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糖尿病视网膜病变患者糖尿病药物及手术治疗的安全性——综述

The Safety of Pharmacological and Surgical Treatment of Diabetes in Patients with Diabetic Retinopathy-A Review.

作者信息

Matuszewski Wojciech, Baranowska-Jurkun Angelika, Stefanowicz-Rutkowska Magdalena Maria, Gontarz-Nowak Katarzyna, Gątarska Ewa, Bandurska-Stankiewicz Elżbieta

机构信息

Department of Internal Medicine, Endocrinology, Diabetology and Internal Medicine Clinic, University of Warmia and Mazury in Olsztyn, 10-719 Olsztyn, Poland.

Nephrology, Transplantology and Internal Medicine Clinic, Pomeranian Medicine University in Szczecin, 70-204 Szczecin, Poland.

出版信息

J Clin Med. 2021 Feb 11;10(4):705. doi: 10.3390/jcm10040705.

Abstract

BACKGROUND

Diabetes mellitus (DM) is a non-infectious pandemic of the modern world; it is estimated that in 2045 it will affect 10% of the world's population. As the prevalence of diabetes increases, the problem of its complications, including diabetic retinopathy (DR), grows. DR is a highly specific neurovascular complication of diabetes that occurs in more than one third of DM patients and accounts for 80% of complete vision loss cases in the diabetic population. We are currently witnessing many groundbreaking studies on new pharmacological and surgical methods of treating diabetes.

AIM

The aim of the study is to assess the safety of pharmacological and surgical treatment of DM in patients with DR.

MATERIAL AND METHODS

An analysis of the data on diabetes treatment methods currently available in the world literature and their impact on the occurrence and progression of DR.

RESULTS

A rapid decrease in glycaemia leads to an increased occurrence and progression of DR. Its greatest risk accompanies insulin therapy and sulfonylurea therapy. The lowest risk of DR occurs with the use of SGLT2 inhibitors; the use of DPP-4 inhibitors and GLP-1 analogues is also safe. Patients undergoing pancreatic islet transplants or bariatric surgeries require intensive monitoring of the state of the eye, both in the perioperative and postoperative period.

CONCLUSIONS

It is of utmost importance to individualize therapy in diabetic patients, in order to gradually achieve treatment goals with the use of safe methods and minimize the risk of development and progression of DR.

摘要

背景

糖尿病(DM)是现代世界的一种非传染性大流行病;据估计,到2045年,它将影响世界10%的人口。随着糖尿病患病率的增加,其并发症问题,包括糖尿病视网膜病变(DR),也日益严重。DR是糖尿病一种高度特异性的神经血管并发症,在超过三分之一的糖尿病患者中发生,占糖尿病患者完全失明病例的80%。目前,我们正在见证许多关于治疗糖尿病的新药理学和手术方法的开创性研究。

目的

本研究的目的是评估糖尿病视网膜病变患者糖尿病药物和手术治疗的安全性。

材料与方法

分析世界文献中目前可用的糖尿病治疗方法的数据及其对糖尿病视网膜病变发生和进展的影响。

结果

血糖快速下降会导致糖尿病视网膜病变的发生率和进展增加。胰岛素治疗和磺脲类药物治疗伴随的风险最大。使用SGLT2抑制剂时糖尿病视网膜病变的风险最低;使用DPP-4抑制剂和GLP-1类似物也很安全。接受胰岛移植或减肥手术的患者在围手术期和术后都需要密切监测眼部状况。

结论

糖尿病患者治疗个体化至关重要,以便通过使用安全方法逐步实现治疗目标,并将糖尿病视网膜病变发生和进展的风险降至最低。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0115/7916896/d25a70db8428/jcm-10-00705-g001.jpg

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