REVIEW  EMERGING ISSUES ON DIABETIC RETINOPATHY AND DIABETIC MACULAR EDEMA 

Minerva Oftalmologica 2018 June;60(2):21-5

DOI: 10.23736/S0026-4903.18.01798-1

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

The role of glycemic control in the progression of diabetic retinopathy

Matteo FALLICO, Michele REIBALDI ✉

Eye Clinic, Vittorio Emanuele University Hospital, Catania, Italy

INTRODUCTION: Diabetic retinopathy (DR) remains one of the leading causes of visual loss throughout the world. Ever-increasing attention has been paid to this disease and how to prevent or slow its progression. Glycemic control has been shown to play a key role in the progression of diabetic retinopathy.
EVIDENCE ACQUISITION: We conducted a Medline search of all studies on the role of glycemic control in the progression of diabetic retinopathy, published between 1980 and 2016. The search strategy involved the terms “diabetic retinopathy,” “diabetic macular edema,” “diabetic eye disease,” “progression,” “glycemic control,” “glucose control.”
EVIDENCE SYNTHESIS: In the nineties, the Diabetes Control and Complications Trial (DCCT) and the UK Prospective Diabetes Study (UKPDS) demonstrated that intensive glucose control significantly reduced DR progression compared to conventional therapy, in type 1 and type 2 diabetic patients, respectively. Recent systematic reviews and meta-analysis studies corroborated these findings, showing significant reduction of risk of developing microvascular complication, in particular diabetic retinopathy, in patients receiving intensive glucose control. Furthermore, intensive glycemic control proved a long-lasting effect in reducing the risk of retinopathy both in type 1 and type 2 diabetic patients. However, a tight blood glucose lowering may cause drawbacks both in type 1 and type 2 diabetic patients, being severe hypoglycemic episodes the most common.
CONCLUSIONS: In conclusion, a good glycemic control has to be considered as the first line approach in order to prevent or slow diabetic retinopathy, taking into account that the glycemic targets should to be individualized for each patient according to clinical variables, and that, in general, aiming for an HbA1c less than 7%, but not less than 6%, seems acceptable for most patients.

KEY WORDS: Diabetic retinopathy - Blood glucose - Diabetes mellitus