Relation of the Course of Retinopathy to Control of Diabetes, Age, and Therapeutic Agents in Diabetic Japanese Patients

Abstract

Follow-up results of the progression of diabetic retinopathy in 364 patients who attended the Diabetes Clinic of the Third Department of Internal Medicine (University of Tokyo) regularly for more than two years were analyzed in relation to their degree of control, age and therapeutic agents. Ophthalmologic examinations were performed by two ophthalmologists without referring to other data.In 289 untreated cases, retinopathy at the initial visit was more frequent and more severe when known duration of diabetes was longer and initial fasting blood sugar was higher. The degree of control was judged by fasting blood sugar values determined frequently and regularly. Progression of retinopathy was significantly more frequent in the fair and poor control groups than in the good control group. In older age groups, progression, especially occurrence of new lesions, was more frequent. Sulfonylurea did not appear inferior to insulin so long as an acceptable degree of control was maintained. DIABETES 18: 773-80, November, 1969. Vascular disease is the most serious problem faced by the diabetic patient. Whether the patient can be protected from this complication by intensive treatment is not known for certain. Accordingly, a prospective study of diabetic retinopathy in relation to treatment was designed in the Diabetes Clinic of our Department. In this report, the development and progression of lesions during an observation period of two to six years are analyzed in relation to the degree of chemical control of diabetes and other factors. Fasting blood sugar values, determined frequently and regularly in all the patients, were adopted as the most reliable index of degree of control. The preliminary data appear to suggest that control delayed the course of retinopathy. Age was another factor influencing the progression of retinopathy. Finally, assessment of usefulness of sulfonylurea therapy for prevention of retinopathy is tried by comparing the result with that of insulin therapy. MATERIALS AND METHODS PatientsThree hundred and sixty-four ambulatory patients followed regularly for more than two years in the Diabetes Clinic of the Third Department of Internal Medicine, University of Tokyo, were the subjects of this study. The age and sex distributions at the initial visit are shown in figure 1. The majority of patients had maturity onset type of diabetes.

Coping Behaviors of Severe Diabetics

“…It is a wellestablished fact that the frequency of diabetic retinopathy among diabetics depends upon both the duration of diabetes and the pa tient's level of diabetic control [1][2][3][4][5][6][7][8]. It has also been confirmed that if the duration of the disease in 2 patients with diabetes melli tus is equal, the frequency of occurrence of diabetic retinopathy depends on the level of diabetic control [5,9,10].…”

“…As the most powerful risk factor for diabetic retinopathy the duration of diabetes has been reported [1][2][3][4][5][6][7][8]. However, the present study was undertaken to control this factor so that the duration of both groups was equal.…”

Relation of diabetic control to development of microvascular complications

“…Among 14 prospective studies in patients with established retinal or glomerular lesions [21,22,35,[37][38][39][40][41][42][43][44][45][46][47][48] 4 drew negative conclusions. The UGDP study has just been mentioned [35].…”

“…All other studies have demonstrated that good or very good control slows down the rate of deterioration of established lesions [21,22,37,40,[43][44][45][46][47][48].…”

Search for a biochemical basis of diabetic microangiopathy

“…During the last three decades many clinical investigations have been undertaken in various parts of the world to determine if the incidence of microangiopathy is related to the degree of control of the diabetes [46]. With only a few exceptions [47] these studies have indicated that microvascular disease is less common in well controlled diabetics than in those in whom a less careful regimen of therapy is maintained [48][49][50][51][52]. Perhaps foremost in these clinical assessments is the ambitious longterm prospective study of Pirart and his collaborators [52] which has shown that diabetic capillary disease is closely related to the degree of glycemic control.…”