73 patients belonging to the reference group). Patients with diabetic retinopathy had significantly higher mean blood pressures of 112 and 110 mmHg as compared to patients without diabetic retinopathy (96 mmHg). ACE/ AT1-inhibitors were used significantly less by patients with as compared to patients without diabetic retinopathy. Only 37% of patients with diabetic retinopathy were treated according to DDG and ADA guidelines. There are striking deficits for the implementation of guideline oriented prevention and therapy of diabetic retinopathy in daily practice. The possible reasons are insufficient compliance of patients who consulted medical advice only when complications of diabetes occurred, the necessary improvement of the medical therapy and the suboptimal cooperation between ophthalmology and diabetes specialists.

Rapid, bloody, and blinding diabetic retinopathy

Rapid, bloody, and blinding diabetic retinopathy

Effects of blood pressure lowering and intensive glucose control on the incidence and progression of retinopathy in patients with type 2 diabetes mellitus: a randomised controlled trial

The aim of the present study was to investigate the effect of blood pressure lowering and intensive glucose control on the incidence and progression of retinopathy in type 2 diabetic patients. The Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) Retinal Measurements study, a substudy of ADVANCE, is a randomised (using a central, computer-based procedure) controlled 2 x 2 factorial trial comprising a double-blind comparison of blood pressure lowering with perindopril-indapamide vs placebo, and an open comparison of standard vs intensive glucose control targeting a HbA(1c) of < or = 6.5% in 1,602 diabetic patients from ADVANCE centres with access to retinal cameras conducted from 2001 to 2008. At baseline and the final visit, seven-field stereoscopic retinal photographs were taken and graded by blinded readers (gradeable baseline and final photographs from 1,241 patients). Progression of > or =2 steps in the Early Treatment of Diabetic Retinopathy Study classification (using the eye with worst grading) was the primary outcome. Retinopathy progressed in 59 (4.8%) patients and developed in 128 (10.3%) patients over 4.1 years. Fewer patients on blood pressure-lowering treatment (n = 623) experienced incidence or progression of retinopathy compared with patients on placebo (n = 618), but the difference was not significant (OR 0.78; 95% CI 0.57-1.06; p = 0.12). Blood pressure-lowering treatment reduced the occurrence of macular oedema (OR 0.50; 95% CI 0.29-0.88; p = 0.016) and arteriovenous nicking compared with placebo (OR 0.60; 95% CI 0.38-0.94; p = 0.025). Compared with standard glucose control (n = 611), intensive glucose control (n = 630) did not reduce (p = 0.27) the incidence and progression of retinopathy (OR 0.84; 95% CI 0.61-1.15). Lower, borderline significant risks of microaneurysms, hard exudates and macular oedema were observed with intensive glucose control, adjusted for baseline retinal haemorrhages. These effects of the two treatments were independent and additive. Adverse events in the ADVANCE study are reported elsewhere. Blood pressure lowering or intensive glucose control did not significantly reduce the incidence and progression of retinopathy, although consistent trends towards a benefit were observed, with significant reductions in some lesions observed with both interventions. ClinicalTrials.gov ID no. NCT00145925. Grants from Servier and the National Health and Medical Research Council of Australia.