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Studies show better insulin management reduces retinopathy in type 1 diabetes patients

October 21, 2013

Two new studies funded by the National Institutes of Health (NIH) find the frequency and severity of retinopathy in patients with type 1 diabetes is decreasing. Improved diabetes care – especially better insulin management – is the likely reason, the studies suggest.

“This research affirms that overall strict diabetes management is a necessary component of care for diabetes-related eye conditions,” said Michael R. Duenas, O.D., AOA chief public health officer. “Optometrists must play an active role in educating patients with diabetes on the effective management of their condition. They should be prepared to immediately begin counseling patients on good diabetes management even before diabetic retinopathy is found in the course of an eye examination. When caring for any patient with diabetes, optometrists should record glucose levels, A1C, body mass index (BMI) and other pertinent information in the patient record. They should also be prepared to share their findings, including fundus images and treatment recommendations with the other practitioners in the diabetes patient’s care team.”

The new research suggests that more intensive insulin management and diabetes care, implemented over recent years following the Diabetes Control and Complications Trial (DCCT), has effectively changed the retinopathy prognosis for people with type 1 diabetes. The DCCT found that intensive glucose control was effective in slowing the onset and progression of diabetes-related eye, kidney, and nerve damage, and improved the overall health of diabetes patients. The two new NIH-funded, population-based studies compared the results of diabetes care before and after publication of the DCCT.

The studies looked at the frequency and severity of eye disease among two groups of patients, in the same geographic region, who had diabetes for 20 years. A group of 305 subjects from the Wisconsin Diabetes Registry Study (WDRS) received retinal examinations from 2007 to 2011. A group of 583 subjects from the Wisconsin Epidemiological Study of Diabetes Retinopathy (WESDR) received retinal examinations from 1980 to 1996.

Researchers found the frequency and severity of diabetic retinopathy was lower for individuals in the WDRS group compared with those in the WESDR group.

“This research gives optometrists and other health care practitioners a powerful new tool to help encourage strict patient compliance with diabetes care regimes. It shows that patients with diabetes can help save their eyesight – the sense people value most – by controlling their systemic condition,” Dr. Duenas said. “It is also further evidence that optometrists are an essential part of the care team for patients with diabetes.”

The new study, “Assessing progress in retinopathy outcomes in type 1 diabetes: comparing findings from the Wisconsin Diabetes Registry Study and the Wisconsin Epidemiologic Study of Diabetic Retinopathy,” is available at http://tinyurl.com/PubMed3204.

The AOA Diabetes and Eye Health webpage (http://tinyurl.com/AOAdiabetes) offers a variety of online resources on diabetic retinopathy and the importance of eye care for patients with diabetes, including an interactive BMI calculator. The AOA Marketplace (www.aoa.org/marketplace-login-info) offers a selection of brochures and other print resources optometrists can use to help educate patients with diabetes on proper care.

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