Slowing down diabetic retinopathy

Diabetes comes with a lot of complications and one of them is vision loss due to retinopathy. Diabetic retinopathy is a condition wherein the blood vessels supplying the retina, the light-sensitive area of the eye gets damaged by diabetes. This damage leads to leaks, swelling, and development of abnormal blood vessels. This eye disease is the leading cause of vision loss among Americans of working age.

Based on recent results, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Eye Study funded by the National Institutes of Health (NIH) reports about therapies that slow down the progression of this diabetes-related eye disease.

The ACCORD clinical trial included 10,251 patients with type 2 diabetes mellitus and had high risk for heart attack, stroke or death due to cardiovascular events. The trial evaluated the efficacy and safety of 3 intensive treatments strategies and compared them to standard treatments. A subset of this consisting of 2,856 patients was used to evaluate the effects of cardiovascular treatments strategies on the blood vessels of the eye. Two strategies are especially promising, namely:

Intensive control of blood sugar levels

The glycemic target of standard diabetes management strategies is 7.5% haemoglobin A1c. The intensive control strategy has a much lower blood sugar target – 6.5%. Those who achieved this target also experienced a slowing down in the progression of diabetic retinopathy – from 10.4 to 7.3% over 4 years.

According to Dr. Paul A. Sieving, director of the National Eye Institute

“Previous clinical trials have shown the beneficial effects of intensive blood sugar control on slowing the progression of diabetic retinopathy in people with type 1 diabetes or newly diagnosed type 2 diabetes. The ACCORD Eye Study expands these findings to a larger population of adults who had type 2 diabetes for an average of 10 years, and demonstrates that the eye benefits from the reduction of glucose below previously established levels.”

This strategy, however, comes with some risks, especially hypoglycemia, i.e. blood sugar levels which are too low.

Combination lipid therapy with fenofibrate plus simvastatin

Combining fenofibrate with the cholesterol-lowering drug simvastatin also showed a reduction in the progression of retinopathy in diabetes patients. Disease progression was reduced from 10.2 to 6.5% over five years.

According to Dr. Emily Chew, M.D., chairperson of the Eye Study

“The ACCORD Eye Study clearly indicates that intensive glycemic control and fibrate treatment added to statin therapy separately reduce the progression of diabetic retinopathy. The main ACCORD findings showed that fibrate treatment added to statin therapy is safe for patients like those involved in the study. However, intensive blood sugar control to near normal glucose levels increased the risk of death and severe low blood sugar, so patients and their doctors must take these potential risks into account when implementing a diabetes treatment plan.”