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Diabetics need ‘intensive’ glucose control to prevent, delay retinopathy, surgeon says

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PHILADELPHIA — Patients with diabetes who have poor glucose control, high levels of hemoglobin or a long history of the disease are at heightened risk of developing retinopathy and macular edema. These patients should be encouraged to maintain “intensive” glucose control, even if it means switching to a different internist or endocrinologist, according to a speaker here.

“Internists should push tight glucose control earlier. The sooner you get a patient under good control, the better the chance their eye disease won’t progress,” said Brooks W. McCuen II, MD, a professor of ophthalmology at Duke University Eye Center in Durham, N.C.

Dr. McCuen spoke here at the Update on Management of Diabetic Retinopathy and its Complications, an educational meeting sponsored by SLACK Incorporated, the publisher of the OSN SuperSite, and supported by a grant from Ista Pharmaceuticals.

Diabetic retinopathy — the leading cause of blindness among patients age 20 to 64 — affects one quarter of the 16 million Americans diagnosed with diabetes. With the incidence of diabetes escalating due to the rising prevalence of obesity and overweight in many developed countries, Dr. McCuen said that the prevalence of diabetic retinal disease is sure to increase in coming years.

Patients who have lived with diabetes for 25 years have a 90% chance of developing retinopathy, while patients who had the disease for 10 years have only a 7% chance, Dr. McCuen noted. Macular edema is present in 5% of patients after 5 years and 15% of patients after 15 years.

Dr. McCuen said that at-risk patients need “tight” or “intensive” control of their glucose levels, with measurements taken three or more times a day and insulin administered as needed. Patients should also have periodic checks of hemoglobin, he said.

“Hemoglobin levels should be very low,” Dr. McCuen said. “Ask your patients what their levels are. If they don’t know or haven’t heard of hemoglobin, it’s time to refer them to a different doctor who will provide more aggressive management.”