1. Modification risk factors classification a. Non modification : genetic , sex and diabetes duration.
b. Modification : blood glucose, blood pressure and lipid. c. Additional : artery diseases, gravida, nephropathy and smoking
2. Consistenst risk factors classification a. duration, hyperglycemic HbA1c , hypertension, hyperlipidemia,
gravida and nephropathy b. obesitas , smoking , alcohol, and physic inactivity
3. Three Major risk factor a . Diabetes duration , HbA1c and blood pressure
three major modifiable risk factors —hyperglycemia, hypertension,
and dyslipidemia —on the risk of all DR Joanne
Pedoman Penangganan Reinopati Doabetika 2013 Gitalisa A. Retina 2014
Joanne W : Global Prevalensi and Major Risk Factors DR, Mar 2012
Risk Factors
There are two type risk factors
Consistent risk factors : duration, hyperglycemic HbA1c , hypertension, hyperlipidemia,
gravida and nephropathy
Less consistent risk factors : obesitas , smoking , alcohol, and physic inactivity
three major risk factors for DR —diabetes duration
17 ,
19 ,
28 , HbA
1c
17 ,
28 –
32 , and blood pressure
17 ,
28 ,
33 Joanne Globa
lHyperglycemia, hypertension, hyperlipidemia, and renal disease are considerable risk factors. Obesity, smoking, alcohol consumption, and physical inactivity are also important risk factors, though
considered less consistent. Pregnant women with diabetes are a higher risk for developing DR. April 13, 2011
American
Gitalisa Andayani dr : RETINA JEC Penanganan Terkini Retinopati Diabetika; 2011
American
1. Glygemia
Poor glygemic control HbA1c strongly associated with DR
Diabetic Control and Complication Trial DCCT Study with intensif teraphy reducing HbA1c from 9,1 to 7,3 for 6.5 years
significant reduce DR increasing 3 step at ETDRS
UK Prospectif Diabetes Study UKPDS follow up for 10 years reducing HbA1c from 7,9 to 7.0 reducing microvascular risk
25
WESDR report that with mean HbA1c level over 12 were 3,2 times more likely to have retinopathy after 4 years than subject
with HbA1c level under 12.
• Joanne WY : Global Prevalence and Major Risk Factor of DR , Diabetic Care 35, 2012 • Pedoman Penangganan Retinopati Diabetika, 2013
• Guidelines for the Management of Diabetic retinopathy, Cmwealth of Australia 2008
2. Blood pressure
Fenofibrate, however, acts mostly on triglycerides, and its effects on retinopathy in those trials were independent of lipid levels achieved.
Statins, however, did not affect DR severity in the few studies
UKPDS showed reducing BP from average 154 to 144 mmHg follow up 4,5 years reducing microaneurysm, excudat and cotton wool spot
f.u. until 7,5 years . Tight control of blood pressure resulted in 34 reduced in progression of retinopathy with 47 reduced risk in
detorioration in visual acuity of three lines
ACCORD Eye control BP intensively lower than 120 mmHg from 140 mmHg, but fail to reducing improvement DR.
EURODIABEUCLID Study, a 50 reduction in the progression of DR over 2 years was observed in normotensive persons taking lisinopril,
ACE inhibitor .
American
• Joanne WY : Global Prevalence and Major Risk Factor of DR , Diabetic Care 35, 2012 • Pedoman Penangganan Retinopati Diabetika , 2013
• Ramandeep Sing et all : Diabetic Retinopathy An Update , Indian J.O 2008 May-Jul • Guidelines of the Management of Diabetic Retinopathy, Cwealth.Australia 2008
Fenofibrate, a lipid-altering agent, may slow the development and progression of DR
34 . Fenofibrate, however, acts mostly on
triglycerides, and its effects on retinopathy in those trials were independent of lipid levels achieved.
ETDRS has reported a positive correlation between serum lipids and risk of retinal hard exudates in type 2 DM. Gupta et all reported
reduction in edema, severity of hard exudates and subfoveal lipid migration and dislipidemia, using a lipid lowering drug atorvastatin,
as an adjuvanct to macular photocoagulantion.
Randomised controlled trials suggest that lipid-lowering therapy with statins or fibrates could be useful in managing DR and as an adjunct
to laser treatment for maculopathy. Target LDL cholesterol 2.5 mmoll and triglycerides 2.0 mmoll.
• Joanne WY : Global Prevalence and Major Risk Factor of DR , Diabetic Care 35, 2012 • Ramandeep Sing et all : Diabetic Retinopathy An Update , Indian J.O 2008 May-Jul
• Guidelines of the Management of Diabetic Retionopathy, Cwealth Australia 2008
American
4. Smoking
