Management of retinopathy in type 2 diabetes - Nature

Management of

GIULIANA SILVESTRI

retinopathy in type 2 diabetes The 'bad companions' of diabetes: should the ophthalmologist get involved? Diabetic retinopathy continues to be the most

complications has been well demonstrated.9

common cause of blindness in the working-age

However, for the more complex type 2 diabetes,

population.1 The incidence of diabetes

up to now the importance of attending to these

continues to rise and despite our best efforts as

risk factors has been suspected but not strictly

clinicians, the complications of this disease

proven.

continue to occur. It is estimated that by the

It has been known for many years that type 2

year 2010 the world diabetic population will

diabetes and hypertension are commonly

have doubled, reaching an estimated 221

associated conditions, with approximately 40%

million? Although the increase in numbers will

of patients with type 2 diabetes at the age of 45

include type 1 diabetes, the rise will be

years being hypertensive, the proportion rising

predominantly due to type 2. Interestingly, in

to 60% at the age of 75 years. Studies have

this current issue of Eye Rhatigan et al? present

shown that hypertension increases the high risk

the results of their study that shows the

of cardiovascular disease with type 2 diabetes

underlying cause of blindness in the majority of

and that it is also a risk factor for the

diabetics who are registered partially sighted or

development of nephropathy and

blind, is, in fact, not diabetic retinopathy.3

microalbinuria.1o The UKPDS asked the

For those whose clinical practice

following important questions: (1) Does the

encompasses the care of diabetics, some recent

tight control of hypertension reduce the risk of

changes in terminology and recommendations

complications in type 2 diabetes? (2) If it does,

are notable. Last year the American Diabetes

do ACE inhibitors offer any advantages over

Association revised the classification and

beta-blockers?

diagnostic criteria for diabetes.4 The revised

The UKPDS confirms that rigorous control of

diagnostic criteria include the lowering of the

hypertension is indicated in type 2 diabetes. The

fasting plasma glucose level required for

first take-away message from the study is: Tight

diagnosis to a level of 7.0 mmol/l or greater;

control of blood pressure, i.e.