Optimizing Medical Management in Patients with Sight-Threatening Diabetic Retinopathy

Abstract

IntroductionDiabetic retinopathy is a leading cause of blindness in adults of working age. Patients with sight-threatening diabetic retinopathy (STDR) often have poor control of modifiable risk factors, including blood pressure and blood glucose. Patients in our eye department with STDR whose diabetes was managed only by their general practitioner (GP) were referred to a diabetes specialist. We have reviewed these referrals and assessed the control of modifiable risk factors in these patients at the time of referral.MethodsA retrospective study was performed which identified 54 patients with STDR who had been referred from our eye department to a diabetes specialist between May 2013 and August 2014. Patient demographics, grades of retinopathy, glycated hemoglobin (HbA1c) levels, blood pressure, and lipid profiles were noted from the initial clinic visit and the first clinic appointment after 12 months. Initial management and any subsequent changes to management were recorded.ResultsOf the 54 patients initially referred to the dedicated diabetic retinopathy clinic, data from 32 patients were available for analysis; 22 patients failed to attend the clinic. The majority of patients who presented to the clinic were found to have inadequate control of modifiable risk factors. At the initial clinic visit, nine of the 32 (28%) patients had a blood pressure that was less than the target of 130/80 mmHg and only two (6%) had a HbA1c level of less than the target of 48 mmol/L for type 2 diabetes and 58 mmol/L for type 1 diabetes, respectively. Changes were made to the management in 24 (75%) of the patients. Blood pressure management was changed in 18 (56%) patients. Overall, changes were made to blood pressure management and lipid and glycemic medication, including insulin.ConclusionThe majority of patients with STDR were receiving suboptimal medical management. Collaboration between GPs, diabetes specialists, and ophthalmologists can lead to optimized medical management. All eye departments should develop protocols specifying when patients with diabetic retinopathy should be referred for to a diabetes specialist for input.

Screening for diabetic retinopathy: new perspectives and challenges

“…40 Since then several issues have become abundantly clear: that an ever-increasing eligible patient population (+5% per annum) in the environment of reduced budgets is not sustainable 16,18,22,[54][55][56][57] ; that a significant proportion of screened patients have repeated annual 'no retinopathy detected' results and are demonstrably at very low risk of future vision loss; 22,37,38 there is a frustrating ceiling of <85% take-up of annual eye screening invites in the English NHS Diabetic Eye Screening Programme ([NHS KPI data 2018-19]); that nonattendance at screening significantly increases the risk of the subsequent detection of visionthreatening retinal features; 45,58 and to have greatest effect screening has to be offered at locations and times which matches the needs of the patient, not the provider. [59][60][61] These findings may have even greater implication in resource-poor situations and in those locations where systematic screening is being newly introduced. 30 A key message however is that programmes which are being designed or initialized must learn from the mistakes made by those with already-established screening programmes.…”

A study of the prognostic value of leptin to assess the risk of progression of diabetic retinopathy in patients with type 2 diabetes

“…Концентрация лептина в крови повышается при ожирении и положительно коррелирует с висцера льным и подкожным жиром и ДРП [4,5]. Некоторые авторы связывают участие лептина в возникновении патологии сетчатки с повышением его уровня в стекловидном теле при пролиферативной ДРП и отслойке сетчатки, а также с его наличием в фиброваскулярной эпиретинальной ткани [6,7]. Нахож дение лептина в стекловидном теле глаза может быть возможным фактором развития васкулярных и пролиферативных заболеваний сетчатки.…”

Qualitative and Quantitative Analysis of B-Cell-Produced Antibodies in Vitreous Humor of Type 2 Diabetic Patients with Diabetic Retinopathy

“…Moreover, based on the above results with regard to the correlation analysis and multiple linear regression analysis, the extent of ocular B-cell activation in the vitreous humor of DR patients showed correlation with the levels of certain serum metrics. These findings remind us of the necessity of cooperation of ophthalmologists with endocrinologists and renal physicians to monitor microvascular damage in DM [ 33 , 34 ].…”