Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, 610041 Sichuan, China.
J Diabetes Res. 2020 Jan 17;2020:8765139. doi: 10.1155/2020/8765139. eCollection 2020.
Intensive glucose therapy can protect the retina of individuals with diabetes, but it is unknown if it provides the same protection to patients with different severity of diabetic retinopathy (DR). We finally included DR-related studies involving intensive glucose control with large sample size and long follow-up time, including five large and high-quality randomized clinical trials (RCTs): DCCT, UKPDS, ACCORD, AdRem, and VADT. With DCCT as a reference, we supposed a DR severity threshold that is verified by other RCTs then. We found that individuals who have DR lesions that are equivalent to or less severe than moderate NPDR achieve benefits for the retina by intensive glycemic control. However, these are realized only if the HbA1c in type 1 or type 2 diabetic patients is reduced at least by 0.8% versus the control group or it is reduced to <7% and >3 years of intensive glucose control is required. If the severity of DR lesions is worse than moderate NPDR, intensive glycemic control may not bring benefits.
强化血糖治疗可以保护糖尿病患者的视网膜，但尚不清楚它是否对不同严重程度的糖尿病视网膜病变（DR）患者提供相同的保护。我们最终纳入了涉及强化血糖控制的 DR 相关研究，这些研究具有较大的样本量和较长的随访时间，包括五项大型高质量随机临床试验（RCT）：DCCT、UKPDS、ACCORD、AdRem 和 VADT。以 DCCT 为参照，我们假设了一个 DR 严重程度阈值，然后用其他 RCT 进行验证。我们发现，DR 病变等效或轻于中度 NPDR 的患者通过强化血糖控制可以使视网膜受益。然而，这只有在 1 型或 2 型糖尿病患者的 HbA1c 相对于对照组降低至少 0.8%或降低至<7%，并且需要至少 3 年的强化血糖控制时才会实现。如果 DR 病变的严重程度超过中度 NPDR，强化血糖控制可能不会带来益处。
