At present, the number of diabetic patients in China exceeds 1400 million, of which diabetic retinopathy (DR) is a chronic progressive blinding eye disease caused by diabetes, with approximately 1 in 3 patients with diabetes mellitus having DR [1]. If not screened in time, identified as soon as possible and actively intervened, the disease can progress rapidly and lead to irreversible visual impairment, which has now become the first blinding eye disease in the working-age population.
DR's risk control and management
As a chronic and progressive complication, retinal microvascular damage caused by long-term hyperglycemia is not a "one-day effort". Therefore, it is important for patients with DR to actively control the risk factors of DR and carry out systemic chronic disease management, such as scientific control of blood glucose, blood pressure, and blood lipids, which can effectively prevent, control, and delay the occurrence and progression of DR [1].
1.Duration of diabetes: the most important risk factor for DR, the longer the course of the disease, the greater the risk of developing the disease, and the prevalence of DR in patients with a duration of diabetes mellitus 20 25 years can climb to 527%。
2.Hyperglycemia: It is a key factor affecting the occurrence and progression of DR, and intensive glycemic control is beneficial to DR and can slow down the progression of DR lesions, and the criteria can be divided into HBA1C0%。However, overly strict criteria may increase the risk of hypoglycemia, so criteria should be set in conjunction with the professional judgment of the endocrinologist. Among them, the criteria for elderly patients with cardiovascular disease can be appropriately relaxed.
3.Reasonable control of hypertension and hyperlipidemia.
4.Improve bad habits such as smoking and drinking.
5.Focus on risk factors such as kidney disease, pregnancy, obesity, and genetics.
Screening for DR
Regular early screening is important for people with diabetes, especially those with these risk factors. For different types of diabetes, the timing of initiation of screening for DR varies. According to the recommendations in the Guidelines for the Clinical Diagnosis and Treatment of Diabetic Retinopathy in China (2022), the DR screening process is shown in Figure 1. It should be noted that once DR is diagnosed, the appropriate screening frequency should be selected according to the severity of DR for standardized chronic disease management
1.Those without DR should be rechecked at least once every 1 2 years;
2.Mild non-proliferative stage DR (NPDR): Repeat every 6 to 12 months;
3.Moderate NPDR: Repeat every 3 to 6 months;
4.Severe NPDR: Follow-up should be < 3 months;
5.Proliferative DR (PDR): 1 month of follow-up frequency;
6.Patients with macular edema (DME) should be followed more frequently.
Figure 1 Screening flow chart of DR.
NPDR: non-proliferative DR;PDR: Proliferative stage DR;DME: Diabetic macular edema.
Relationship between a novel blood glucose composite index, GRI and DR
Among the various screening and evaluation methods for DR, Academician Jia Weiping and Professor Zhou Jian of the 2023 American Diabetes Association Scientific Meeting (ADA) proposed a new type of blood glucose risk index (GRI), a new blood glucose composite index, for the assessment and early identification of DR risk.
Fig. 2 The original title of the literature on the relationship between GRI indicators and DR.
The glycemic risk index was measured by 3 mmol L, 39 mmol L is the cut-off point of blood glucose below the target range time (TBR) and 10 mmol L, 139mmol L is weighted by the time when the cut-point blood glucose is above the target range (TAR), which can comprehensively reflect the two-dimensional information of hyperglycemia and hypoglycemia, and is a new composite index to evaluate glycemic control. This index forms a two-dimensional score of 0 100, which comprehensively reflects the risk of high and low blood sugar.
Elevated GRI levels in patients with type 2 diabetes were found to be significantly associated with an increased risk of retinopathy, with a 20 percent increased risk of DR for every 1 standard deviation increase in GRI levels [2]. Therefore, GRI may have advantages in comprehensively reflecting the quality of glycemic control, and may be an effective indicator for risk assessment of diabetic complications.
dr's**
In terms of DR clinical **, in addition to the **control** described above, it also includes microvascular improvement and surgery**, such as laser photocoagulation, anti-VEGF drugs, vitrectomy, etc. But the long-term effectiveness and effectiveness of these methods are still worth paying attention to. Oral TCM has been used for **DR for thousands of years, and it is still widely used today, and the advantages of TCM with multiple targets and multiple effects are constantly highlighted. Among them, Compound Danshen Dripping Pill has been recommended for DR by a number of guidelines and consensuses, such as the Clinical Evidence-based Practice Guidelines for Traditional Chinese Medicine for Diabetes (2016 Edition) and the Multidisciplinary Chinese Expert Consensus on the Prevention and Treatment of Diabetes-related Eye Diseases (2021 Edition). The remarkable effect of compound Danshen Dripping Pill on DR** is mainly due to its ability to play a role in the pathogenesis of DR. The ** of DR is mainly related to a series of pathological changes such as hemodynamic abnormalities, local inflammation and oxidative stress caused by elevated blood glucose. The two main components of Compound Danshen Dripping Pills, Danshensu and Saponin, have anti-inflammatory and antioxidant effects, which can effectively reduce the apoptosis of retinal cells, resist oxidative stress [3], promote bleeding absorption, thereby improving the microcirculation state of retinal blood vessels, improving symptoms such as blurred vision, and effectively delaying the progression of retinopathy. At the same time, combined with the specific degree of the patient's condition, it also shows a good combination effect when combined with a variety of Western medicines.
References
1] Fundus Disease Group, Ophthalmology Branch, Chinese Medical Association, Fundus Disease Group, Ophthalmologist Branch, Chinese Medical Doctor Association, Xu Xun, Li Xiaoxin. Guidelines for the Clinical Diagnosis and Treatment of Diabetic Retinopathy in China (2022)——Revision Based on Evidence-based Medicine[J].Chinese Journal of Fundus Diseases,2023,39(2):99-124
2] yaxin wang, jingyi lu, jiaying ni, et al. 956-p: association between glycemia risk index (gri) and diabetic retinopathy in type 2 diabetes—a prospective cohort study [j]. diabetes. 2023,72 (supplement_1): 956–p.
3] le liu, xiaoqiang li, wenbin cai, et al. coadministration of compound danshen dripping pills and bezafibrate has a protective effect against diabetic retinopathy. front pharmacol. 2022, 13:1014991.