Intensive control of glucose, cholesterol reduces retinopathy
Intensive control of glucose, cholesterol reduces retinopathy
Intensive control of glycemia and dyslipidemia slowed progression of diabetic retinopathy, according to a new analysis from the ACCORD trial.
The subgroup analysis included 2,856 patients who were randomized to either intensive or standard control of glycemia (target hemoglobin A1c <6% or 7.0-7.9%), dyslipidemia (simvastatin plus either 160 mg daily fenofibrate or placebo) and blood pressure (target <120 or <140 mm Hg systolic). The effect of the intervention was measured after four years. Retinopathy was considered to have progressed if patients moved three or more steps on the Early Treatment Diabetic Retinopathy Study Severity Scale or needed laser photocoagulation or vitrectomy.
The intensive glycemic control was associated with a reduced progression to retinopathy—7.3% of patients in the intensive group compared to 10.4% in the standard treatment group (P=0.003). The use of fenofibrate also reduced progression (6.5% of those taking the drug vs. 10.2% of the placebo group, P=0.006). However, intensive blood pressure control did not significantly affect the odds of progressive retinopathy (10.4% vs. 8.8%, P=0.29).
The results confirm previous trials indicating that fenofibrate slows the progression of diabetic retinopathy, the study authors concluded. The study also showed that intensive glycemic control can have a positive effect on retinopathy, even in type 2 diabetics who are at high risk of cardiovascular disease. Previous research has shown an effect in type 1 diabetics and people newly diagnosed with type 2. The study appeared in the July 14 New England Journal of Medicine.
The lack of effect shown by tight blood pressure control may have related to the study's relatively short follow-up and narrow range of blood pressures, speculated an accompanying editorial. The apparent effectiveness of fenofibrate is an exciting finding which could suggest the importance of the drug in treating diabetic retinopathy, and further research is needed to determine whether the results were due to an interaction between fenofibrate and simvastatin, the editorialist said.