Less diabetic retinopathy, more macular degeneration?

Key Takeaways

• Achieving target blood sugar and lipid levels reduces the risk for diabetic retinopathy but was associated with a greater risk of developing age-related macular degeneration (AMD).
• In patients with type 1 diabetes, the presence of AMD was associated with less severe diabetic eye disease, and milder diabetic retinopathy was associated with increased risk of AMD. 

New research suggests that achieving target blood sugar and lipid levels reduces the risk for diabetic retinopathy (DR), an eye disease caused by diabetes in which high blood sugar damages the blood vessels of the retina, and other adverse health outcomes in people with diabetes, but are associated with a greater risk of developing developing age-related macular degeneration (AMD), an eye disease that causes damage to the macula, a small but important area in the center of the retina that allows you to clearly see details of objects in front of you.  In two groups of patients with type 1 diabetes, the presence of AMD was associated with less severe DR and diabetic macular edema (DME), a form of diabetic eye disease in which leaking fluid causes swelling (edema) in the central part of the retina (macula), while milder DR at baseline was associated with an increased risk for AMD. Measures of metabolic health, including insulin sensitivity, glucose (blood sugar), and triglyceride/high-density lipoprotein ratio, were also inversely associated with AMD. The findings were presented at the annual American Diabetes Association (ADA) 84th Scientific Sessions by Ward Fickweiler, MD, a clinical fellow in ophthalmology at the Joslin Diabetes Center and Harvard Medical School, Boston. 

The reasons for the paradox aren’t clear, “but we think it might have to do with glucose and lipid metabolism,” Fickweiler said, adding that while this shouldn’t discourage people with diabetes from controlling their blood sugar, “I do think future studies are urgently needed to investigate this interaction.””Given the increasing prevalence of diabetes in the elderly, understanding factors that influence age-related macular degeneration and diabetic retinopathy is crucial to target intervention for both,” Fickweiler said in his presentation. 

Edited by Miriam Kaplan, PhD

Source: Miriam Tucker, Medscape Medical News, June 28, 2024; see source article