This article originally posted 18 April, 2012 and appeared in Issue 450
Test Your Knowledge Answer #450
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Correct answer: D. Start more intensive glycemic therapy plus antihypertensive therapy
Key Point
Diabetic retinopathy is an important predictor of overall morbidity and mortality in patients who have diabetes and mandates tight blood glucose control.
Retinopathy is well established as an important predictor of all-cause mortality and cardiovascular events. Improving glycemic control and blood pressure, even at levels minimally above normal, leads to improved outcomes. In this patient, the optimal therapy is to both lower blood pressure and improve glycemic control. Studies of type 1 diabetes have clearly shown that tight glycemic control prevents the progression of early stage retinopathy; a similar benefit will likely be obtained in patients who have type 2 diabetes.
Bibliography
Adler AI, Stratton IM, Neil HA, Yudkin JS, Matthews DR, Cull CA, et al. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ. 2000;321:412-9. [PMID: 10938049] [PubMed]
The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med. 1993;329:977-86. [PMID: 8366922] [PubMed]
EURODIAB prospective complications study. Diabetic retinopathy is associated with mortality and cardiovascular disease incidence: the EURODIAB prospective complications study. Diabetes Care. 2005;28:1383-9. [PMID: 15920056] [PubMed]
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