Published 12 February 2009, doi:10.1136/bmj.b441
Cite this as: BMJ 2009;338:b441

Editorials

Systemic management of diabetic retinopathy

New evidence from trials has implications for clinical practice

The first 150 words of the full text of this article appear below.

Diabetic retinopathy is a major cause of blindness in adults. Ever since the United Kingdom Prospective Diabetes Study (UKPDS) and Diabetes Control and Complications Trials (DCCT),1 2 3 intensive control of blood glucose and blood pressure has been the mainstay of the systemic management of diabetic retinopathy. Because epidemiological studies indicated a direct and continuous relation between the degree of hyperglycaemia and the risk of diabetic retinopathy,4 the control of blood sugar and blood pressure has been guided by the belief that "lower is better."

Three new trials in the past year—Action in Diabetes and Vascular Disease (ADVANCE), the Diabetic Retinopathy Candesartan Trials (DIRECT), and Fenofibrate Intervention and Event Lowering in Diabetes (FIELD)—have provided new insights into the effectiveness and limitations of systemic treatment for diabetic retinopathy.

ADVANCE recruited 11 140 patients with type 2 diabetes and found that lowering glycated haemoglobin to 6.5% or less had no measurable effect on five . . . [Full text of this article]

Gerald Liew, ophthalmology registrar2, Paul Mitchell, professor of ophthalmology2, Tien Y Wong, professor of ophthalmology1

1 Singapore Eye Research Institute, National University of Singapore, Singapore 168751, 2 Centre for Vision Research, University of Sydney, Sydney, NSW 2006, Australia

ophwty@nus.edu.sg


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Relevant Article

Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38
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BMJ 1998 317: 703-713. [Abstract] [Full Text] [PDF]

Rapid Responses:

Read all Rapid Responses

Isn’t it better to readdress the basis of UKPDS conclusions under new evidence?
Arya K Kumarasena
bmj.com, 20 Feb 2009 [Full text]
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