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Review
. 2021 Feb 11;10(4):705.
doi: 10.3390/jcm10040705.

The Safety of Pharmacological and Surgical Treatment of Diabetes in Patients with Diabetic Retinopathy-A Review

Wojciech Matuszewski  1 , Angelika Baranowska-Jurkun  1 , Magdalena Maria Stefanowicz-Rutkowska  1 , Katarzyna Gontarz-Nowak  1 , Ewa Gątarska  2 , Elżbieta Bandurska-Stankiewicz  1
Affiliations
Review

The Safety of Pharmacological and Surgical Treatment of Diabetes in Patients with Diabetic Retinopathy-A Review

Wojciech Matuszewski et al. J Clin Med. .

Abstract

Background: Diabetes mellitus (DM) is a non-infectious pandemic of the modern world; it is estimated that in 2045 it will affect 10% of the world's population. As the prevalence of diabetes increases, the problem of its complications, including diabetic retinopathy (DR), grows. DR is a highly specific neurovascular complication of diabetes that occurs in more than one third of DM patients and accounts for 80% of complete vision loss cases in the diabetic population. We are currently witnessing many groundbreaking studies on new pharmacological and surgical methods of treating diabetes.

Aim: The aim of the study is to assess the safety of pharmacological and surgical treatment of DM in patients with DR.

Material and methods: An analysis of the data on diabetes treatment methods currently available in the world literature and their impact on the occurrence and progression of DR.

Results: A rapid decrease in glycaemia leads to an increased occurrence and progression of DR. Its greatest risk accompanies insulin therapy and sulfonylurea therapy. The lowest risk of DR occurs with the use of SGLT2 inhibitors; the use of DPP-4 inhibitors and GLP-1 analogues is also safe. Patients undergoing pancreatic islet transplants or bariatric surgeries require intensive monitoring of the state of the eye, both in the perioperative and postoperative period.

Conclusions: It is of utmost importance to individualize therapy in diabetic patients, in order to gradually achieve treatment goals with the use of safe methods and minimize the risk of development and progression of DR.

Keywords: diabetes; diabetic retinopathy; microvascular complications.

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Conflict of interest statement

The authors have no potential conflicts of interest.

Figures

Figure 1
Figure 1
Modifiable risk factors for the development of EWDR- Early Worsening of Diabetic Retinopathy.
Figure 2
Figure 2
Eye monitoring and treatment algorithm associated with intensive diabetes treatment. DR: diabetic retinopathy; EWDR: early worsening diabetic retinopathy; VEGF: vascular endothelial growth factor; IT: intensive treatment [23].
Figure 3
Figure 3
Potential mechanisms of Early Worsening of Diabetic Retinopathy development. GH/IGF1- growth hormone/insulin-like growth factor 1,VEGF- vascular endothelial growth factor
Figure 4
Figure 4
Comparisons of risk of diabetic retinopathy events associated with glucose lowering drugs in patients with DM. DR-diabetic retinopathy, SGLT2i- Sodium-dependent glucose transporters, GLP1- glucagon-like peptide 1,DPP4- dipeptidyl peptidase-4,TZD- thiazolidinediones, SU- Sulfonylurea.
See this image and copyright information in PMC

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