Volume 2015 Supplement 1

Abstracts from the 8th APPES Biennial Scientific Meeting

Open Access

Prevention of retinopathy in type 1 diabetes: a systematic review and meta-analysis

  • Sohaib Virk1, 2,
  • Kim Donaghue1, 3,
  • Tien Wong4 and
  • Maria Craig1, 2, 3
International Journal of Pediatric Endocrinology20152015(Suppl 1):O47

DOI: 10.1186/1687-9856-2015-S1-O47

Published: 28 April 2015

Diabetic retinopathy (DR) is the most serious ocular complication of type 1 diabetes (T1D) and leading cause of acquired blindness in working aged adults. Although various interventions have been trialled to prevent the development or progression of DR, the evidence to support many of these remains unclear. We systematically reviewed the evidence for primary and secondary interventions, to guide the management of DR in people with T1D.

Systematic searches were performed using MEDLINE, EMBASE and CENTRAL databases (from January 1990 to June 2014) to identify randomised controlled trials and controlled cohort studies reporting the incidence or progression of DR following administration of systemic interventions. English-language studies with a minimum follow-up of one year were eligible. Meta-analyses of extracted data were performed to determine pooled relative risk (RR) reduction.

Twenty-three studies met the inclusion criteria. Intensive insulin therapy significantly reduced the risk of both incident DR (RR 0.44, 95% CI 0.22-0.86, p=0.02) and progression of DR (RR 0.55, 0.31-0.97, p=0.04) compared with conventional therapy. Continuous subcutaneous insulin infusion (CSII) pumps provided significantly greater protection than multiple daily injection therapy (RR 0.33, 95% CI 0.19-0.57, p<0.0001). Angiotensin-converting enzyme inhibition had no impact on DR incidence but reduced progression (RR 0.57, 95% CI 0.34-0.94, p=0.03). Conversely, angiotensin receptor blockade was effective in decreasing DR incidence (RR 0.65, 95% CI 0.49-0.85, p=0.002) but had non-significant effect on progression. Both pancreas-alone and combined pancreas-kidney transplantation retarded progression of DR (RR 0.20, 95% CI 0.10-0.41, p<0.0001). Islet cell transplantation provided no benefit compared with either intensive or conventional insulin therapy.

In people with T1D, there is strong evidence supporting intensive insulin therapy for prevention of DR. Anti-hypertensives also provide protection against DR in normotensive, normoalbuminuric adults but their effectiveness in other populations is yet to be investigated. In patients with T1D of longer duration, pancreas transplantation slows progression of DR. There is insufficient evidence to recommend the use of anti-lipid therapy or other medical interventions.

Authors’ Affiliations

(1)
The Children’s Hospital at Westmead
(2)
University of New South Wales
(3)
University of Sydney
(4)
Singapore Eye Research Institute

Copyright

© Virk et al; licensee BioMed Central Ltd. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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