The Effect of Interventions to Prevent Type 2 Diabetes on the Development of Diabetic Retinopathy: The DPP/DPPOS Experience

Abstract

OBJECTIVE To determine whether interventions that slow or prevent the development of type 2 diabetes in those at risk reduce the subsequent prevalence of diabetic retinopathy. RESEARCH DESIGN AND METHODS The Diabetes Prevention Program (DPP) randomized subjects at risk for developing type 2 diabetes because of overweight/obesity and dysglycemia to metformin (MET), intensive lifestyle intervention (ILS), or placebo (PLB) to assess the prevention of diabetes. During the DPP and DPP Outcome Study (DPPOS), we performed fundus photography over time on study participants, regardless of their diabetes status. Fundus photographs were graded using the Early Treatment Diabetic Retinopathy Study grading system, with diabetic retinopathy defined as typical lesions of diabetic retinopathy (microaneurysms, exudates, or hemorrhage, or worse) in either eye. RESULTS Despite reduced progression to diabetes in the ILS and MET groups compared with PLB, there was no difference in the prevalence of diabetic retinopathy between treatment groups after 1, 5, 11, or 16 years of follow-up. No treatment group differences in retinopathy were found within prespecified subgroups (baseline age, sex, race/ethnicity, baseline BMI). In addition, there was no difference in the prevalence of diabetic retinopathy between those exposed to metformin and those not exposed to metformin, regardless of treatment group assignment. CONCLUSION Interventions that delay or prevent the onset of type 2 diabetes in overweight/obese subjects with dysglycemia who are at risk for diabetes do not reduce the development of diabetic retinopathy for up to 20 years.

Preventable risk factors for type 2 diabetes can be detected using noninvasive spontaneous electroretinogram signals

“…The clinically relevant information our system contributes to, is to detect people with preventable risk factors for type 2 diabetes. Even though the Diabetes Prevention Program recently reported that interventions that delay the development of type 2 diabetes in those at risk (overweight/obese with dysglycemia) do not reduce the subsequent prevalence of DR [ 97 ], this concerns people who have progressed to diabetes. In cases where intensive lifestyle intervention and metformin managed to prevent progression to type 2 diabetes, DR does not happen [ 97 ].…”

“…Even though the Diabetes Prevention Program recently reported that interventions that delay the development of type 2 diabetes in those at risk (overweight/obese with dysglycemia) do not reduce the subsequent prevalence of DR [ 97 ], this concerns people who have progressed to diabetes. In cases where intensive lifestyle intervention and metformin managed to prevent progression to type 2 diabetes, DR does not happen [ 97 ]. In this regard, it is important to recognize that lifestyle interventions must be carried out with considerable involvement of clinicians and that acheiving awareness among patients and family relatives is challenging.…”

Spontaneous electroretinogram signals to screen people with early risk factors for diabetic retinopathy

“…The clinically relevant information our system contributes to is to detect people with high likelihood of preventable risk factors for DR. Even though the Diabetes Prevention Program recently reported that interventions that delay the development of type 2 diabetes in those at risk (overweight/obese with dysglycemia) do not reduce the subsequent prevalence of DR 81 , this concerns people who have progressed to diabetes. In cases where intensive lifestyle intervention and metformin managed to prevent progression to type 2 diabetes, DR does not happen 81 .…”

“…Even though the Diabetes Prevention Program recently reported that interventions that delay the development of type 2 diabetes in those at risk (overweight/obese with dysglycemia) do not reduce the subsequent prevalence of DR 81 , this concerns people who have progressed to diabetes. In cases where intensive lifestyle intervention and metformin managed to prevent progression to type 2 diabetes, DR does not happen 81 . In this regard, it is important to recognize that lifestyle interventions must be carried out with considerable involvement of clinicians and that acheiving awareness among patients and family relatives is challenging.…”

Eye Health Screening in Migrant Population: Primary Care Experience in Lazio (Italy) from the PROTECT Project

“…Regarding eye screening, the role of prevention of ocular pathologies in the general population had been extensively discussed, with a relevant reduction of complications especially in diabetic patients [16,17]. Many studies have previously investigated visual health and visual healthcare access in refugees or displaced persons, with a prevalence of blindness ranging from 1.6 to 26.2% and a high prevalence of ocular infectious diseases such as trachoma [18].…”