Strategies to reduce complications of type 2 diabetes

Screening for retinopathy

Several trials have evaluated interventions in the diagnosis and prevention of visual loss. As discussed previously, intensive glucose control with sulfonylureas or insulin reduced the need for retinal photocoagulation by 39% in the UKPDS (NNT=320 patient-years).¹⁴ Similarly in this trial, tight blood pressure control reduced the progression of retinopathy, compared with usual care. ¹⁰

Specific treatments for retinopathy include photocoagulation, which has been demonstrated to significantly reduce severe visual loss by 58% (NNT=30 patient-years).⁴⁰ One cohort study suggests that screening for retinopathy coupled with appropriate treatment may reduce the onset of visual loss.⁴¹ The ADA recommends annual screening for retinopathy with a dilated eye exam based on indirect evidence of its benefit (SOR: B).⁷

Correspondence
Paul Ullom-Minnich, MD, Partners in Family Care, PO Box 640, Moundridge, KS 67107. E-mail: paulum66@hotmail.com.