title: Optimizing Medical Management in Patients with Sight-Threatening Diabetic Retinopathy.
abstract: BACKGROUND
  Diabetic retinopathy is a leading cause of blindness in adults of working age. Patients with sight-threatening diabetic retinopathy (STDR) often have poor control of modifiable risk factors, including blood pressure and blood glucose. Patients in our eye department with STDR whose diabetes was managed only by their general practitioner (GP) were referred to a diabetes specialist. We have reviewed these referrals and assessed the control of modifiable risk factors in these patients at the time of referral.
  
  
  METHODS
  A retrospective study was performed which identified 54 patients with STDR who had been referred from our eye department to a diabetes specialist between May 2013 and August 2014. Patient demographics, grades of retinopathy, glycated hemoglobin (HbA1c) levels, blood pressure, and lipid profiles were noted from the initial clinic visit and the first clinic appointment after 12 months. Initial management and any subsequent changes to management were recorded.
  
  
  RESULTS
  Of the 54 patients initially referred to the dedicated diabetic retinopathy clinic, data from 32 patients were available for analysis; 22 patients failed to attend the clinic. The majority of patients who presented to the clinic were found to have inadequate control of modifiable risk factors. At the initial clinic visit, nine of the 32 (28%) patients had a blood pressure that was less than the target of 130/80 mmHg and only two (6%) had a HbA1c level of less than the target of 48 mmol/L for type 2 diabetes and 58 mmol/L for type 1 diabetes, respectively. Changes were made to the management in 24 (75%) of the patients. Blood pressure management was changed in 18 (56%) patients. Overall, changes were made to blood pressure management and lipid and glycemic medication, including insulin.
  
  
  CONCLUSIONS
  The majority of patients with STDR were receiving suboptimal medical management. Collaboration between GPs, diabetes specialists, and ophthalmologists can lead to optimized medical management. All eye departments should develop protocols specifying when patients with diabetic retinopathy should be referred for to a diabetes specialist for input.
authors.affiliation: Sunderland Eye Infirmary, Queen Alexandra Rd, Sunderland, SR2 9HP, UK. s.p.mamtora@hotmail.com.
authors.forename: Sunil
authors.identifier: http://orcid.org/0000-0002-1718-8973
authors.initials: S
authors.lastname: Mamtora
authors.affiliation: Sunderland Eye Infirmary, Queen Alexandra Rd, Sunderland, SR2 9HP, UK.
authors.forename: Teresa
authors.initials: T
authors.lastname: Sandinha
authors.affiliation: Sunderland Royal Hospital, Kayll Rd, Sunderland, SR4 7TP, UK.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Carey
authors.affiliation: Institute of Genetic medicine, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK.
authors.forename: David H W
authors.initials: DHW
authors.lastname: Steel
keywords: Blood pressure; Diabetes; Diabetic retinopathy; Maculopathy; Multidisciplinary; Systemic control