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The Effect of Interventions to Prevent Type 2 Diabetes on the Development of Diabetic Retinopathy: The DPP/DPPOS
Neil H White1, Qing Pan2, William C Knowler3
1Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO.
Objective:
To determine whether interventions that slow or prevent the development of type 2 diabetes in those at risk reduce the subsequent prevalence of diabetic retinopathy.
Research Design And Methods:
The Diabetes Prevention Program (DPP) randomized subjects at risk for developing type 2 diabetes because of overweight/obesity and dysglycemia to metformin (MET), intensive lifestyle intervention (ILS), or placebo (PLB) to assess the prevention of diabetes. During the DPP and DPP Outcome Study (DPPOS), we performed fundus photography over time on study participants, regardless of their diabetes status. Fundus photographs were graded using the Early Treatment Diabetic Retinopathy Study grading system, with diabetic retinopathy defined as typical lesions of diabetic retinopathy (microaneurysms, exudates, or hemorrhage, or worse) in either eye.
Results:
Despite reduced progression to diabetes in the ILS and MET groups compared with PLB, there was no difference in the prevalence of diabetic retinopathy between treatment groups after 1, 5, 11, or 16 years of follow-up. No treatment group differences in retinopathy were found within prespecified subgroups (baseline age, sex, race/ethnicity, baseline BMI). In addition, there was no difference in the prevalence of diabetic retinopathy between those exposed to metformin and those not exposed to metformin, regardless of treatment group assignment.
Conclusion:
Interventions that delay or prevent the onset of type 2 diabetes in overweight/obese subjects with dysglycemia who are at risk for diabetes do not reduce the development of diabetic retinopathy for up to 20 years.
Insights
Preventing type 2 diabetes with lifestyle changes or metformin does not reduce diabetic retinopathy. This study found no difference in retinopathy prevalence among intervention groups over 20 years.
Area of Science:
- Endocrinology
- Ophthalmology
- Preventive Medicine
Background:
- Type 2 diabetes is a leading cause of preventable blindness.
- Diabetic retinopathy is a major complication of diabetes.
- Interventions to prevent or delay type 2 diabetes are crucial.
Purpose of the Study:
- To investigate if interventions preventing type 2 diabetes reduce diabetic retinopathy.
- To analyze the long-term impact of diabetes prevention strategies on retinopathy.
Main Methods:
- The Diabetes Prevention Program (DPP) randomized at-risk individuals to lifestyle intervention, metformin, or placebo.
- Fundus photography was used to assess diabetic retinopathy over 20 years.
- Retinopathy was graded using the Early Treatment Diabetic Retinopathy Study system.
Main Results:
- Intensive lifestyle intervention and metformin reduced diabetes progression but did not affect retinopathy prevalence.
- No differences in diabetic retinopathy were observed between treatment groups across follow-up periods.
- Subgroup analyses and metformin exposure did not reveal any impact on retinopathy.
Conclusions:
- Interventions delaying type 2 diabetes onset do not decrease the development of diabetic retinopathy.
- This finding highlights the need for specific retinopathy screening and management in at-risk populations.
- Long-term data suggest diabetes prevention alone may not be sufficient to prevent retinopathy.
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