Metabolic control in diabetic retinopathy

Diabetic retinopathy can be difficult to diagnose, as many symptoms resemble age-related degeneration, however, there are specific signs that people with diabetes and their caregivers should watch out for.

Vision problems are a common side effect of aging, but if you are someone with diabetes, it can signal other problems. One of the lesser-known complications of diabetes is diabetic retinopathy (DR) – a catch-all term for all retinal disorders caused by diabetes. Left unchecked, DR can lead to permanent vision loss1.

Diabetic retinopathy can be difficult to diagnose, as many symptoms resemble age-related degeneration, however, there are specific signs that people with diabetes and their caregivers should watch out for. If you or your loved ones suffer from it, it’s time to consult a doctor1.

However, once you are diagnosed with DR, there is a lot you can do to prevent the disease from progressing. Looking at the body as a whole, there are different systems that interact with each other. What happens in your kidneys is important to what happens with your retina, even if you don’t see the connection. Over the years, research around DR has shown several links between disease progression and hypertension, hypercholesterolemia, diabetic kidney failure, hyperglycemia, vitamin and mineral deficiencies, and even exercise.2.

Control sugar fluctuations

Controlling sugar fluctuations is something you do anyway, as a person with diabetes. The good news is that it helps reduce both the risk of developing DR and its progression. Even a 1% decrease in HbA1c is linked to a 35% reduction in the risk of developing DR, 15-25% reduction in disease progression, 25% reduction in visual acuity loss and 15% development of blindness3.

The NHS UK recommends checking sugar levels several times a day as levels can vary. If you check your blood sugar at home, it should be 4-7 mmol/L. As someone with diabetes, your average blood sugar, or HbA1c, should be around 48 mmol/mol or 6.5%4.

Blood pressure control

If you have diabetes, the NHS recommends that you aim for blood pressure readings of no more than 140/80 mmHg, or less than 130/80 mmHg if you have diabetes complications, such as eye damage.4. A comparison of patients with a BP of 180/100 mmHg and those with a BP of 150/85 mmHg showed a 33% decrease in DR progression and a 50% reduction in vision loss in the second band3.

Control blood lipids

When we say “lipids” we generally include cholesterol, lipoproteins, chylomicrons, VLDL, LDL, apolipoproteins and HDL.3. The NHS recommends a healthy total cholesterol level below 4 mmol/l4.

High serum lipid levels are linked to a specific risk of a complication of DR known as “hard exudates”. Reducing elevated serum lipid levels has been shown to decrease the risk of hard exudates in people with diabetic retinopathy5. So even if your serum lipids are high right now, you can improve your vision by taking corrective action today.

Obesity, physical activity and DR

It is common knowledge that obesity and diabetes can go hand in hand. Now science backs it up. In people with type 2 diabetes, meta-analysis shows obesity increases incidence of DR3.

The good news is that increasing physical activity reduces the risk of developing DR! Not only are higher levels of physical activity independently associated with a lower incidence of DR in people with type 2 diabetes, but the risk of DR progression may be reduced by 40% when physical activity lasts at least 30 minutes five days a week3.

Proven diets and foods that help with DR

For those who want to fight DR by improving their diet, the options are many. Although we all try to get a good mix of fruits, vegetables, dairy products, grains and other food groups, there are particular diets and certain foods that have been shown to be more effective in combating DR and other chronic diseases.

  1. One study found that the Mediterranean diet enriched with extra virgin olive oil or walnuts along with a low-fat diet was associated with a more than 40% reduction in the risk of retinopathy!3
  2. Eating oily fish at least twice a week was associated with an almost 60% reduction in the risk of retinopathy3.
  3. Many vegetables, fruits, and seeds contain minerals, polyphenols, and other phytochemicals that reduce oxidative stress, inflammation, and insulin resistance. Indeed, a high consumption of fruits and vegetables rich in flavonoids is linked to a lower risk of diabetic retinopathy.3.

Vitamin and mineral deficiencies

We all try to eat well. Between the daily stress of cooking and ordering, the quality of the products available in our cities and our likes and dislikes for certain foods, small deficiencies can infiltrate. Regular blood tests and visits to the doctor can help you overcome these deficiencies and preserve not just your vision, but several other organ systems in the body.

Vitamin B1 (thiamin):Thiamine supplementation in high doses (50–100 mg/day) is safe and useful for neuroprotection, treatment, and prevention of target organ damage, including DR and diabetic nephropathy3.

Vitamin D: Maintaining an optimal level of vitamin D plays a vital role in reducing the risk and severity of DR. In addition, it helps the proper functioning of the pancreas and helps fight against atherosclerosis, cardiovascular disease, type 2 diabetes and hypertension.3.

Vitamin E: In a 10-year study of people with type 1 diabetes, vitamin E supplementation at a dose of 1800 IU daily improved blood flow to the retina. It also reduced oxidative stress, which is high in DR3.

Zinc: Zinc deficiency is linked to the progression of chronic diseases such as metabolic syndrome, diabetes, diabetic microvascular complications and DR3.

The Most Powerful Defense Against Vision Loss: Regular Testing

The journey to good health, especially when it comes to diabetes and DR, starts with the right diagnosis. Often, diabetes leads to complications that seem to have nothing to do with insulin or high blood sugar. Indeed, diabetes affects the functioning of several organ systems in the body; therefore understanding what is wrong is the first step to taking corrective action.

As the symptoms of DR only become noticeable once the disease is advanced, it is important to carry out preventive and regular screening for DR. Based on an analysis of 35 studies conducted between 1980 and 2008 worldwide, the overall prevalence of DR in people with diabetes using retinal images has been estimated at 35%, with vision-threatening DR present in 12% of cases.6. In India, the number of people with diabetes is expected to reach 134 million by 2045sevenmaking DR an important public health challenge.

However, once DR is detected, you and your doctor can chart a clear course for you to manage your health and prevent further damage to your vision. All it takes is realizing that DR exists and needs to be tested on a regular basis1.

This is the reason why Network18 has launched “Netra Suraksha” – India Against Diabetes initiative, in association with Novartis, in 2021. During the first season, the initiative brought together the best minds of the medicine, policy development and think tanks to raise awareness about DR. This year, the initiative is taking a huge step forward by foraying into in-person health camps across the country.

You can find knowledge articles, how-to videos, and panel discussions from Season 1 on the Netra Suraksha website, as well as the latest information on when and where Health Camps are taking place. Partner with us to spread the word to others with diabetes and to arm yourself with knowledge.

Remember that vision loss due to DR can be stopped short. As with anything related to your health, make all changes to your diet, exercise regimen, and lifestyle in consultation with your doctor. Slowly but surely, we are succeeding!

References:

  • Diabetic retinopathy. Available [online] at URL: https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/diabetic-retinopathy. Accessed August 3, 2022.
  • Saini DC, Kochar A, Poonia R. Clinical correlation of diabetic retinopathy with nephropathy and neuropathy. Indian J Ophthalmol 2021;69:3364-8.
  • Bryl A, Mrugacz M, Falkowski M, Zorena K. The effect of diet and lifestyle on the course of diabetic retinopathy – A review of the literature. Nutrients. 2022 Mar 16;14(6):1252.
  • Prevention of diabetic retinopathy. Available [online] at URL: https://www.nhs.uk/conditions/diabetic-retinopathy/prevention/. Accessed August 3, 2022.
  • Chew EY, Klein ML, Ferris FL, et al. Association of elevated serum lipid levels with retinal hard exudate in diabetic retinopathy: report of the early treatment of diabetic retinopathy study (ETDRS) 22. Arch Ophthalmol.1996;114(9):1079–1084.
  • Yau JW, et al. Eye Disease Meta-Analysis Study Group (META-EYE). Worldwide prevalence and major risk factors for diabetic retinopathy. Diabetic treatments. 2012 Mar;35(3):556-64.
  • Nanditha A, et al. SECURE TRENDS IN DIABETES IN INDIA (STRiDE–I): 10-year prevalence trends among urban and rural populations in Tamil Nadu.Diabetes Care 2019;42:476–485

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