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Combined glycemic, lipid control lowers diabetic retinopathy progression rate
N Engl J Med. 2010;doi:10.1056/NEJMoa1001288.
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Intensive glycemic control combined with dual therapy to control blood lipid levels significantly reduced the rate of progression of diabetic retinopathy, but intensive blood pressure control did not have a protective effect, according to a study.
In an analysis of 2,856 participants in the ACCORD eye study, a subgroup of the larger ACCORD (Action to control cardiovascular risk in diabetes) study, the rate of progression of diabetic retinopathy after 4 years was 7.3% in patients treated under a protocol to bring glycated hemoglobin levels below 6%, compared with 10.4% in patients for whom the targeted glycemic level was between 7% and 7.9%.
Among patients treated with both a statin (simvastatin) and a fibrate (fenofibrate), the rate of progression was 6.5%, which was significantly lower than the 10.2% among patients treated with simvastatin plus placebo.
"The ACCORD Eye Study clearly indicates that intensive glycemic control and fibrate treatment added to statin therapy separately reduce the progression of diabetic retinopathy," Emily Chew, MD, chair of the study and chief of the Clinical Trials Branch of the Division of Epidemiology and Clinical Applications at the National Eye Institute, said in a release announcing the results.
"The main ACCORD findings showed that fibrate treatment added to statin therapy is safe for patients like those involved in the study. However, intensive blood sugar control to near normal glucose levels increased the risk of death and severe low blood sugar, so patients and their doctors must take these potential risks into account when implementing a diabetes treatment plan," she said.
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