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This article is from the NEJM Journal Watch
Do Glucose-Lowering Interventions Prevent Retinopathy in Patients with Prediabetes?
Whether hypoglycemic measures can prevent retinopathy in patients with prediabetes
Review by Allan S.
In a long-term study with certain limitations, the answer was "no
.
"
In the randomized trial DPP (Diabetes Prevention Program), overweight (body mass index ≥24 kg/m2) adults in prediabetes received intensive lifestyle interventions, metformin or placebo (NEJM JW Gen Med Mar 15 2002 and N Engl J Med 2002; 346:393)
。
Two active intervention groups were less likely to meet blood glucose standards in diabetic patients at 3 years than controls, but the question of greatest concern was whether this laboratory outcome could ultimately translate into better long-term clinical outcomes
.
To answer this question, DPP researchers initiated long-term follow-up studies (DPP outcome studies
).
In the study, investigators continued to provide metformin to patients in the initial metformin group and intensive counseling
to patients in the initial lifestyle intervention group.
Retinal photographs are taken every 5 years to assess the occurrence of diabetic retinopathy
.
During the up to 20-year follow-up period, the prevalence of diabetic retinopathy was similar
in the 3 groups initially randomly assigned.
In addition, patients who continued to take metformin and those who did not take metformin had similar
prevalence of retinopathy during follow-up.
In a further recent analysis of the study, the 20-year mortality rate of patients initially assigned to the metformin or enhanced lifestyle intervention group was no lower than that of the control group (NEJM JW Gen Med Feb 1 2022 and Diabetes Care 2021; 44:2775)
。
This time, we obtained a negative result
in the microvascular outcome (retinopathy).
Follow-up studies after the end of the randomized trial phase are bound to be somewhat confusing; The authors conclude: "Whether interventions to lower blood glucose in prediabetes can alter the course of long-term complications need to be further studied
.
"
”
Commented on the article
White NH et al.
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NEJM Journal Watch, published by NEJM Group, invites internationally renowned physicians to review important papers in the field of medicine and help physicians understand and apply the latest advances.