Effects of medical therapies on retinopathy progression in type 2 diabetes

Emily Y. Chew, Walter T. Ambrosius, Matthew D. Davis, Ronald P. Danis, Sapna Gangaputra, Craig M. Greven, Larry Hubbard, Barbara A. Esser, James F. Lovato, Letitia H. Perdue, David C. Goff, William Cushman, Henry N. Ginsberg, Marshall Elam, Saul Genuth, Hertzel C. Gerstein, Ulrich Schubart, Lawrence J. Fine

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: We investigated whether intensive glycemic control, combination therapy for dyslipidemia, and intensive blood-pressure control would limit the progression of diabetic retinopathy in persons with type 2 diabetes. Previous data suggest that these systemic factors may be important in the development and progression of diabetic retinopathy. METHODS: In a randomized trial, we enrolled 10,251 participants with type 2 diabetes who were at high risk for cardiovascular disease to receive either intensive or standard treatment for glycemia (target glycated hemoglobin level, <6.0% or 7.0 to 7.9%, respectively) and also for dyslipidemia (160 mg daily of fenofibrate plus simvastatin or placebo plus simvastatin) or for systolic blood-pressure control (target, <120 or <140 mm Hg). A subgroup of 2856 participants was evaluated for the effects of these interventions at 4 years on the progression of diabetic retinopathy by 3 or more steps on the Early Treatment Diabetic Retinopathy Study Severity Scale (as assessed from seven-field stereoscopic fundus photographs, with 17 possible steps and a higher number of steps indicating greater severity) or the development of diabetic retinopathy necessitating laser photocoagulation or vitrectomy. RESULTS: At 4 years, the rates of progression of diabetic retinopathy were 7.3% with intensive glycemia treatment, versus 10.4% with standard therapy (adjusted odds ratio, 0.67; 95% confidence interval [CI], 0.51 to 0.87; P=0.003); 6.5% with fenofibrate for intensive dyslipidemia therapy, versus 10.2% with placebo (adjusted odds ratio, 0.60; 95% CI, 0.42 to 0.87; P=0.006); and 10.4% with intensive blood-pressure therapy, versus 8.8% with standard therapy (adjusted odds ratio, 1.23; 95% CI, 0.84 to 1.79; P=0.29). CONCLUSIONS: Intensive glycemic control and intensive combination treatment of dyslipidemia, but not intensive blood-pressure control, reduced the rate of progression of diabetic retinopathy. (Funded by the National Heart, Lung, and Blood Institute and others; ClinicalTrials.gov numbers, NCT00000620 for the ACCORD study and NCT00542178 for the ACCORD Eye study.)

Original languageEnglish (US)
Pages (from-to)233-244
Number of pages12
JournalNew England Journal of Medicine
Volume363
Issue number3
DOIs
StatePublished - Jul 15 2010

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Type 2 Diabetes Mellitus
Diabetic Retinopathy
Dyslipidemias
Blood Pressure
Fenofibrate
Simvastatin
Therapeutics
Odds Ratio
Confidence Intervals
Placebos
National Heart, Lung, and Blood Institute (U.S.)
Light Coagulation
Vitrectomy
Glycosylated Hemoglobin A
Lasers
Cardiovascular Diseases

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Chew, E. Y., Ambrosius, W. T., Davis, M. D., Danis, R. P., Gangaputra, S., Greven, C. M., ... Fine, L. J. (2010). Effects of medical therapies on retinopathy progression in type 2 diabetes. New England Journal of Medicine, 363(3), 233-244. https://doi.org/10.1056/NEJMoa1001288

Effects of medical therapies on retinopathy progression in type 2 diabetes. / Chew, Emily Y.; Ambrosius, Walter T.; Davis, Matthew D.; Danis, Ronald P.; Gangaputra, Sapna; Greven, Craig M.; Hubbard, Larry; Esser, Barbara A.; Lovato, James F.; Perdue, Letitia H.; Goff, David C.; Cushman, William; Ginsberg, Henry N.; Elam, Marshall; Genuth, Saul; Gerstein, Hertzel C.; Schubart, Ulrich; Fine, Lawrence J.

In: New England Journal of Medicine, Vol. 363, No. 3, 15.07.2010, p. 233-244.

Research output: Contribution to journalArticle

Chew, EY, Ambrosius, WT, Davis, MD, Danis, RP, Gangaputra, S, Greven, CM, Hubbard, L, Esser, BA, Lovato, JF, Perdue, LH, Goff, DC, Cushman, W, Ginsberg, HN, Elam, M, Genuth, S, Gerstein, HC, Schubart, U & Fine, LJ 2010, 'Effects of medical therapies on retinopathy progression in type 2 diabetes', New England Journal of Medicine, vol. 363, no. 3, pp. 233-244. https://doi.org/10.1056/NEJMoa1001288
Chew EY, Ambrosius WT, Davis MD, Danis RP, Gangaputra S, Greven CM et al. Effects of medical therapies on retinopathy progression in type 2 diabetes. New England Journal of Medicine. 2010 Jul 15;363(3):233-244. https://doi.org/10.1056/NEJMoa1001288
Chew, Emily Y. ; Ambrosius, Walter T. ; Davis, Matthew D. ; Danis, Ronald P. ; Gangaputra, Sapna ; Greven, Craig M. ; Hubbard, Larry ; Esser, Barbara A. ; Lovato, James F. ; Perdue, Letitia H. ; Goff, David C. ; Cushman, William ; Ginsberg, Henry N. ; Elam, Marshall ; Genuth, Saul ; Gerstein, Hertzel C. ; Schubart, Ulrich ; Fine, Lawrence J. / Effects of medical therapies on retinopathy progression in type 2 diabetes. In: New England Journal of Medicine. 2010 ; Vol. 363, No. 3. pp. 233-244.
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AU - Chew, Emily Y.

AU - Ambrosius, Walter T.

AU - Davis, Matthew D.

AU - Danis, Ronald P.

AU - Gangaputra, Sapna

AU - Greven, Craig M.

AU - Hubbard, Larry

AU - Esser, Barbara A.

AU - Lovato, James F.

AU - Perdue, Letitia H.

AU - Goff, David C.

AU - Cushman, William

AU - Ginsberg, Henry N.

AU - Elam, Marshall

AU - Genuth, Saul

AU - Gerstein, Hertzel C.

AU - Schubart, Ulrich

AU - Fine, Lawrence J.

PY - 2010/7/15

Y1 - 2010/7/15

N2 - BACKGROUND: We investigated whether intensive glycemic control, combination therapy for dyslipidemia, and intensive blood-pressure control would limit the progression of diabetic retinopathy in persons with type 2 diabetes. Previous data suggest that these systemic factors may be important in the development and progression of diabetic retinopathy. METHODS: In a randomized trial, we enrolled 10,251 participants with type 2 diabetes who were at high risk for cardiovascular disease to receive either intensive or standard treatment for glycemia (target glycated hemoglobin level, <6.0% or 7.0 to 7.9%, respectively) and also for dyslipidemia (160 mg daily of fenofibrate plus simvastatin or placebo plus simvastatin) or for systolic blood-pressure control (target, <120 or <140 mm Hg). A subgroup of 2856 participants was evaluated for the effects of these interventions at 4 years on the progression of diabetic retinopathy by 3 or more steps on the Early Treatment Diabetic Retinopathy Study Severity Scale (as assessed from seven-field stereoscopic fundus photographs, with 17 possible steps and a higher number of steps indicating greater severity) or the development of diabetic retinopathy necessitating laser photocoagulation or vitrectomy. RESULTS: At 4 years, the rates of progression of diabetic retinopathy were 7.3% with intensive glycemia treatment, versus 10.4% with standard therapy (adjusted odds ratio, 0.67; 95% confidence interval [CI], 0.51 to 0.87; P=0.003); 6.5% with fenofibrate for intensive dyslipidemia therapy, versus 10.2% with placebo (adjusted odds ratio, 0.60; 95% CI, 0.42 to 0.87; P=0.006); and 10.4% with intensive blood-pressure therapy, versus 8.8% with standard therapy (adjusted odds ratio, 1.23; 95% CI, 0.84 to 1.79; P=0.29). CONCLUSIONS: Intensive glycemic control and intensive combination treatment of dyslipidemia, but not intensive blood-pressure control, reduced the rate of progression of diabetic retinopathy. (Funded by the National Heart, Lung, and Blood Institute and others; ClinicalTrials.gov numbers, NCT00000620 for the ACCORD study and NCT00542178 for the ACCORD Eye study.)

AB - BACKGROUND: We investigated whether intensive glycemic control, combination therapy for dyslipidemia, and intensive blood-pressure control would limit the progression of diabetic retinopathy in persons with type 2 diabetes. Previous data suggest that these systemic factors may be important in the development and progression of diabetic retinopathy. METHODS: In a randomized trial, we enrolled 10,251 participants with type 2 diabetes who were at high risk for cardiovascular disease to receive either intensive or standard treatment for glycemia (target glycated hemoglobin level, <6.0% or 7.0 to 7.9%, respectively) and also for dyslipidemia (160 mg daily of fenofibrate plus simvastatin or placebo plus simvastatin) or for systolic blood-pressure control (target, <120 or <140 mm Hg). A subgroup of 2856 participants was evaluated for the effects of these interventions at 4 years on the progression of diabetic retinopathy by 3 or more steps on the Early Treatment Diabetic Retinopathy Study Severity Scale (as assessed from seven-field stereoscopic fundus photographs, with 17 possible steps and a higher number of steps indicating greater severity) or the development of diabetic retinopathy necessitating laser photocoagulation or vitrectomy. RESULTS: At 4 years, the rates of progression of diabetic retinopathy were 7.3% with intensive glycemia treatment, versus 10.4% with standard therapy (adjusted odds ratio, 0.67; 95% confidence interval [CI], 0.51 to 0.87; P=0.003); 6.5% with fenofibrate for intensive dyslipidemia therapy, versus 10.2% with placebo (adjusted odds ratio, 0.60; 95% CI, 0.42 to 0.87; P=0.006); and 10.4% with intensive blood-pressure therapy, versus 8.8% with standard therapy (adjusted odds ratio, 1.23; 95% CI, 0.84 to 1.79; P=0.29). CONCLUSIONS: Intensive glycemic control and intensive combination treatment of dyslipidemia, but not intensive blood-pressure control, reduced the rate of progression of diabetic retinopathy. (Funded by the National Heart, Lung, and Blood Institute and others; ClinicalTrials.gov numbers, NCT00000620 for the ACCORD study and NCT00542178 for the ACCORD Eye study.)

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