Effects of Medical Therapies on Retinopathy Progression in Type 2 Diabetes

• Published in: The New England journal of medicine Vol. 363; no. 3; pp. 233 - 244
• Main Authors: Chew, Emily Y, Ambrosius, Walter T, Davis, Matthew D, Danis, Ronald P, Gangaputra, Sapna, Greven, Craig M, Hubbard, Larry, Esser, Barbara A, Lovato, James F, Perdue, Letitia H, Goff, Jr, David C, Cushman, William C, Ginsberg, Henry N, Elam, Marshall B, Genuth, Saul, Gerstein, Hertzel C, Schubart, Ulrich, Fine, Lawrence J
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 15-07-2010
• Subjects: Antihypertensive Agents - therapeutic use; Biological and medical sciences; Blood pressure; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - mortality; Cholesterol; Cholesterol, LDL - blood; Diabetes; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Diabetes. Impaired glucose tolerance; Diabetic retinopathy; Diabetic Retinopathy - etiology; Diabetic Retinopathy - prevention & control; Disease Progression; Drug Therapy, Combination; Dyslipidemias - complications; Dyslipidemias - drug therapy; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Fenofibrate - therapeutic use; Follow-Up Studies; General aspects; Glycated Hemoglobin - metabolism; Humans; Hyperglycemia - drug therapy; Hypertension - complications; Hypertension - drug therapy; Hypoglycemic Agents - therapeutic use; Hypolipidemic Agents - therapeutic use; Male; Medical sciences; Middle Aged; Ophthalmology; Retinopathies; Simvastatin - therapeutic use; Endocrinopathy; Type 2 diabetes; Medicine; Eye disease; Prognosis; Retinopathy; Treatment; Metabolic diseases; Evolution
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa1001288

Patients with type 2 diabetes mellitus were evaluated for progression of diabetic retinopathy after being randomly assigned to receive several medical therapies. At 4 years, the rate of progression was significantly lower with intensive glycemia therapy than with standard glycemia therapy and significantly lower with simvastatin plus fenofibrate than with simvastatin plus placebo.
Patients with type 2 diabetes mellitus were evaluated for progression of diabetic retinopathy after being randomly assigned to receive several medical therapies. At 4 years, the rate of progression was significantly lower with intensive glycemia therapy than with standard glycemia therapy and significantly lower with simvastatin plus fenofibrate than with simvastatin plus placebo.
Diabetic retinopathy, an important microvascular complication of diabetes, is a leading cause of blindness in the United States.
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Randomized, controlled clinical trials in cohorts of patients with type 1 diabetes and those with type 2 diabetes have shown the beneficial effects of intensive glycemic control
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–
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and intensive treatment of elevated blood pressure
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on the progression of diabetic retinopathy. Elevated serum cholesterol and triglyceride levels have been implicated, in observational studies and small trials, as additional risk factors for the development of diabetic retinopathy and visual loss.
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The Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study (Current Controlled . . .