Intensive Glycemic Control, Cholesterol Drugs Slow Progression of Retinopathy

The VA Maryland Health Care System participated in a landmark national study of more than 10,251 high-risk diabetic adults across the nation, testing if three complementary treatment strategies can reduce the high rate of heart disease and stroke associated with type 2 diabetes and if these treatment strategies can also slow the progression of eye disease associated with diabetes, the leading cause of blindness in working-age Americans.

Funded by the National Institutes of Health and conducted more than 77 clinics throughout the US and Canada, the landmark study--the Action to Control Cardiovascular Risk in Diabetes (ACCORD)-- included more than 10, 251 patients, and of those, a subset of nearly 3,000 patients participated in the ACCORD Eye Study.

Results of the study, published in the New England Journal of Medicine and presented on the same day at the 70th Scientific Sessions of the American Diabetes Association—found none of the three treatment strategies resulted in a significant decrease in the combined rates of heart attack, stroke, or cardiovascular death compared with standard treatment. Intensive blood sugar control in conjunction with a combination of cholesterol lowering drugs called statins and fibrates, however, reduced the progression of retinopathy.

Findings of the ACCORD Eye study indicate that standard control of a diabetic’s sugar levels decreased the progression of eye disease by about one-third, from 10.4 percent to 7.3 percent over four years, but the intensive control of sugar, the progression was reduced to 6.5 percent.

In addition to these data, results of the ACCORD Eye Study show that using a combination of lipid drug therapy reduces the progression of retinopathy by about one third. “This is the first study indicating that combination lipid therapy reduces eye disease progression,” says Rex Ballinger, OD, FAAO, local investigator for the study. "We are pleased to have been able to participate in this study at the VA Maryland Health Care System. Most importantly, we are excited that such a study has shown benefits to reducing the risk of diabetic eye disease in our veteran population." This is especially important given the VA's commitment to identifying patients with diabetes and in screening such patients for diabetic retinopathy".

Ballinger added that it is important for all diabetics to have an eye examination that includes careful evaluation of the retina. “Often this includes dilation of the pupils to look for signs of retinopathy,” he said.

At the VA Maryland Health Care System, 55 patients completed the study, which began nationwide in 2001 and during which participants were treated and monitored for an average of five years. Results of the blood sugar clinical trial were reported in 2008 when the intensive blood sugar therapy was stopped 18 months early due to the increased risk of death in that treatment group, as compared to the standard blood sugar control group.

With the growing prevalence of obesity in the U.S., heart disease and blindness associated with the trajectory of type-2 diabetes is expected to become a greater public health challenge in the coming decades, increasing the risks of heart disease, stroke, and progressive eye disease related to diabetes.

Source: VA Maryland Health Care System