Systemic risk factors in prevention of diabetic retinopathy

Česká verzia

Authors: L. Křížová
Authors place of work: Přednosta: prof. MUDr. Tomáš Zima, DrSc., MBA. ; 1. lékařská fakulta ; Ústav klinické biochemie a laboratorní diagnostiky 1. LF UK a VFN ; Univerzita Karlova, Praha
Published in the journal: Prakt. Lék. 2009; 89(5): 227-229
Category: Reviews

Summary

Aim:
Today, blindness from diabetic retinopathy (DR) is preventable with timely diagnosis and appropriate therapeutic intervention. The aim of this review is to refer to systemic risk factors that contribute to the onset and progression of DR and to emphasize the role of general practitioners and other specialists in the long-term care of diabetic patients.

Findings:
The most important determinants in onset and progression of DR and macular edema are disease duration and the level of metabolic control. Intensive treatment of systemic hypertension reduces the risk of new onset of DR and slows the progression of existing DR. Diabetic nephropathy and anemia can lead to progression of DR. Hyperlipoproteinemia is associated with the amount of macular exudates and increase of visual acuity. Therapeutic anticoagulation is not contraindicated in any form of DR. During pregnancy, decompensation of DR can occur, therefore is it essential to control the patients regularly.

Conclusion:
Patients’ general condition and concomitant systemic disorders might have a significant impact on the onset and progression of diabetic retinopathy and loss of vision. Interdisciplinary cooperation in diagnosis and therapy of diabetes and other systemic disorders can improve both the systemic and ocular health of patients with diabetes.

Key words:
diabetic retinopathy, risk factors, prevention, diabetes mellitus.

Zdroje

1. Aiello, L.P., Cahill, M.T., Wong, J.S. Systemic considerations in the management of diabetic retinopathy. Am. J. Ophthalmol. 2001, 132, p. 760-776.

2. Berghoff, K., Clar, C., Richter, B. Aspirin in diabetic retinopathy. A systematic review. Endocrinol. Metab. Clin. North Am. 2002, 3, p. 779-793.

3. Davis, M.D., Fisher, M.R., Gangnon, R.E. et al. Risk factors for high-risk proliferative diabetic retinopathy and severe visual loss: Early Treatment Diabetic Retinopathy Study Report 18. Invest. Ophthalmol. Vis. Sci. 1998, 39, p. 233-252.

4. Davis, M.D. Worsening of diabetic retinopathy after improvement of glycemic control. Arch. Ophthalmol. 1998, 116, p. 931-932.

5. Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N. Engl. J. Med. 1993, 329, p. 977-986.

6. Diabetes Control and Complications Trial Research Group. Progression of retinopathy with intensive versus conventional treatment in the Diabetes Control and Complications Trial. Ophthalmology 1995, 102, p. 647-661.

7. Diabetes Control and Complications Trial Research Group. Early worsening of diabetic retinopathy in the Diabetes Control and Complications Trial. Arch. Ophthalmol. 1998, 116, p. 874-886.

8. Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy. N. Engl. J. Med. 2000, 342, p. 381-389.

9. Diabetes Control and Complications Trial Research Group. Effect of pregnancy on microvascular complications in the diabetes control and complications trial. Diabetes Care 2000, 23, p. 1084-1091.

10. Ferris, F.L., Chew, E.Y., Hoogwerf, B.J. Serum lipids and diabetic retinopathy. Early Treatment Diabetic Retinopathy Study Research Group. Diabetes Care 1996, 19, p. 1291-1293.

11. Fišer, I. Diabetická retinopatie. In: Kuchynka, P., a kol. Oční lékařství. Praha: Grada Publishing, 2007, s. 293-308.

12. Harris, M.I. Undiagnosed NIDDM: clinical and public health issues. Diabetes Care 1993, 16, p. 642–652.

13. Chew, E.Y. Diabetic retinopathy and lipid abnormalities. Curr. Opin. Ophthalmol. 1997, 8, p. 59-62.

14. Klein, R., Klein, B.E., Moss, S.E., DeMets, D.L. Blood pressure and hypertension in diabetes. Am. J. Epidemiol. 1985, 112, p. 75-89.

15. Klein, B.E., Moss, S.E., Klein, R., Surawicz, T.S. The Wisconsin Epidemiologic Study of Diabetic Retinopathy, XIII: relationship of serum cholesterol to retinopathy and hard exudate. Ophthalmology 1991, 98, p. 1261-1265.

16. Klein, R., Moss, S.E., Klein, B.E. Is gross proteinuria a risk factor for the incidence of proliferative diabetic retinopathy? Ophthalmology 1993, 100, p. 1140-1146.

17. Klein, R., Klein, B.E., Moss, S.E., Cruichshanks, K.J. Ten-year incidence of gross proteinuria in people with diabetes. Diabetes 1995, 44, p. 916-923.

18. Klein, R., Klein, B.E., Lee, K.E. et al. The incidence of hypertension in insulin-dependent diabetes. Arch. Intern. Med. 1996, 156, p. 662-667.

19. Klein, R., Klein, B.E., Moss, S.E., Cruickshanks, K.J. The Wisconsin Epidemiologic Study of Diabetic Retinopathy, XVII: the 14-year incidence and progression of diabetic retinopathy and associated risk factors in type 1 diabetes. Ophthalmology 1998, 105, p. 1801-1815.

20. Leiter, L.A. The prevention of diabetic microvascular complications of diabetes: Is there a role for lipid lowering? Diabetes Res. Clin. Pract. 2005, 68, p. 3-14.

21. Marshall, G., Garg, S.K., Jackson, W.E. et al. Factors influencing the onset and progression of diabetic retinopathy in subjects with insulin-dependent diabetes mellitus. Ophthalmology 1993, 100, p. 1133-1139.

22. Porta, M., Sjølie, A.K. Chaturvedi, N. et al. EURODIAB Prospective Complications Study Group. Risk factors for progression to proliferative diabetic retinopathy in the EURODIAB Prospective Complications Study. Diabetologia 2001, 44, p. 2203-2209.

23. Qiao, Q., Keinanen-Kiukaanniemi, S., Laara, E. The relationship between hemoglobin levels and diabetic retinopathy. J. Clin. Epidemiol. 1997, 50, p. 153-158.

24. Schocket, L.S., Grunwald, J.E., Tsang, A.F., DuPont, J. The effect of pregnancy on retinal hemodynamics in diabetic versus nondiabetic mothers. Am. J. Ophthalmol. 1999, 128, p. 477-484.

25. Sheth, B.P. Does pregnancy accelerate the rate of progression of diabetic retinopathy?: an update. Curr. Diab. Rep. 2008, 4, p. 270-273.

26. Shorb, S.R. Anemia and diabetic retinopathy. Am. J. Ophthalmol. 1985, 100, p. 434-436.

27. Sosna, T. Rizikové a projektivní faktory diabetické retinopatie. Interní medicína pro praxi 2001, 1, s. 22-25.

28. Suzuma, I., Hata, Y., Rook, S.L. et al. Cyclic stretch and hypertension induce retinal VEGF-R2 (KDR) expression: Potential mechanisms for exacerbation of diabetic retinopathy by hypertension. Diabetes 2001, 50, p. 444-454.

29. Standardy pro diagnostiku a léčbu diabetické retinopatie a jejích komplikací. DMEV 2004, č. 1, s. 22-26.

30. Thomas, M., Tsalamandris, C., MacIsaac, R., Jerums, G. Anemia in diabetes: an emerging complication of microvascular disease. Curr. Diabetes Rev. 2005, 1, p. 107-126.

31. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998, 317, p. 703-713.

32. Valešová, L., Hycl, J. Diabetická retinopatie. Praha: Triton, 2002.

33. Vekasi, J., Koltai, K., Gaal, V. et al. The effect of aspirin on hemorheological parameters of patients with diabetic retinopathy. Clin. Hemorheol. Microcirc. 2008, 4, p. 385-389.

34. Zhang, L., Krzentowski, G., Albert, A., Lefebvre, P.J. Risk of developing retinopathy in Diabetes Control and Complications Trial type 1 diabetic patients with good or poor metabolic control. Diabetes Care 2001, 24, p. 1275-1279.