Diabetic Retinopathy: A Position Statement by the American Diabetes Association

Solomon, Sharon D.; Chew, Emily Y.; Duh, Elia J.; Sobrin, Lucia; Sun, Jennifer K.; VanderBeek, Brian L.; Wykoff, Charles C.; Gardner, Thomas W.

doi:10.2337/dc16-2641

Cited by 704 publications

(634 citation statements)

References 55 publications

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“…In fact, the ADA has recently defined diabetic retinopathy as a highly tissue-specific neurovascular complication involving progressive disruption of the interdependence between multiple cell-types in the retina [7]. In this review, we provide a critical overview on the role of neurodegeneration in the pathogenesis of diabetic retinopathy and how this new knowledge changes the traditional view of the disease.…”

Section: Introductionmentioning

confidence: 99%

Neurodegeneration in diabetic retinopathy: does it really matter?

2018

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The concept of diabetic retinopathy as a microvascular disease has evolved, in that it is now considered a more complex diabetic complication in which neurodegeneration plays a significant role. In this article we provide a critical overview of the role of microvascular abnormalities and neurodegeneration in the pathogenesis of diabetic retinopathy. A special emphasis is placed on the pathophysiology of the neurovascular unit (NVU), including the contributions of microvascular and neural elements. The potential mechanisms linking retinal neurodegeneration and early microvascular impairment, and the effects of neuroprotective drugs are summarised. Additionally, we discuss how the assessment of retinal neurodegeneration could be an important index of cognitive status, thus helping to identify individuals at risk of dementia, which will impact on current procedures for diabetes management. We conclude that glial, neural and microvascular dysfunction are interdependent and essential for the development of diabetic retinopathy. Despite this intricate relationship, retinal neurodegeneration is a critical endpoint and neuroprotection, itself, can be considered a therapeutic target, independently of its potential impact on microvascular disease. In addition, interventional studies targeting pathogenic pathways that impact the NVU are needed. Findings from these studies will be crucial, not only for increasing our understanding of diabetic retinopathy, but also to help to implement a timely and efficient personalised medicine approach for treating this diabetic complication.Electronic supplementary materialThe online version of this article (10.1007/s00125-018-4692-1) contains a slideset of the figures for download, which is available to authorised users.

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Section: Introductionmentioning

confidence: 99%

Neurodegeneration in diabetic retinopathy: does it really matter?

2018

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“…This complication can be diagnosed already after five years from the onset of diabetes, and almost all patients will show variable degrees of retinopathy after 20 years of diabetes. 36 Diabetic peripheral neuropathy is a common complication estimated to affect 30-50% of individuals with diabetes, although clinical symptoms do not generally occur until long after the onset of diabetes. Abnormalities of the autonomic nervous system can also occur in patients with diabetes, with early subclinical manifestations, such as decreased heart rate variability, being detectable within a year of diagnosis in patients with T2D, and within two years in patients with T1D.…”

Section: Chronic Complications Of Diabetes-vascular Complicationsmentioning

confidence: 99%

Complications of Acute and Chronic Hyperglycemia

Marcovecchio¹

2017

US Endocrinology

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Hyperglycemia is due to a dysregulation in the complex mechanisms implicated in glucose homeostasis. Chronic hyperglycemia, as measured by hemoglobin A1c (HbA1c), is a key risk factor for the development of microvascular and macrovascular complications, which in turn negatively influence the prognosis of patients with diabetes. Several studies have shown that acute hyperglycemia can add to the effect of chronic hyperglycemia in inducing tissue damage. Acute hyperglycemia can manifest as high fasting plasma glucose (FPG) or high postprandial plasma glucose (PPG) and can activate the same metabolic and hemodynamic pathways as chronic hyperglycemia. Glucose variability, as expressed by the intraday glucose fluctuations from peaks to nadirs, is another important parameter, which has emerged as an HbA1c-independent risk factor for the development of vascular complications, mainly in the context of type 2 diabetes. Treatments able to decrease HbA1c have been associated with positive effects in terms of reducing risk for the development and progression of complications. Further studies are required to clarify the impact of strategies more specifically targeting components of acute hyperglycemia, to improve outcomes in patients with diabetes. KeywordsHyperglycemia, complications, vascular, acute, chronic Disclosure: M Loredana Marcovecchio has nothing to disclose in relation to this article. No funding was received in the publication of this article. This study involves a review of the literature and did not involve any studies with human or animal subjects performed by any of the authors.Authorship: Thel named author meets the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, takes responsibility for the integrity of the work as a whole, and has given final approval to the version to be published.Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. From glucose homeostasis to hyperglycemiaGlucose homeostasis is maintained by a complex neurohormonal system, which modulates peripheral glucose uptake, hepatic glucose production, and exogenous glucose utilization following food ingestion.1,2 This allows the maintenance of plasma glucose concentrations within normal range, with average values of around 90 mg/dl throughout a 24-hour period, postmeal concentration below 140 mg/dl, and minimal values, such as those after moderate fasting or exercise, above 55 mg/dl. 1,2Hormones implicated in glucose regulation include insulin, glucagon, amylin, glucagon-like petide-1 (GLP-1), glucose-dependent insulinotropic peptide, epinephrine, cortisol, and growth hormone. These hormones act on several target tissues, including muscle, liver, adipocyte, and brain to regulate glucose levels. 3Insulin is a key glucoregulatory hormone, produced by pancreatic β-cells, whose levels are low durin...

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“…There are currently three anti-VEGF agents commonly used to treat eyes with central-involved diabetic macular edemadbevacizumab, ranibizumab, and aflibercept (69).…”

Section: Anti-vascular Endothelial Growth Factor Treatmentmentioning

confidence: 99%

10. Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes—2018

2017

Diabetes Care

246

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The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations, please refer to the Standards of Care Introduction. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

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Diabetic Retinopathy: A Position Statement by the American Diabetes Association

Cited by 704 publications

References 55 publications

Neurodegeneration in diabetic retinopathy: does it really matter?

Neurodegeneration in diabetic retinopathy: does it really matter?

Complications of Acute and Chronic Hyperglycemia

10. Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes—2018

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