Hansson-Lundblad C, Agardh E, Agardh C D
Department of Ophthalmology, University Hospital, Lund, Sweden.
Acta Ophthalmol Scand. 1997 Jun;75(3):244-8. doi: 10.1111/j.1600-0420.1997.tb00765.x.
The aim of the present study was to examine whether type 2 diabetic patients with good metabolic control achieved on diet treatment only, developed sight-threatening retinopathy during a four-year follow-up period.
A retrospective four-year follow-up study was carried out including all diabetic patients on diet treatment only, registered at the out-patient clinic at the Department of Medicine and referred for fundus photography to the Department of Ophthalmology in 1989 as well as all patients referred from primary care units for fundus photography during 1988 and 1989. One hundred and seventeen diabetic patients treated with diet only were examined with fundus photography after remittance, and after two and four years.
Age at diabetes diagnosis was 58.8 +/- 13.8 years (mean +/- SD), age at baseline was 61.5 +/- 13.6 years, and diabetes duration was 2.7 +/- 3.1 years. During the four-year follow-up period, 48 of the patients (41%) remained on diet treatment only whereas diabetes treatment was changed in 66 (56%), from diet to oral agents only in 57 (49%), and from diet to insulin alone or in combination with oral agents in 9 (8%) of the patients. One hundred and six patients (91%) did not have any retinopathy at baseline and 11 patients (9%) had minimal background retinopathy. At follow-up, there were no signs of retinopathy in 93 patients (79%), 22 (19%) had minimal background retinopathy, and two had developed moderate background retinopathy. Out of those patients who were still on diet at follow-up, five (10%) had developed minimal background retinopathy. Mean blood glucose and HbA1c levels, registered every year during the observation period, were higher at most time points in patients who received oral agents or insulin treatment compared to those who were treated with diet only during the entire observation period. No differences were observed between patients who received oral agents and those who received insulin alone or in combination with oral agents.
It is suggested, that if the initial retinal examination reveals no or minimal diabetic retinopathy at the time of diagnosis of type 2 diabetes mellitus, the second examination can be postponed at least 4 years in patients with good metabolic control on diet treatment only.
本研究旨在探讨仅通过饮食治疗实现良好代谢控制的2型糖尿病患者在四年随访期内是否会发生威胁视力的视网膜病变。
进行了一项为期四年的回顾性随访研究，纳入所有仅接受饮食治疗的糖尿病患者，这些患者于1989年在医学部门诊登记并被转诊至眼科进行眼底摄影，以及1988年和1989年从基层医疗单位转诊来进行眼底摄影的所有患者。117例仅接受饮食治疗的糖尿病患者在转诊后、两年和四年时接受了眼底摄影检查。
糖尿病诊断时的年龄为58.8±13.8岁（均值±标准差），基线时年龄为61.5±13.6岁，糖尿病病程为2.7±3.1年。在四年随访期内，48例患者（41%）仍仅接受饮食治疗，而66例（56%）患者的糖尿病治疗发生了改变，其中57例（49%）从饮食治疗改为仅口服降糖药，9例（8%）从饮食治疗改为单独使用胰岛素或与口服降糖药联合使用。106例患者（91%）在基线时没有任何视网膜病变，11例患者（9%）有轻度背景性视网膜病变。随访时，93例患者（79%）没有视网膜病变迹象，22例（19%）有轻度背景性视网膜病变，2例发展为中度背景性视网膜病变。在随访时仍接受饮食治疗的患者中，5例（10%）发展为轻度背景性视网膜病变。在观察期内每年记录的平均血糖和糖化血红蛋白水平，在接受口服降糖药或胰岛素治疗的患者中，大多数时间点都高于在整个观察期内仅接受饮食治疗的患者。接受口服降糖药的患者与接受单独胰岛素治疗或胰岛素与口服降糖药联合治疗的患者之间未观察到差异。
建议在2型糖尿病诊断时，如果初始视网膜检查未发现或仅有轻度糖尿病视网膜病变，对于仅通过饮食治疗实现良好代谢控制的患者，第二次检查可至少推迟4年。
