4.7 Article

The Effect of Interventions to Prevent Type 2 Diabetes on the Development of Diabetic Retinopathy: The DPP/DPPOS Experience

Journal

DIABETES CARE
Volume 45, Issue 7, Pages 1640-1646

Publisher

AMER DIABETES ASSOC
DOI: 10.2337/dc21-2417

Keywords

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Funding

  1. National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) [U01 DK048489, U01 DK048339, U01 DK048377, U01 DK048349, U01 DK048381]
  2. Eunice Kennedy Shriver National Institute of Child Health and Human Development
  3. National Institute on Aging
  4. National Eye Institute
  5. National Heart Lung and Blood Institute
  6. National Cancer Institute
  7. Office of Research on Women's Health
  8. National Institute on Minority Health and Health Disparities
  9. Centers for Disease Control and Prevention
  10. American Diabetes Association
  11. NIDDK
  12. Indian Health Service
  13. 'National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)' [U01 DK048375, U01 DK048514, U01 DK048437, U01 DK048413, U01 DK048411, U01 DK048406, U01 DK048380, U01 DK048397, U01 DK048412, U01 DK048404, U01 DK048387, U01 DK048407, U01 DK048443, U01 DK048400]
  14. the National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) [U01 DK048468, U01 DK048434, U01 DK048485]

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The interventions aimed at delaying or preventing the development of type 2 diabetes in overweight/obese individuals at risk do not reduce the prevalence of diabetic retinopathy.
OBJECTIVE To determine whether interventions that slow or prevent the development of type 2 diabetes in those at risk reduce the subsequent prevalence of diabetic retinopathy. RESEARCH DESIGN AND METHODS The Diabetes Prevention Program (DPP) randomized subjects at risk for developing type 2 diabetes because of overweight/obesity and dysglycemia to metformin (MET), intensive lifestyle intervention (ILS), or placebo (PLB) to assess the prevention of diabetes. During the DPP and DPP Outcome Study (DPPOS), we performed fundus photography over time on study participants, regardless of their diabetes status. Fundus photographs were graded using the Early Treatment Diabetic Retinopathy Study grading system, with diabetic retinopathy defined as typical lesions of diabetic retinopathy (microaneurysms, exudates, or hemorrhage, or worse) in either eye. RESULTS Despite reduced progression to diabetes in the ILS and MET groups compared with PLB, there was no difference in the prevalence of diabetic retinopathy between treatment groups after 1, 5, 11, or 16 years of follow-up. No treatment group differences in retinopathy were found within prespecified subgroups (baseline age, sex, race/ethnicity, baseline BMI). In addition, there was no difference in the prevalence of diabetic retinopathy between those exposed to metformin and those not exposed to metformin, regardless of treatment group assignment. CONCLUSIONS Interventions that delay or prevent the onset of type 2 diabetes in overweight/ obese subjects with dysglycemia who are at risk for diabetes do not reduce the development of diabetic retinopathy for up to 20 years.

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