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How to Reduce the Risk of Diabetic Retinopathy 

Feb 4, 2020
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Alayna Marteal Wyre, Pharm. D. Candidate, South College School of Pharmacy

Study examines effect of statins in diabetic retinopathy risk for type 2 diabetes patients. 

According to this new study, over 191 million people across the world will develop diabetic retinopathy by the year 2030. Diabetic retinopathy is the primary cause of blindness in working-age adults and, as unfortunate as it is, one of the leading microvascular complications of today. Statins have demonstrated the ability to decrease the possibility of diabetic retinopathy development in patients with type 2 diabetes. The study will cover the association between statin therapy and the development of diabetic retinopathy in subjects with type 2 diabetes and dyslipidemia. 

This population-based cohort study contains longitudinal evidence that was conducted under senior author Yih-Shiou Hwang, MD, Ph.D., of Chang Gung Memorial Hospital in Taoyuan, Taiwan, and his professional colleagues. Approximately 37,894 Taiwanese subjects participated in this research between January 1, 1998, and December 31, 2013. They were recognized in the National Health Insurance Research Database as having type 2 diabetes and dyslipidemia.  

Within the cohort analysis, outcomes were contrasted between those subjects taking statins and those not taking statins. Measures were observed at all stages of diabetic retinopathy and treatment for vision-threating diabetic retinopathy. No lipid-lowering agent of any kind, except statins, was authorized to be used by subjects during the study. Patients taking statins were detected to have a compelling lower rate of diabetic retinopathy and need for treatments for vision-threatening diabetic retinopathy than those not taking statins.  

The complications and outcomes were characterized as making three or more visits to an outpatient clinic or at least one inpatient diagnosis after the exposure cycle occurred. Safety outcomes included major adverse cardiovascular events, de novo hemodialysis, and diabetic neuropathy, and diabetic foot ulcers. Complications of diabetic retinopathy, including vitreous hemorrhage and tractional retinal detachment, were restricted, and no proliferative diabetic retinopathy and diabetic macular edema were established. Also, the rate and number of interventions for vision-threatening diabetic retinopathy, including retinal laser treatment, intravitreal injection, and vitrectomy were defined in the research. Covariate assessments were made using the same method as for the outcomes. The comorbidities of heart disease, chronic kidney disease, hemodialysis, hypertension, and peripheral arterial disease were incorporated into the study design.  

Statistical analysis was performed from May 1 to 31 with statin therapy exposure ranging at a rate of 80% or more. Patients taking statin demonstrated a lower number of interventions than the others during treatment. 

During the study period, there were 1,648, 305 patients diagnosed with type 2 diabetes. Of that number 219, 359 patients were eligible for analysis over the study period. The reports comprised of 199, 760 patients taking statins and 19 ,599 patients not taking statins. Patients were then evaluated after propensity score matching. Of the group that was taking statins, 18,947 patients, 10,436 were women, and 8,511 were men, with a mean [SD] age of 61.5 [10.8] years. Of the group that was not taking statins, 18 ,947 patients, 10,430 were women, and 8,517 were men with a mean [SD] age of 61.0 [11.0] years. The mean follow-up resulted in 7.6 years for the statin group and 7.3 years for the non-statin group. During the survey period, 2,004 patients in the statin group (10.6%) and 2,269 patients in the group not taking statins (12.0%) developed diabetic retinopathy.  

Patients taking statins had a significantly lower rate of diabetic retinopathy than the patients not taking statins. The patients utilizing statins in this study presented with the findings of a hazard ratio [HR], 0.86; 95% CI, 0.81-0.91), non-proliferative diabetic retinopathy (HR, 0.92; 95% CI, 0.86-0.99), proliferative diabetic retinopathy (HR, 0.64; 95% CI, 0.58-0.70), vitreous hemorrhage (HR, 0.62; 95% CI, 0.54-0.71), tractional retinal detachment (HR, 0.61; 95% CI, 0.47-0.79), and macular edema (HR, 0.60; 95% CI, 0.46-0.79). Not only did the statin group have lower rates of interventions like retinal laser treatment (HR, 0.71; 95% CI, 0.65-0.77), intravitreal injection (HR, 0.74; 95% CI, 0.61-0.89), and vitrectomy (HR, 0.58; 95% CI, 0.48-0.69), there were a smaller number of the interventions. Lower risks of major adverse cardiovascular events (HR, 0.81; 95% CI, 0.77-0.85), new-onset diabetic neuropathy (HR, 0.85; 95% CI, 0.82-0.89), and new-onset diabetic foot ulcers (HR, 0.73; 95% CI, 0.68-0.78) were also associated with patients using statins.  

The authors concluded that statin therapy was associated with a decreased risk of diabetic retinopathy in Taiwanese patients with type 2 diabetes and dyslipidemia. Statin therapy could also aid in the impediment of vision-threatening diabetic retinopathy. The study also suggests that a reduction in intravitreal injection, vitrectomies, and retinal laser treatments are results of statin usage. 

Practice Pearls: 

  • Diabetic retinopathy is the leading cause of blindness in working-age adults.  
  • Statins are associated with a lower prevalence of diabetic retinopathy.  
  • Statins may decrease the progression of diabetic retinopathy in patients with type 2 diabetes and dyslipidemia. 

 

Kang EY, Chen T, Garg SJ, et al. Association of Statin Therapy With Prevention of Vision-Threatening Diabetic Retinopathy. JAMA Ophthalmol.2019;137(4):363–371. doi:10.1001/jamaophthalmol.2018.6399 

Alayna Marteal Wyre, Pharm. D. Candidate, South College School of Pharmacy 

 

 

 

See more about statins and diabetes.