Prevention of diabetes in people at risk fails to delay diabetic retinopathy
USA: The development of diabetic retinopathy is not reduced by the interventions that delay or prevent the onset of type 2 diabetes in obese/overweight subjects having dysglycemia and are at risk for diabetes, says a new study. The study was featured in the journal Diabetes Care on May 25 2022.
The study was conducted by Neil H. White, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, and colleagues with the objective to determine whether interventions that slow or prevent the development of type 2 diabetes in those at risk reduce the subsequent development of diabetic retinopathy.
The Diabetes Prevention Program (DPP) included subjects at risk for developing type 2 diabetes because of overweight/obesity and dysglycemia. They were randomized to receive metformin (MET), intensive lifestyle intervention (ILS), or placebo (PLB) to assess diabetes prevention. Fundus photography over time was performed overtime on study participants during the DPP and DPP Outcome Study (DPPOS), regardless of their diabetes status.
The Early Treatment Diabetic Retinopathy Study grading system was used for grading of fundus photographs, diabetic retinopathy was defined as typical lesions of diabetic retinopathy (microaneurysms, exudates, or hemorrhage, or worse) in either eye.
Key findings of the study include:
- Despite reduced progression to diabetes in the ILS and MET groups compared with PLB, there was no difference in the prevalence of diabetic retinopathy between treatment groups after 1, 5, 11, or 16 years of follow-up.
- No treatment group differences in retinopathy were found within prespecified subgroups (baseline age, sex, race/ethnicity, baseline BMI).
- There was no difference in the prevalence of diabetic retinopathy between those exposed to metformin and those not exposed to metformin, regardless of treatment group assignment.
The authors conclude, "interventions that delay or prevent the type 2 diabetes onset in overweight/obese individuals with dysglycemia who are at diabetes risk do not reduce the development of diabetic retinopathy for up to 20 years."
Reference:
Writing Group:, Neil H. White, Qing Pan, William C. Knowler, Emily B. Schroeder, Dana Dabelea, Emily Y. Chew, Barbara Blodi, Ronald B. Goldberg, Xavier Pi-Sunyer, Christine Darwin, Mathias Schlögl, David M. Nathan; for the Diabetes Prevention Program Research Group, The Effect of Interventions to Prevent Type 2 Diabetes on the Development of Diabetic Retinopathy: The DPP/DPPOS Experience. Diabetes Care 2022; dc212417. https://doi.org/10.2337/dc21-2417
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