Role of General Medical Services in Diabetic Eye Disease
AT Bettersight we recognise the help that our colleagues in general practice and in hospital diabetes clinics can provide for patients who develop any noteable diabetic eye problems.
Many studies over the years have demonstrated the importance of better sugar control, better blood pressure control and better cholesterol control in helping to reduce the rate of progression of diabetic eye complications.
In our view the two major landmark studies that give us clear guidance on the importance of general medical care in reducing the risk of diabetes related complications are:
- UKPDS (UK Prospective Diabetes Study) – This examined the impact of general medical controls in type 2 diabetics
- The DCCT (Diabetes control and complications trial) – This examined the impact of general medical controls in type 1 diabetics
Learn more about these two major studies below.
- The UKPDS Trial
The landmark UK Prospective Diabetes Study (UKPDS) study conducted in type 2 diabetes patients and involving 5102 patients showed the following conclusions :
- Lowering the HBA1c ( a measure of glucose control) from an average of 7.9% down to 7.0% with ‘intensive treatment measures’ showed a very significant 25% reduction in the prospect of advancing diabetic eye disease, diabetic kidney disease and possibly also diabetic nerve problems.
- Every 1% reduction in HBA1c led to a 35% reduction in the risk of diabetic eye and kidney complications !
- Even those patients who started of with ‘good control’ in the study showed some additional benefit from further blood glucose lowering
- Every 1% reduction in HBA1c led to a 25% reduction in diabetes related deaths
- A clear relationship existed between blood pressure control and all the above outcomes too.
These outcomes have paved the way for better management of diabetes in the UK for over two decades now.
- The DCCT
This trial was completed in 1993 and involved 1441 patients between the ages of 13 to 39 with type 1 diabetes across 29 medical centres in the US.
The major findings of the DCCT were that ‘intensive control of blood glucose aiming for HBA1c levels as close as possible to 6%’ led to :
- A 76% reduction in the risk of eye disease development
- A 50% reduced risk of kidney disease and
- A 60% reduction in the risk of diabetic nerve problems (neuropathy).
The study volunteers were then followed up on a longer term basis to see what further impacts arise in with better control – this was called the EDIC study (Epidemiology of diabetes interventions and complications). The EDIC follow on study led to the following major conclusion :
Intensive glucose control reduces the risk of
- Any cardiovascular event (e.g stroke or heart attack) by 42%
There was little doubt about the positive impact of better glucose control in type 1 diabetes !