| Microvascular disease: what does the UKPDS tell us about diabetic retinopathy? | |
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MedLine Citation:
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PMID: 18717974 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Background The UK Prospective Diabetes Study (UKPDS) was a randomised controlled clinical study which looked at the effect of improved blood glucose and blood pressure control on macro- and microvascular complications in Type 2 diabetes. Retinopathy was the commonest microvascular outcome and this paper looks at this complication. Methods Newly diagnosed diabetic patients were randomised to intensive or conventional glycaemic control and a subset of hypertensive patients to tight or less tight blood pressure control. Patients were seen every 3 months in study clinics and retinopathy was assessed by adjudicated grading of triennial colour retinal photographs. Photocoagulation treatment, vitreous haemorrhage and cataract extraction were predefined UKPDS endpoints. Observational analyses of the data were used to examine the relationship of updated mean glycated haemoglobin (HbA(1c)) and mean blood pressure levels to retinopathy outcomes. Results The UKPDS showed that both improved glucose control and improved blood pressure control reduced the risk of retinopathy, with a linear relationship between the log hazard ratio for retinopathy and both updated mean HbA(1c) and updated mean blood pressure. A 1% decrement in HbA(1c) equated to a 31% reduction in retinopathy and a 10 mmHg decrement in systolic blood pressure equated to an 11% reduction in photocoagulation or vitreous haemorrhage. Evidence of retinopathy at diagnosis, including the presence of microaneurysms only, increased significantly the risk of progression to photocoagulation. Conclusions The UKPDS stands out as a landmark study in Type 2 diabetes, emphasising the crucial importance of controlling both blood glucose and blood pressure in order to minimise the risk of developing sight-threatening retinopathy. |
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Authors:
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E M Kohner |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Diabetic medicine : a journal of the British Diabetic Association Volume: 25 Suppl 2 ISSN: 1464-5491 ISO Abbreviation: Diabet. Med. Publication Date: 2008 Aug |
Date Detail:
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Created Date: 2008-08-22 Completed Date: 2008-12-04 Revised Date: 2009-01-08 |
Medline Journal Info:
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Nlm Unique ID: 8500858 Medline TA: Diabet Med Country: England |
Other Details:
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Languages: eng Pagination: 20-4 Citation Subset: IM |
Affiliation:
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Medical School, London, UK. evakohner@gmail.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Blood Glucose
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metabolism* Diabetes Mellitus, Type 2 / complications, drug therapy* Diabetic Retinopathy / etiology, prevention & control Great Britain / epidemiology Humans Hypertension / drug therapy*, etiology Randomized Controlled Trials as Topic Risk Factors Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Blood Glucose |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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