Glycaemic control and control of risk factors in diabetes patients in an ophthalmology clinic: what lessons have we learned from the UKPDS and DCCT studies?
OBJECTIVE
The Diabetes Control and Complications Trial (DCCT) and UK Prospective Diabetes Study (UKPDS) have studied glycaemic control as well as other risk factors in preventing the progression of diabetic end-organ disease, including diabetic retinopathy. We wished to determine to what extent a cross-section of diabetes patients attending our eye clinic met the targets laid down by recent landmark studies.


METHODS
We prospectively assessed 44 consecutive diabetes patients attending outpatient clinics for assessment of diabetic retinopathy. Each patient had HbA1c levels, serum cholesterol and blood pressure checked. A proforma was completed for each patient.


RESULTS
Of the 44 patients studied, 11 had type 1 diabetes mellitus (DM) and 33 had type 2 DM (11 insulin-dependent DM [IDDM], 22 non-insulin-dependent DM [NIDDM]). The mean age of type 1 DM patients was 43 years; that of type 2 DM patients was 62 years. Five of 11 (46%) type 1 DM patients had poorly controlled diabetes (HbA1c > 9%) compared with four of 33 (12%) type 2 DM patients. Overall, 27 of 44 (62%) patients were on antihypertensive medication. The prevalence of poorly controlled blood pressure (> 150/85 mmHg treated; > 160/90 mmHg untreated) was 16 of 44 (36%) patients overall, and was higher for type 2 DM patients (13/33, 39%) than for type 1 DM patients (3/11, 27%). Random serum cholesterol levels > 5.2 were found in 10 of 44 (23%) patients overall (4/11 [36%] type 1 and 6/33 [18%] type 2 DM patients).


CONCLUSIONS
Control of HbA1c, hypertension and hypercholesterolaemia can slow progression of retinopathy and other DM end-points. Many of our patients were poorly controlled in terms of these risk factors. More attention should be addressed to these primary preventative factors in the management of diabetes patients.
Higgins
Gareth T
GT
St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK. chanhiggins@tiscali.co.uk
Khan
Javeed
J
Pearce
Ian A
IA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D002784:Cholesterol / Q000097:blood; D002986:Clinical Trials as Topic; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000503:physiopathology*; D003930:Diabetic Retinopathy / Q000097:blood / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D038321:Glycemic Index; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000517:prevention & control*; D006973:Hypertension / Q000097:blood / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012307:Risk Factors; D006113:United Kingdom
D000924:Anticholesteremic Agents; D000959:Antihypertensive Agents; D001786:Blood Glucose; D002784:Cholesterol; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human