Retinopathy in Recently Diagnosed Type 2 Diabetes: It Doesn't Look Good
The best solution to eye complications is tight control
At the American Diabetes Association's 65th Scientific Sessions and Annual Meeting, held in San Diego June 10-14, 2005, Dr. Richard F. Hamman, Professor and Chair of the Department of Preventive Medicine and Biometrics, (University of Colorado Health Sciences Center, Denver) presented "Retinopathy in Recent Onset Diabetes and Persons at High Risk of Diabetes in the Diabetes Prevention Program" during the late-breaking clinical trials session. The late-breaking session is the one where often the latest and most intriguing research is unveiled. Dr. Hamman's research revealed that a large number of people either have retinopathy (diabetic eye disease) at the time of their diagnosis of type 2 diabetes or will get it within six to twelve months after their diagnosis. Even more concerning is that patients who are not technically diabetic by the current diagnosis criteria may have early-stage retinopathy.
Diabetes affects an estimated 20.8 million Americans, with about 13 million of us actually diagnosed. [EDITOR'S NOTE: As of 2008, 23.6 million people had diabetes, with 17.9 million actually diagnosed.] These numbers are actually underestimated since they haven't been updated in a couple of years. We look for an update soon and anticipate that the number will, for the first time ever, exceed 20 million people with diabetes. During the ADA meeting, the recent finding that prediabetes, which affects over 41 million Americans, can contribute to retinopathy was extremely troubling for healthcare providers and researchers. According to the American Diabetes Association, diabetic retinopathy is responsible for 8% of legal blindness, making it the leading cause of new cases of blindness in adults 20-74 years of age in the United States. Each year, 12,000 to 24,000 Americans lose their sight because of diabetes. With more and more of us being diagnosed with diabetes every year (over a million per year at last glance) and so many with prediabetes, blindness related to blood glucose levels is likely to increase too. Figure 1 shows the difference between normal sight and the sight of someone with diabetic retinopathy. Most cases of diabetic retinopathy are treatable with surgery, but many are not.
The Diabetes Control and Complications Trial (DCCT) showed that tight control of blood glucose levels in people with diabetes could, to a great extent, prevent or delay the onset of retinopathy. Though the DCCT included only people with type 1 diabetes, its results suggested that tight blood glucose control in all people with diabetes is worth the effort. The American Diabetes Association urges that we try to keep our A1C at or below 7% in large part because of the DCCT results, which showed that people with an A1C of 8% have a significantly greater risk of developing retinopathy compared to people with an A1C of 7% or less over a period of several years (see Fig. 2). Likewise, DCCT participants with an A1C of 9% were dramatically more likely to develop retinopathy than people with an A1C of 8%. In the DCCT, the intensive diabetes management group took at least three injections of insulin per day or used an insulin pump and checked their blood glucose levels an average of four times per day. The conventional management group had two injections of insulin per day and checked their blood glucose two to three times per day. Figure 3 shows clearly that about 60% of the conventionally managed patients developed retinopathy but only 20% of the intensively managed patients developed retinopathy. The power of metabolic memory appears quite significant.
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One of the online diabetes groups I belong to (but don't frequently post to) is geared towards "frum" (Orthodox or "observant") Jewish people with (mostly type 1) diabetes. Most of the chat on the mailing list centers around people needing last-minute supplies before Shabbat or a holiday, where to acquire supplies and get medical help when visiting Israel, and advice on which pump is best for one's type 1 child — in other words, the usual sort of diabetes chatter, but...