What do Cochrane systematic reviews say about diabetic retinopathy?

Abstract

CONTEXT AND OBJECTIVE: Diabetic retinopathy is a disease caused by increased permeability of retinal vessels. Its incidence and prevalence have been increasing due to urbanization, greater life expectancy and the habits of modern life. Its onset is insidious and it may lead to blindness in 75% of individuals who have been diabetic for more than 20 years. The aim here was to evaluate the evidence from Cochrane systematic reviews on interventions relating to diabetic retinopathy. DESIGN AND SETTING: Review of systematic reviews, conducted at Cochrane Brazil. METHODS:We included Cochrane systematic reviews on interventions relating to diabetic retinopathy. Two researchers evaluated the inclusion criteria, summarized the reviews and presented the results narratively. RESULTS: Ten reviews met the inclusion criteria. They showed some evidence of benefits from: (a) photocoagulation for diabetic retinopathy; (b) strict glucose and pressure control for postponing the onset of retinopathy; (c) antiangiogenic drugs for macular edema (high-quality evidence); (d) anti-vascular endothelial growth factor agents for proliferative diabetic retinopathy (very low to low-quality evidence); and (e) intravitreal injection or surgical implantation for treating persistent or refractory macular edema. However, blood pressure control seems to have no benefit after the onset of retinopathy. CONCLUSION: Only a few options are likely to be effective for treating diabetic retinopathy. These include photocoagulation and anti-vascular endothelial growth factor agents. Strict glucose and pressure control seem to postpone the onset of retinopathy. For macular edema, antiangiogenic drugs, intravitreal injection and surgical implantation seem to have some benefit. RESUMO CONTEXTO:A retinopatia diabética é uma doença causada pelo aumento da permeabilidade dos vasos da retina. Sua incidência e prevalência vêm aumentando devido à urbanização, maior expectativa de vida e hábitos de vida modernos. Seu início é insidioso e pode levar à cegueira em 75% dos pacientes diabéti-cos com mais de 20 anos de doença. O objetivo foi avaliar a evidência das revisões sistemáticas Cochrane sobre intervenções para retinopatia diabética.

Biopsychosocial factors associated with complaints of dizziness in older adults with Type 2 Diabetes Mellitus

“…Older adults with DM2 commonly develop, over time, changes in the visual 8 , somatosensory 9 and vestibular 10,11 systems which are responsible for PB, and which can make complaints of dizziness more common in this population.…”

“…It should be noted that complaints of dizziness are common in older adults, but are not always sufficiently valued by family members and/or medical staff, as they are vague, unspecific or simply considered innate to the human aging process. However, the description of the complaint provides important information to elucidate the etiology of the condition and/or warn of other disorders, such as hearing, vestibular and memory alterations or risk of falls [8][9][10][11] .…”

“…In this context, DM2 is responsible for disturbances in postural balance (PB), such as dizziness 6 . Over time, individuals with DM2 can develop diseases such as retinopathy 8 and/or peripheral neuropathy 9 and changes in the vestibular system 10,11 , as the inner ear has intense metabolic activity and no energy reserve, which makes it sensitive to acute or chronic disorders in blood glucose levels. Thus, the sensory systems involved in sending information to the Central Nervous System (CNS) to maintain body balance may be altered [8][9][10][11] .…”

Screening of Diabetic Retinopathy in Patients with Type 2 Diabetes in a Community of the Paraíba Semi-Arid Using Original Score

“…Diabetic retinopathy (RD) has an insidious onset and can lead to blindness in 75% of diabetic patients with more than 20 years of disease [9]. Its prevalence as a disease that threatens vision and produces blindness is variable worldwide with a confidence interval between 3 and 8% of patients with diabetes [10] [11].…”

Diseases and symptoms associated with changes in postural balance in diabetics: an integrating literature review

“…DM2 is considered a potential cause of changes in postural balance (PB) 7 . Patients with diabetes often present with disorders in the sensory systems responsible for the maintenance of PB due to comorbidities such as retinopathy, peripheral neuropathy, and disorders in the vestibular system [7][8][9][10] .…”