Effects of medical therapies on retinopathy progression in type 2 diabetes.

Abstract

BACKGROUND:

We investigated whether intensive glycemic control, combination therapy for dyslipidemia, and intensive blood-pressure control would limit the progression of diabetic retinopathy in persons with type 2 diabetes. Previous data suggest that these systemic factors may be important in the development and progression of diabetic retinopathy.

METHODS:

In a randomized trial, we enrolled 10,251 participants with type 2 diabetes who were at high risk for cardiovascular disease to receive either intensive or standard treatment for glycemia (target glycated hemoglobin level, <6.0% or 7.0 to 7.9%, respectively) and also for dyslipidemia (160 mg daily of fenofibrate plus simvastatin or placebo plus simvastatin) or for systolic blood-pressure control (target, <120 or <140 mm Hg). A subgroup of 2856 participants was evaluated for the effects of these interventions at 4 years on the progression of diabetic retinopathy by 3 or more steps on the Early Treatment Diabetic Retinopathy Study Severity Scale (as assessed from seven-field stereoscopic fundus photographs, with 17 possible steps and a higher number of steps indicating greater severity) or the development of diabetic retinopathy necessitating laser photocoagulation or vitrectomy.

RESULTS:

At 4 years, the rates of progression of diabetic retinopathy were 7.3% with intensive glycemia treatment, versus 10.4% with standard therapy (adjusted odds ratio, 0.67; 95% confidence interval [CI], 0.51 to 0.87; P=0.003); 6.5% with fenofibrate for intensive dyslipidemia therapy, versus 10.2% with placebo (adjusted odds ratio, 0.60; 95% CI, 0.42 to 0.87; P=0.006); and 10.4% with intensive blood-pressure therapy, versus 8.8% with standard therapy (adjusted odds ratio, 1.23; 95% CI, 0.84 to 1.79; P=0.29).

CONCLUSIONS:

Intensive glycemic control and intensive combination treatment of dyslipidemia, but not intensive blood-pressure control, reduced the rate of progression of diabetic retinopathy. (Funded by the National Heart, Lung, and Blood Institute and others; ClinicalTrials.gov numbers, NCT00000620 for the ACCORD study and NCT00542178 for the ACCORD Eye study.)

• Authors: ACCORD Study Group, ACCORD Eye Study Group, Emily Y Chew, Walter T Ambrosius, Matthew D Davis, Ronald P Danis, Sapna Gangaputra, Craig M Greven, Larry Hubbard, Barbara A Esser, James F Lovato, Letitia H Perdue, David C Goff Jr, William C Cushman, Henry N Ginsberg, Marshall B Elam, Saul Genuth, Hertzel C Gerstein, Ulrich Schubart, Lawrence J Fine
• Journal: The New England journal of medicine (N Engl J Med) Vol. 363 Issue 3 Pg. 233-44 (Jul 15 2010) ISSN: 1533-4406 [Electronic] United States
• PMID: 20587587 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural)
• Copyright: 2010 Massachusetts Medical Society

Chemical References

• Antihypertensive Agents
• Cholesterol, LDL
• Glycated Hemoglobin A
• Hypoglycemic Agents
• Hypolipidemic Agents
• Simvastatin
• Fenofibrate

Topics

• Antihypertensive Agents (therapeutic use)
• Cardiovascular Diseases (epidemiology, mortality)
• Cholesterol, LDL (blood)
• Diabetes Mellitus, Type 2 (complications, drug therapy)
• Diabetic Retinopathy (etiology, prevention & control)
• Disease Progression
• Drug Therapy, Combination
• Dyslipidemias (complications, drug therapy)
• Female
• Fenofibrate (therapeutic use)
• Follow-Up Studies
• Glycated Hemoglobin (metabolism)
• Humans
• Hyperglycemia (drug therapy)
• Hypertension (complications, drug therapy)
• Hypoglycemic Agents (therapeutic use)
• Hypolipidemic Agents (therapeutic use)
• Male
• Middle Aged
• Simvastatin (therapeutic use)