Skip to main content
Erschienen in: Spektrum der Augenheilkunde 3/2016

01.06.2016 | original article

Statins and fibrates as the treatment of nonproliferative diabetic retinopathy in type 2 diabetes mellitus

verfasst von: Yevgeniya Ilyina, Pavlo Bezditko, Ajaj Samer Mohamed, Olesya Zavoloka, Darya Zubkova

Erschienen in: Spektrum der Augenheilkunde | Ausgabe 3/2016

Einloggen, um Zugang zu erhalten

Summary

Background

Diabetic retinopathy is the result of microvascular retinal changes. Hyperglycemia-induced intramural pericyte death and thickening of the basement membrane lead to incompetence of the vascular walls. The purpose was to improve medication for nonproliferative diabetic retinopathy in patients with type 2 diabetes mellitus using statins and fibrates.

Methods

A total of 47 patients (94 eyes) with nonproliferative diabetic retinopathy (moderate stage) in type 2 diabetes mellitus took part in the research. All patients received standard treatment using angioprotectors and antioxidants. Additionally, correctors of dyslipidemia were prescribed – statins (atorvastatin 20 mg per a day) and fibrates (lipofen 250 mg per a day) – to 21 of the patients. The quantity of microaneurysms, hemorrhages, hard and soft exudates, areas of macular edema were determined by perimetry, optical coherence tomography (OCT), and fluorescein angiography (FA). The patients were observed for 1 year.

Results

After using statins and fibrates, macular disease (MD) decreased from −3.5 to −4.5 dB, and in the control group (without using correctors of dyslipidemia) it increased from −3.7 to −8.1 dB (p < 0.01). The quantity of local defects in visual fields in both research groups increased from 11.9 to 16.5 points, but increased significantly in the control group from 12.3 to 20.6 points (p < 0.01) compared with the treated group. On FA and OCT there were more intraretinal hemorrhages and hard exudates in control patients than in the research group.

Conclusions

Correctors of dyslipidemia are useful for patients with nonproliferative diabetic retinopathy in type 2 diabetes mellitus. The treatment slows down the progression of diabetic retinopathy.
Literatur
1.
Zurück zum Zitat Feld S, Hellman R, Dickey R. Consensus development conference on insulin resistance american diabetes association. Diabetes Care. 2012;21:310–2. Feld S, Hellman R, Dickey R. Consensus development conference on insulin resistance american diabetes association. Diabetes Care. 2012;21:310–2.
2.
Zurück zum Zitat Zimmet P, Alberti K, Shaw J. Global and social implications of the diabetic epidemic. Nature. 2009;414:782–7.CrossRef Zimmet P, Alberti K, Shaw J. Global and social implications of the diabetic epidemic. Nature. 2009;414:782–7.CrossRef
3.
Zurück zum Zitat Klein RB, Klein EK, Moss SE, Cruikshank KJ. The Wisconsin epidemiological study of diabetic retinopathy: XVII. The 14 year incidence and progression of diabetic retinopathy and associated risk factors. Ophthalmology. 2008;105:1801–5.CrossRef Klein RB, Klein EK, Moss SE, Cruikshank KJ. The Wisconsin epidemiological study of diabetic retinopathy: XVII. The 14 year incidence and progression of diabetic retinopathy and associated risk factors. Ophthalmology. 2008;105:1801–5.CrossRef
4.
Zurück zum Zitat lawn A, King H. Diabetes in the eastern Mediterranean (Middle East) region: The world health organization responds to a major public health challenge. Diabet Med. 2005;12:1057–8. lawn A, King H. Diabetes in the eastern Mediterranean (Middle East) region: The world health organization responds to a major public health challenge. Diabet Med. 2005;12:1057–8.
5.
Zurück zum Zitat WHO/IDF Europe. Diabetes care and research in Europe: The St.Vincent Declaration. Diabet Med. 1999;7:360. WHO/IDF Europe. Diabetes care and research in Europe: The St.Vincent Declaration. Diabet Med. 1999;7:360.
6.
Zurück zum Zitat Bresnick GH. Diabetic retinopathy. In: Principles and practice of ophthalmology, II edn. Philadelphia: WB Saunders; 2009. pp. 1205–76. Bresnick GH. Diabetic retinopathy. In: Principles and practice of ophthalmology, II edn. Philadelphia: WB Saunders; 2009. pp. 1205–76.
7.
Zurück zum Zitat Narendran V, John RK, Raghuram A. Diabetic retinopathy among self reported diabetics in southern India: a population based assessment. Br J Ophthalmol. 2010;86:1014–8.CrossRef Narendran V, John RK, Raghuram A. Diabetic retinopathy among self reported diabetics in southern India: a population based assessment. Br J Ophthalmol. 2010;86:1014–8.CrossRef
8.
Zurück zum Zitat Kohner EM. Diabetic retinopathy. Br Med Bull. 1989;5:148–73. Kohner EM. Diabetic retinopathy. Br Med Bull. 1989;5:148–73.
9.
Zurück zum Zitat Karamanus B, Porta M, Songini M, Metelko Z. Different risk factors of microangiopathy in patients with type2 diabetes mellitus of short versus long duration. Diabetologia. 2010;43:348–55.CrossRef Karamanus B, Porta M, Songini M, Metelko Z. Different risk factors of microangiopathy in patients with type2 diabetes mellitus of short versus long duration. Diabetologia. 2010;43:348–55.CrossRef
10.
Zurück zum Zitat Roy MS, Klein R, O’Colmain BJ. The prevalence of diabetic retinopathy among adult type 2 diabetic persons in the United States. Arch Ophthalmol. 2004;122(4):546–51.CrossRefPubMed Roy MS, Klein R, O’Colmain BJ. The prevalence of diabetic retinopathy among adult type 2 diabetic persons in the United States. Arch Ophthalmol. 2004;122(4):546–51.CrossRefPubMed
11.
Zurück zum Zitat Brown MM, Brown GC, Sharma S. Utility values and diabetic retinopathy. Am J Ophthalmol. 2009;128:324–30.CrossRef Brown MM, Brown GC, Sharma S. Utility values and diabetic retinopathy. Am J Ophthalmol. 2009;128:324–30.CrossRef
12.
Zurück zum Zitat Segato T, Midena E, Grigoletto F, Veneto Group for Diabetic Retinopathy. The epidemiology and prevalence of diabetic retinopathy in the Veneto region of north east Italy. Diabet Med. 2010;8:511–6. Segato T, Midena E, Grigoletto F, Veneto Group for Diabetic Retinopathy. The epidemiology and prevalence of diabetic retinopathy in the Veneto region of north east Italy. Diabet Med. 2010;8:511–6.
13.
Zurück zum Zitat Davis MD, Fisher MR, Gangnon RE. Risk factors for highrisk proliferative diabetic retinopathy and severe visual loss: Early treatment diabetic retinopathy study report. Invest Ophthalmol Vis Sci. 2008;39:233–52. Davis MD, Fisher MR, Gangnon RE. Risk factors for highrisk proliferative diabetic retinopathy and severe visual loss: Early treatment diabetic retinopathy study report. Invest Ophthalmol Vis Sci. 2008;39:233–52.
14.
Zurück zum Zitat Service FJ, O’Brien PC. Progression of retinopathy in the diabetic control and complications trial. Am J Ophthalmol. 2012;133:436. Service FJ, O’Brien PC. Progression of retinopathy in the diabetic control and complications trial. Am J Ophthalmol. 2012;133:436.
15.
Zurück zum Zitat Keen H, Lee ET, Russell D. The appearance of retinopathy and progression to proliferative retinopathy: the WHO multinational study of vascular disease in diabetes. Diabetologia. 2010;44:22–30.CrossRef Keen H, Lee ET, Russell D. The appearance of retinopathy and progression to proliferative retinopathy: the WHO multinational study of vascular disease in diabetes. Diabetologia. 2010;44:22–30.CrossRef
16.
Zurück zum Zitat JAMA. Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults: executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA. 2010;285:2486–97. JAMA. Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults: executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA. 2010;285:2486–97.
17.
Zurück zum Zitat Howard BV. Pathogenesis of diabetic dyslipidaemia. Diabetes Rev. 2005;3:423–32. Howard BV. Pathogenesis of diabetic dyslipidaemia. Diabetes Rev. 2005;3:423–32.
19.
Zurück zum Zitat Gotto AM. Contemporary diagnosis and management of lipid disorders, handbook of medicinal herbs. Florida: Boca Raton; 2010. Gotto AM. Contemporary diagnosis and management of lipid disorders, handbook of medicinal herbs. Florida: Boca Raton; 2010.
20.
Zurück zum Zitat Manzato E, Zambon A, Lapolla A. Lipoprotein abnormalities in well-treated type II diabetic patients. Diabetes Care. 2008;16:469–75.CrossRef Manzato E, Zambon A, Lapolla A. Lipoprotein abnormalities in well-treated type II diabetic patients. Diabetes Care. 2008;16:469–75.CrossRef
21.
Zurück zum Zitat Vakkilainen J, Steiner G, Ansqner JC. Relationships between lowdensity lipoprotein particle size, plasma lipoproteins, and progression of coronary artery disease: the diabetes atherosclerosis intervention study. Circulation. 2003;107:1733–7.CrossRefPubMed Vakkilainen J, Steiner G, Ansqner JC. Relationships between lowdensity lipoprotein particle size, plasma lipoproteins, and progression of coronary artery disease: the diabetes atherosclerosis intervention study. Circulation. 2003;107:1733–7.CrossRefPubMed
22.
Zurück zum Zitat Williams M, Lacson EJ, Teng M. Extremes of glycemic control (HbA1c) increase hospitalization risk in diabetic hemodialysis patients in the USA. Am J Nephrol. 2009;29:54–61.CrossRefPubMed Williams M, Lacson EJ, Teng M. Extremes of glycemic control (HbA1c) increase hospitalization risk in diabetic hemodialysis patients in the USA. Am J Nephrol. 2009;29:54–61.CrossRefPubMed
23.
Zurück zum Zitat Peacock TP, Shihabi ZK, Bleyer AJ. Comparison of glycated albumin and hemoglobin A (1c) levels in diabetic subjects on hemodialysis. Kidney Int. 2008;73:1062–8.CrossRefPubMed Peacock TP, Shihabi ZK, Bleyer AJ. Comparison of glycated albumin and hemoglobin A (1c) levels in diabetic subjects on hemodialysis. Kidney Int. 2008;73:1062–8.CrossRefPubMed
24.
Zurück zum Zitat Diabetes Prevention Program Research Group. Progress in the prevention of type 2 diabetes mellitus. N Engl J Med. 2009;346:393–403. Diabetes Prevention Program Research Group. Progress in the prevention of type 2 diabetes mellitus. N Engl J Med. 2009;346:393–403.
25.
Zurück zum Zitat Gerstein HC, Miller ME, Byington RP. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2009;358:2545–59. Gerstein HC, Miller ME, Byington RP. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2009;358:2545–59.
26.
Zurück zum Zitat Marion J. Management of dyslipidemia in adults with diabetes. Diabetes Care. 2012;25:74–7. Marion J. Management of dyslipidemia in adults with diabetes. Diabetes Care. 2012;25:74–7.
27.
Zurück zum Zitat Diabetes control and complications trial research group. The effect of intensive treatment of diabetes on the development and progression of longterm complications in diabetes mellitus. N Engl J Med. 2009;329:977–86. Diabetes control and complications trial research group. The effect of intensive treatment of diabetes on the development and progression of longterm complications in diabetes mellitus. N Engl J Med. 2009;329:977–86.
28.
Zurück zum Zitat Jaross N, Ryan P, Newland H. Incidence and progression of diabetic retinopathy in an Aboriginal Australian population: results from the katherine region diabetic retinopathy study (KRDRS). Clin Experiment Ophthalmol. 2005;53:26–33.CrossRef Jaross N, Ryan P, Newland H. Incidence and progression of diabetic retinopathy in an Aboriginal Australian population: results from the katherine region diabetic retinopathy study (KRDRS). Clin Experiment Ophthalmol. 2005;53:26–33.CrossRef
29.
Zurück zum Zitat Ferris FL, Davis MD, Aiello LM. Treatment of diabetic retinopathy. N Engl J Med. 1999;341:667–78.CrossRefPubMed Ferris FL, Davis MD, Aiello LM. Treatment of diabetic retinopathy. N Engl J Med. 1999;341:667–78.CrossRefPubMed
30.
Zurück zum Zitat Study collaborative group. Heart protection study of cholesterol lowering with simvastatin in 20536 highrisk individuals: a randomized placebocontrolled trial heart protection. Lancet. 2009;360:7–22. Study collaborative group. Heart protection study of cholesterol lowering with simvastatin in 20536 highrisk individuals: a randomized placebocontrolled trial heart protection. Lancet. 2009;360:7–22.
31.
Zurück zum Zitat Downs JR, Clearfield M, Weis S. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS study. JAMA. 2011;279:28–35. Downs JR, Clearfield M, Weis S. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS study. JAMA. 2011;279:28–35.
32.
Zurück zum Zitat Pyorala K, Pedersen TR, Kjekshus J. Cholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease. A subgroup analysis of the scandinavian simvastatin survival study. Diabetes Care. 2009;20:614–20.CrossRef Pyorala K, Pedersen TR, Kjekshus J. Cholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease. A subgroup analysis of the scandinavian simvastatin survival study. Diabetes Care. 2009;20:614–20.CrossRef
33.
Zurück zum Zitat Chew EY, Klein ML, Ferris FL. Association of elevated serum lipid levels with retinal hard exudates in diabetic retinopathy. Early treatment diabetic retinopathy study (ETDRS). Arch Ophthalmol. 2006;114:1079–84.CrossRef Chew EY, Klein ML, Ferris FL. Association of elevated serum lipid levels with retinal hard exudates in diabetic retinopathy. Early treatment diabetic retinopathy study (ETDRS). Arch Ophthalmol. 2006;114:1079–84.CrossRef
34.
Zurück zum Zitat Steiner G. Effect of fenofibrate on progression of coronaryartery disease in type 2 diabetes: the diabetes atherosclerosis intervention study, a randomised study. Lancet. 2010;375:905–10. Steiner G. Effect of fenofibrate on progression of coronaryartery disease in type 2 diabetes: the diabetes atherosclerosis intervention study, a randomised study. Lancet. 2010;375:905–10.
35.
Zurück zum Zitat Ryan KE, McCance DR, Powell L. Fenofibrate and pioglitazone improve endothelial function and reduce arterial stiffness in obese glucose tolerant men. Atherosclerosis. 2009;194:123–30.CrossRef Ryan KE, McCance DR, Powell L. Fenofibrate and pioglitazone improve endothelial function and reduce arterial stiffness in obese glucose tolerant men. Atherosclerosis. 2009;194:123–30.CrossRef
36.
Zurück zum Zitat WHO/IDF Europe. Diabetes care and research in europe: The St. Vincent Declaration. Diabet Med. 1990;7:360.CrossRef WHO/IDF Europe. Diabetes care and research in europe: The St. Vincent Declaration. Diabet Med. 1990;7:360.CrossRef
37.
Zurück zum Zitat Standards of Medical Care in Diabetes—2008 American Diabetes Association Diabetes Care 2008 Jan; 31(Supplement 1): S12-S54. Standards of Medical Care in Diabetes—2008 American Diabetes Association Diabetes Care 2008 Jan; 31(Supplement 1): S12-S54.
38.
Zurück zum Zitat Feld S, Hellman R, Dickey R. Consensus development conference on insulin resistance american diabetes association. Diabetes Care. 2012;21:310–2. Feld S, Hellman R, Dickey R. Consensus development conference on insulin resistance american diabetes association. Diabetes Care. 2012;21:310–2.
39.
Zurück zum Zitat Matthews DR. Fenofibrate and statin therapy, compared with placebo and statin, slows the development of retinopathy in type 2 diabetes patients of 10 years duration: the ACCORD study. Evid Based Med. 2011;16(2):45–6.CrossRefPubMed Matthews DR. Fenofibrate and statin therapy, compared with placebo and statin, slows the development of retinopathy in type 2 diabetes patients of 10 years duration: the ACCORD study. Evid Based Med. 2011;16(2):45–6.CrossRefPubMed
40.
Zurück zum Zitat Goldberg RB, Mellies MJ, Sacks FM. Cardiovascular events and their reduction with pravastatin in diabetic and glucose-intolerant myocardial infarction survivors with average cholesterol levels. Subgroup analyses in the cholesterol and recurrent events (CARE) trial. Circulation. 2008;98:2513–9.CrossRef Goldberg RB, Mellies MJ, Sacks FM. Cardiovascular events and their reduction with pravastatin in diabetic and glucose-intolerant myocardial infarction survivors with average cholesterol levels. Subgroup analyses in the cholesterol and recurrent events (CARE) trial. Circulation. 2008;98:2513–9.CrossRef
41.
Zurück zum Zitat Fronzo RA, Ferrannini EE. Insulin resistance, a multifaceted syndrome responsible for NIDDM, obesity, hypertension, dislipidemia and atherosclerotic cardiovascular disease. Diabetes Care. 1991;4(3):173–94.CrossRef Fronzo RA, Ferrannini EE. Insulin resistance, a multifaceted syndrome responsible for NIDDM, obesity, hypertension, dislipidemia and atherosclerotic cardiovascular disease. Diabetes Care. 1991;4(3):173–94.CrossRef
42.
Zurück zum Zitat DAIS Study Group. Effect of fenofibrate on progression of coronary-artery disease in type 2 diabetes: the diabetes atherosclerosis intervention study, a randomised study. Lancet. 2001;357:905–10.CrossRef DAIS Study Group. Effect of fenofibrate on progression of coronary-artery disease in type 2 diabetes: the diabetes atherosclerosis intervention study, a randomised study. Lancet. 2001;357:905–10.CrossRef
43.
Zurück zum Zitat United Kingdom Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes. BMJ. 2008;317:703–13.CrossRef United Kingdom Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes. BMJ. 2008;317:703–13.CrossRef
44.
Zurück zum Zitat Sever PS, Dahlof B, Poulter NR. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average of lower-than-average cholesterol concentrations, in the anglo-scandinavian cardiac outcomes trial – lipid lowering arm (ASCOT-LLA): a multicentre randomized controlled trial. Lancet. 2008;361:365–9. Sever PS, Dahlof B, Poulter NR. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average of lower-than-average cholesterol concentrations, in the anglo-scandinavian cardiac outcomes trial – lipid lowering arm (ASCOT-LLA): a multicentre randomized controlled trial. Lancet. 2008;361:365–9.
45.
Zurück zum Zitat Pyorala K, Pedersen TR, Kjekshus J. Cholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease. A subgroup analysis of the scandinavian simvastatin survival study. Diabetes Care. 2009;20:614–20.CrossRef Pyorala K, Pedersen TR, Kjekshus J. Cholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease. A subgroup analysis of the scandinavian simvastatin survival study. Diabetes Care. 2009;20:614–20.CrossRef
46.
Zurück zum Zitat Rajamani K, Colman P, Li P. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomized controlled trial. Lancet. 2005;366:1849–61.CrossRef Rajamani K, Colman P, Li P. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomized controlled trial. Lancet. 2005;366:1849–61.CrossRef
Metadaten
Titel
Statins and fibrates as the treatment of nonproliferative diabetic retinopathy in type 2 diabetes mellitus
verfasst von
Yevgeniya Ilyina
Pavlo Bezditko
Ajaj Samer Mohamed
Olesya Zavoloka
Darya Zubkova
Publikationsdatum
01.06.2016
Verlag
Springer Vienna
Erschienen in
Spektrum der Augenheilkunde / Ausgabe 3/2016
Print ISSN: 0930-4282
Elektronische ISSN: 1613-7523
DOI
https://doi.org/10.1007/s00717-016-0300-2

Weitere Artikel der Ausgabe 3/2016

Spektrum der Augenheilkunde 3/2016 Zur Ausgabe

DFP-Fortbildung

Sehprothesen

editorial

Editorial