Effects of Medical Therapies on Retinopathy Progression in Type 2 Diabetes.

被引：940

作者：

Chew, Emily Y. ^{[1
]}

Ambrosius, Walter T. ^{[2
]}

Davis, Matthew D. ^{[3
]}

Danis, Ronald P. ^{[3
]}

Gangaputra, Sapna ^{[3
]}

Greven, Craig M. ^{[2
]}

Hubbard, Larry ^{[3
]}

Esser, Barbara A. ^{[3
]}

Lovato, James F. ^{[2
]}

Perdue, Letitia H. ^{[2
]}

Goff, David C., Jr. ^{[2
]}

Cushman, William C. ^{[4
]}

Ginsberg, Henry N. ^{[5
]}

Elam, Marshall B. ^{[4
]}

Genuth, Saul ^{[6
]}

Gerstein, Hertzel C. ^{[7
]}

Schubart, Ulrich ^{[8
]}

Fine, Lawrence J. ^{[9
]}

机构：

[1] NEI, NIH, Clin Res Ctr, Bethesda, MD 20892 USA

[2] Wake Forest Univ, Sch Med, Winston Salem, NC 27109 USA

[3] Univ Wisconsin, Madison, WI 53706 USA

[4] Vet Affairs Med Ctr, Memphis, TN USA

[5] Columbia Univ Coll Phys & Surg, New York, NY 10032 USA

[6] Case Western Reserve Univ, Cleveland, OH 44106 USA

[7] McMaster Univ, Hamilton, ON, Canada

[8] Albert Einstein Coll Med, Bronx, NY 10467 USA

[9] NHLBI, NIH, Bethesda, MD 20892 USA

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2010年 / 363卷 / 03期

基金：

美国国家卫生研究院;

关键词：

MICROVASCULAR COMPLICATIONS; TRIAL; RISK;

D O I：

10.1056/NEJMoa1001288

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: We investigated whether intensive glycemic control, combination therapy for dyslipidemia, and intensive blood-pressure control would limit the progression of diabetic retinopathy in persons with type 2 diabetes. Previous data suggest that these systemic factors may be important in the development and progression of diabetic retinopathy. Methods: In a randomized trial, we enrolled 10,251 participants with type 2 diabetes who were at high risk for cardiovascular disease to receive either intensive or standard treatment for glycemia (target glycated hemoglobin level, <6.0% or 7.0 to 7.9%, respectively) and also for dyslipidemia (160 mg daily of fenofibrate plus simvastatin or placebo plus simvastatin) or for systolic blood-pressure control (target, <120 or <140 mm Hg). A subgroup of 2856 participants was evaluated for the effects of these interventions at 4 years on the progression of diabetic retinopathy by 3 or more steps on the Early Treatment Diabetic Retinopathy Study Severity Scale (as assessed from seven-field stereoscopic fundus photographs, with 17 possible steps and a higher number of steps indicating greater severity) or the development of diabetic retinopathy necessitating laser photocoagulation or vitrectomy. Results: At 4 years, the rates of progression of diabetic retinopathy were 7.3% with intensive glycemia treatment, versus 10.4% with standard therapy (adjusted odds ratio, 0.67; 95% confidence interval [CI], 0.51 to 0.87; P=0.003); 6.5% with fenofibrate for intensive dyslipidemia therapy, versus 10.2% with placebo (adjusted odds ratio, 0.60; 95% CI, 0.42 to 0.87; P=0.006); and 10.4% with intensive blood-pressure therapy, versus 8.8% with standard therapy (adjusted odds ratio, 1.23; 95% CI, 0.84 to 1.79; P=0.29). Conclusions: Intensive glycemic control and intensive combination treatment of dyslipidemia, but not intensive blood-pressure control, reduced the rate of progression of diabetic retinopathy. (Funded by the National Heart, Lung, and Blood Institute and others; ClinicalTrials.gov numbers, NCT00000620 for the ACCORD study and NCT00542178 for the ACCORD Eye study.) N Engl J Med 2010;363:233-44.

引用

页码：233 / 244

页数：12

共 27 条

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