The changing role of the endocrinologist in the care of patients with diabetic retinopathy
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REVIEW
The changing role of the endocrinologist in the care of patients with diabetic retinopathy Massimo Porta • Anna Viola Taulaigo
Received: 14 October 2013 / Accepted: 8 November 2013 Ó Springer Science+Business Media New York 2013
Abstract Diabetic retinopathy (DR) is the most common microvascular complication of diabetes and still represents a leading cause of visual impairment in working age in industrialized countries. It develops following non proliferative (mild, moderate, or severe) and proliferative stages, the earliest being often asymptomatic and with diabetic macular edema potentially developing at any of these. The prevalence and incidence of DR increase with diabetes duration and worsening of metabolic and blood pressure control. Current approaches to prevent and/or treat DR include optimized control of blood glucose and blood pressure and screening for early identification of high risk, though still asymptomatic retinal lesions. Results from the recent clinical trials suggest a role for blockers of the renin–angiotensin system (angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers) and for fenofibrate in reducing progression and/or inducing regression of mild to moderate non proliferative DR. Intravitreal administration of anti-vascular endothelial growth factor agents was shown to reduce visual loss in more advanced stages of DR, especially in macular edema. Keywords Diabetes mellitus Diabetic retinopathy Renin–angiotensin system Serum lipids Vascular endothelial growth factor
M. Porta A. V. Taulaigo Diabetic Retinopathy Centre, Department of Medical Sciences, University of Turin, Turin, Italy M. Porta (&) Department of Medical Sciences, University of Turin, Corso AM Dogliotti 14, 10126 Turin, Italy e-mail: [email protected]
Epidemiology and classification According to World Health Organisation Report [1] in January 2011, over 220 million people worldwide had diabetes and the prevalence will rise to 366 million by 2030 [2]. Type 2 diabetes is spreading due to a combination of longevity and a rapid increase in obesity, and this rise in the incidence of diabetes represents a major public health concern [3] because it is likely to be followed by a rise in its associated complications. DR is the most common microvascular complication of diabetes [4] and is the leading cause of visual impairment in working age in industrialized countries. Moreover, it can reach its more advanced stages in the almost total absence of symptoms. DR prevalence is about 70 % in patients with type 1 diabetes and 40 % among those with type 2, with no differences by gender [5]. The prevalence increases with disease duration and practically all patients with type 1 diabetes develop retinopathy, proliferative in half the cases, within 20 years of the diagnosis. However, remarkable in management of diabetes over the last 30 years have been associated with significant decreases in the prevalence and incidence of DR and visual impairment in type 1 diabetics [6]. The most serious forms of
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