The Safety of Pharmacological and Surgical Treatment of Diabetes in Patients with Diabetic Retinopathy—A Review

Abstract

Background. Diabetes mellitus (DM) is a non-infectious pandemic of the modern world; it is estimated that in 2045 it will affect 10% of the world’s population. As the prevalence of diabetes increases, the problem of its complications, including diabetic retinopathy (DR), grows. DR is a highly specific neurovascular complication of diabetes that occurs in more than one third of DM patients and accounts for 80% of complete vision loss cases in the diabetic population. We are currently witnessing many groundbreaking studies on new pharmacological and surgical methods of treating diabetes. Aim. The aim of the study is to assess the safety of pharmacological and surgical treatment of DM in patients with DR. Material and methods. An analysis of the data on diabetes treatment methods currently available in the world literature and their impact on the occurrence and progression of DR. Results. A rapid decrease in glycaemia leads to an increased occurrence and progression of DR. Its greatest risk accompanies insulin therapy and sulfonylurea therapy. The lowest risk of DR occurs with the use of SGLT2 inhibitors; the use of DPP-4 inhibitors and GLP-1 analogues is also safe. Patients undergoing pancreatic islet transplants or bariatric surgeries require intensive monitoring of the state of the eye, both in the perioperative and postoperative period. Conclusions. It is of utmost importance to individualize therapy in diabetic patients, in order to gradually achieve treatment goals with the use of safe methods and minimize the risk of development and progression of DR.

Relationship Between SGLT-2i and Ocular Diseases in Patients With Type 2 Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials

“…A review by Matuszewski et al showed that rapid decline in glycaemia would lead to the occurrence and development of DR. The risk of DR was the highest when DM patients were treated with sulfonylurea and insulin, and the lowest when the patients were treated using SGLT-2i, GLP-1RA and dipeptidyl-peptidase-4 inhibitor (DPP-4i) ( 80 ). The different mechanisms employed by different drugs to lower blood glucose levels may account for their different effects on retinal diseases.…”

Beyond the Glycaemic Control of Dapagliflozin: Microangiopathy and Non-classical Complications

“…Diabetic retinopathy (DR) is a diabetes-specific complication that occurs in more than one-third of patients and accounts for 80% of cases of total vision loss in the diabetic population [ 42 ]. Paradoxically, an excessively rapid fall in blood glucose is a risk factor for the onset and progression of DR.…”

“…Paradoxically, an excessively rapid fall in blood glucose is a risk factor for the onset and progression of DR. The highest risk is associated with the use of insulin or sulphonylureas, whereas SGLT2i are considered safe in this respect [ 42 ]. In a meta-analysis of 37 clinical trials that looked at the risk of DR with different hypoglycaemic agents in 100,928 patients with T2DM, SGLT2i were not associated with an increased risk of DR compared to placebo [ 43 ].…”

Yoğun Bakima Yatan Ti̇p 2 Di̇yabetli̇ Hastalarin İnsüli̇ne Karşi Algilari İle Di̇yabet Öz Yöneti̇mleri̇ Arasindaki̇ İli̇şki̇ni̇n İncelenmesi̇

“…When the scale is scored, positive items are scored in reverse. The sum of the four positively expressed items (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) provides the positive evaluation sub-dimension while the sum of 16 negatively expressed items (16-80) provides the negative evaluation sub-dimension. Total scale score is obtained by adding the 16 items with negative expressions and the four items with positive expressions after they are reversed.…”

“…[8] Studies have shown that insulin therapy is effective in slowing down the development and progression of chronic complications of diabetes. [9,10] More than half of patients with type 2 diabetes need insulin therapy after 5 years. Despite the importance of insulin therapy, many patients with type 2 diabetes are unwilling or afraid of insulin therapy.…”