The ACCORD Eye Study was designed to evaluate the benefit of intensive glycaemic control (HbA1c <6.0% vs 7.0-7.9%), intensive systolic blood pressure control (<120mmHg vs. <140mmHg), and combined fenofibrate and simvastatin therapy in the development and progression of diabetic retinopathy. There were 3472 type 2 diabetic patients enrolled, and 2856 returned for examination at four years. The mean age of patients was 62 years, while the average duration of diabetes was 10 years. Blood pressure control did not have any effect on diabetic retinopathy progression. In contrast, intensive glycaemic control and fenofibrate treatment were both shown to reduce diabetic retinopathy progression. Interestingly, fenofibrate showed no benefit in eyes that did not have any diabetic retinopathy to start with. The results of this study have to be balanced in the context of intensive glycaemic treatment being associated with a 22% higher risk of death (5.0% vs. 4.0%) and three times higher risk of hypoglycaemic episodes (10.5% vs. 3.5%) compared with standard glycaemic treatment.
Medical management and diabetic retinopathy progression
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