Editor—As editor of a diabetic retinopathy website with patients regulary sending letters, I agree with Marshall and Flyvberg's comments.1 Care is rapidly improving across the United Kingdom, but around a quarter of patients with retinopathy still present with severe retinopathy at time of diagnosis of diabetes. They have not been screened for diabetes, despite having it for 5-10 years and having been recommended screening by medical professionals.2
Thus, in addition to Marshall and Flyvberg's suggestions, screening for diabetes itself must improve if retinopathy is to be prevented; and people must make the lifestyle changes to avoid type 2 diabetes.3
If control of diabetes improves from a poor level yielding a significantly lower HbA1c, however, well established retinopathy may progress rapidly: good control will help in the long but not the short term. This has played a part in worsening severe retinopathy in many people.
Basal bolus insulin regimens may reduce retinopathy progression compared with twice daily regimens, even in type 2 diabetes (A Liebl et al, American Diabetes Association 66th annual scientific sessions, Washington, DC, June 2006), yet regimens of insulin twice daily remain popular.
Figure 1.
Credit: SPL
New and effective drugs are about to be launched to treat diabetic retinopathy. Results of treatment should improve tremendously, but the cost of the drugs might help to bankrupt the NHS unless there are fewer patients to treat (£3000-6000 (€4402-8804, $5595-11 191) per course).4
Competing interests: DJK is editor of www.diabeticretinopathy.org.uk
References
- 1.Marshall SM, A Flyvbjerg A. Prevention and early detection of vascular complications of diabetes. BMJ 2006;333: 475-80. (2 September.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Fong DS, Aiello L, Gardner TW, King GL, Blankenship G, Cavallerano JD, et al, for the American Diabetes Association. Retinopathy in diabetes. Diabetes Care 2004;27(suppl): S84-7. [DOI] [PubMed] [Google Scholar]
- 3.One in three Americans has diabetes or its precursor. Diabetic Microvascular Complications Today 2006;3: 6. [Google Scholar]
- 4.Koury CG. Pegaptanib can reduce proliferative diabetic retinopathy progression. Diabetic Microvascular Complications Today, 2006;3: 38-9. [Google Scholar]