Gale R, Scanlon P H, Evans M, Ghanchi F, Yang Y, Silvestri G, Freeman M, Maisey A, Napier J
The Action on DMO group, UK.
The York Hospital, York, UK.
Eye (Lond). 2017 May;31(S1):S1-S20. doi: 10.1038/eye.2017.53.
This paper identifies best practice recommendations for managing diabetes and sight-threatening diabetic eye disease. The authors provide an update for ophthalmologists and allied healthcare professionals on key aspects of diabetes management, supported by a review of the pertinent literature, and recommend practice principles for optimal patient management in treating visual impairment due to diabetic eye disease. In people with diabetes, early optimal glycaemic control reduces the long-term risk of both microvascular and macrovascular complications. The authors propose more can and should be done to maximise metabolic control, promote appropriate behavioural modifications and encourage timely treatment intensification when indicated to ameliorate diabetes-related complications. All people with diabetes should be screened for sight-threatening diabetic retinopathy promptly and regularly. It is shown that attitudes towards treatment adherence in diabetic macular oedema appear to mirror patients' views and health behaviours towards the management of their own diabetes. Awareness of diabetic macular oedema remains low among people with diabetes, who need access to education early in their disease about how to manage their diabetes to delay progression and possibly avoid eye-related complications. Ophthalmologists and allied healthcare professionals play a vital role in multidisciplinary diabetes management and establishment of dedicated diabetic macular oedema clinics is proposed. A broader understanding of the role of the diabetes specialist nurse may strengthen the case for comprehensive integrated care in ophthalmic practice. The recommendations are based on round table presentations and discussions held in London, UK, September 2016.
本文确定了糖尿病及威胁视力的糖尿病眼病管理的最佳实践建议。作者在对相关文献进行综述的支持下，为眼科医生及相关医疗保健专业人员提供了糖尿病管理关键方面的最新信息，并推荐了在治疗糖尿病眼病所致视力损害时进行最佳患者管理的实践原则。在糖尿病患者中，早期实现最佳血糖控制可降低微血管和大血管并发症的长期风险。作者提出，可以并且应该采取更多措施来最大限度地实现代谢控制，促进适当的行为改变，并在有指征时鼓励及时加强治疗以改善糖尿病相关并发症。所有糖尿病患者都应及时且定期筛查是否患有威胁视力的糖尿病视网膜病变。研究表明，糖尿病性黄斑水肿患者对治疗依从性的态度似乎反映了患者对自身糖尿病管理的看法和健康行为。糖尿病患者对糖尿病性黄斑水肿的认识仍然较低，他们需要在疾病早期就获得关于如何管理糖尿病以延缓病情进展并可能避免眼部相关并发症的教育。眼科医生及相关医疗保健专业人员在多学科糖尿病管理中发挥着至关重要的作用，本文建议设立专门的糖尿病性黄斑水肿诊所。对糖尿病专科护士作用的更广泛理解可能会加强眼科实践中全面综合护理的理由。这些建议基于2016年9月在英国伦敦举行的圆桌会议的报告和讨论。
