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N. Narendran, A. Smith; Cardiovascular Risk Factor Control in Patients With Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2146.
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Diabetes is associated with vascular complications, though it is macrovascular disease that predisposes to premature mortality in these patients, and this largely manifests through cardiovascular disease. To address this issue, the National Institute of Clinical Excellence (NICE) in the UK and the Joint British Society (JBS) in the UK developed guidelines for cardiovascular risk factor control in all diabetic patients.The aim of this work was to assess whether the targets outlined in the NICE and JBS2 Guidelines are being met in patients who have already developed microvascular diabetic retinopathy.
The targets in type 1 and type 2 diabetic patients with retinopathy in the NICE and JBS2 guidelines relate to blood pressure, total cholesterol, HbA1c, smoking status and use of statin and aspirin. This information was obtained from patients routinely attending ophthalmology clinics for treatment of diabetic retinopathy. Only blood results and blood pressure results taken within the preceding 12 months were recorded.
Details on 81 patients were recorded over a 9 week period. The male:female ratio was 45:36. The age range was 23-86 years, and the ratio of type 1 to type 2 diabetics was 25:56. The duration of disease was 2-50 years. The percentage of individuals achieving targets are shown in the table.
Many of our patients failed to achieve the NICE and JBS2 targets for cardiovascular risk management. The percentage of diabetic patients achieving HbA1c and blood pressure targets were particularly low. Our audit has studied a group of diabetic patients with manifest microvascular disease who are at additional risk of premature mortality from cardiovascular disease. Our results have strong implications for the total overall care of these patients.
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