1. DIABETIC STUDIES
DR SATYABRATA TRIPATHY ( 1ST YEAR DOMS)
DHIR HOSPITAL & POST GRADUATE EDUCATION OF OPHTHALMOLOGY
MODERATOR – DR PUSHKAR DHIR
2. • TYPE 1
• Cause :
HLA DQ2 , DR3 ,DR4
etc.
• Beta cell mass
decrease
TYPE 2
• Polygenetic
• Insulin resistance
GESTATIONAL DM
24 to 28 weeks in
pregnancy.
Cause - HPL
OTHERS
MODY
MODY is caused by a
mutation (or change) in a
single gene. If a parent has
this gene mutation, any
child they have, has a 50
per cent chance of
inheriting it from them. If
a child inherit the
mutation they will
generally develop MODY
before they’re 25.
TYPE1.5 DM ( LADA)
Variant of IDM
ANTI GAD , ANTI ISLET
CELL ANTIBODY
3.
4. WESDR( Wisconsin Epidemiological Study of Diabetic Retinopathy)
1979
Purpose Prevalance ,incidence and progression of diabetic retinopathy
along with vision loss
Inclusion criteria <30 yr age patient known diabetic , at 30 yr or older
Result 71 % of patient younger onset group has retinopathy
Older group : 50% had retinopathy , 5% CSME
Conclusion Frequency and severity of retinopathy increased with inc in
duration of diabetes
5.
6. Diabetes Control and Complications Trial
(DCCT)
• Type of study:(1983–1989) Randomized controlled clinical
trial.
• Participant : 1,441 subjects with T1DM ( age group 13-39 yrs)
, 726 primary prevention with no retinopathy at base line ,
715 patient with mild retinopathy at base line
• Settings: 29 international centers
• Aim : To asses the effect of tight glycemic control on
complication of diabetes ( neuropathy , nephropathy)for
person with type 1 DM
• Intensive therapy: >3 insulin injections/day, or use of an insulin
pump Goal pre-prandial blood glucose 70-120; goal post-prandial
<180 Goal A1c <6.05% . Conventional therapy :1-2 daily insulin
injections Adjustments to insulin only to avoid hypo/hyperglycemia
or ketonuria
Inclusion criteria Exclusion criteria
13-39 yrs Hypertension
Primary prevention
prevention group
T1 DM 1-5 yrs
Hyperlipidaemia
No retinopathy Severe diabetic
complication
Urinary albumin
<40 mg/24hrs
Secondary
prevention group
T1DM 1-15 yrs
Mild to moderate
NPDR & urinary
albuminuria <200
mg /24hrs
8. UKPDS(UK PROSPECTIVE DIABETES STUDY)
UKPDS was designed and run by the late Professor Robert Turner and prof Rurry Holman , in 1997
Design
• Randomized control trail, multi centre trial of glycemic therapies
Participant
5,102 patients with newly
diagnosed type 2 diabetes 3867 , 1148 hypertensive type 2 diabetics , it ran 20 yrs , in 23 centers in UK
Aim
• Tight control of blood glucose and blood pressure in reducing progression of diabetic retinopathy
(microvasculopathy)
Intervention
• Conventional therapy : goal “ asymptomatic DM” RBS < 270 mg /dl with diet modification. If further hyperglycemia
occurred , would be secondarily randomized to SU or Insulin
• Intensive therapy: with insulin or sulfonylurea with goal FBS < 110 mg /dl
• HTN control: by B blocker & ACE inhibitor
9. RESULT
• Sulfonylurea or insulin therapy, reduced the risk of any diabetes-related end organ damage by 12% and
microvascular disease by 25% &16% reduced risk of myocardial infarction .
• Hypertensive patients, improving blood pressure (142/82 mmHg versus 154/87 mmHg over median 8.4
years)
• HbA1c 7.0 % v/s 7.9 % over median 10years
• Increased risk of hypoglycemia in the intensive therapy ( especially in insulin subgroup).
10. DRS STUDY
1971
Purpose 1.To determine whether laser photocoagulation helps to
prevent severe visual loss from PDR
2.To determine whether a difference exists in the efficacy and
safety of argon versus xenon photocoagulation for PDR
Inclusion
criteria
BCVA of 20/100 or better in each eye and presence of PDR in
atleast one eye or severe NPDR in both eyes
Result Photocoagulation reduced risk of visual loss by 50% compared with
no treatment
Severe vision loss (5 year rate) reduced from 50% without
treatment to 20% with treatment
Conclusion Xenon resulted in more harmful effects than argon laser
High risk PDR should receive prompt PRP
11. ETDRS STUDY
1979
Purpose Determine the best time to initiate PRP in DR,efficacy
of photocoagulation in DME .Effectiveness of aspirin in
DR
Inclusion
criteria
Pt. with moderate to severe NPDR or mild PDR in both
eyes and VA of 20/40 or better ( 20/200 or better if
macular edema was present )
Result Aspirin had no effect in DR
Focal laser is useful in CSME
Patients with severe NPDR to early PDR , the benefit
of treatment is greater in those who have type 2
diabetes and older than 40 years of age
12. DRVS ( DIABETIC RETINOPATHY VITRECTOMY STUDY )
1976
Purpose Early vitrectomy vs conventional management for recent severe vitreous
hemmorhage
Inclusion criteria At least one eye with recent severe vit hemorrhage and VA of 5/200 or less ,
extensive active neovascular or fibrovascular proliferations
Result Early vitrectomy provided a greater chance of prompt recovery of VA especially in
type 1 diabetics with poor VA in fellow eye, those with both fibrous &
proliferations with at least moderately severe neovascularisation , in which
extensive scatter photocoagulation has been carried out
13. 2007
Purpose Efficacy & safety of intravit RBZ in DME
Inclusion criteria Adults, Type 1 & 2 DM >300 micron CFT , BCVA of ETDRS 73-39 letters
Result RBZ is effective in improving BCVA & well tolerated in DME
RESOLVE ( SAFETY & EFFICACY OF RANIBIZUMAB IN DIABETIC MACULAR
EDEMA )
14. 2007
Purpose Superiority of RBZ 0.5 mg monotherapy or combined with laser over laser alone
in DME
Inclusion criteria Adults, Type 1 & 2 DM & visual impairment due to DME
Result RBZ monotherapy & combined with laser provided superior VA over laser in
patients with DME
RESTORE( RBZ MONOTHERAPY OR COMBINED WITH LASER VS LASR
MONOTHERAPY FOR DIABETIC MACULAR EDEMA )
15. 2007
Purpose Efficacy & safety of intravit RBZ in DME
Inclusion criteria Adults with DME with CFT >275 MICRONS , BCVA of 20/40
Result RBZ rapidly & sustainably improved vision , reduced the risk of further vision loss
, improved macular edema in DME with low rate of ocular harm
• RIDE & RISE ( A STUDY OF RANIBIZUMAB INJECTION IN SUBJECT WITH CLINICALLY SIGNIFICANT MACULAR
EDEMA WITH CENTER INVOLVEMENT SECONDARY TO DM)
16. 2006
Purpose Compare RBZ with focal /grid laser or combination of both DME
Inclusion criteria DME with CFT >250MICRON , VA <20/40
Result At 6 months , RBZ inj had a better visual outcome than focal / grid laser RBZ
provided benefit in DME for at least ,2 yrs combination even more beneficial in
clearing the amount of residual edema & reducing the frequency of injection
needed
• READ 2 (RANIBIZUMAB FOR EDEMA OF THE MACULA ) IT IS PHASE 2 STUDY
17. • DRCR NET( DIABETIC RETINOPATHY CLINICAL
RESEARCH NETWORK)
18. • DRCR NET( DIABETIC RETINOPATHY CLINICAL RESEARCH NETWORK)
Multicenter clinical research of diabetic retinopathy, diabetic macular edema & associated with conditions ,Formulated in sep 2002
&Funded by national eye institute
19. References
AMERICAN ACADEMY OF OPTHALMOLOGY
UNIVERSITY OF OXFORD DEPT OF MED : https://www.rdm.ox.ac.uk/about/our-clinical-facilities-and-
mrc-units/DTU/completed-trials/ukpds
https://dtc.ucsf.edu/types-of-diabetes/type1/what-trial-research-shows/diabetes-control-and-
complications-trial-dcct/
