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A slowing of diabetic retinopathy by intensive treatment of glycemia was observed in persons with type 2 diabetes and cardiovascular disease or cardiovascular risk factors and hyperlipidemia in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Study.120 (Evidence Grade: A) Intensive glycemic control in individuals with type 1 diabetes in the Diabetes Control and Complications Trial/ Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study is associated with a substantial reduction in long-term risk of ocular surgery.118 (Evidence Grade: A) Although intensive glucose control did not significantly reduce the incidence and progression of retinopathy in the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) Retinal Measurements Study of persons with type 2 diabetes, consistent trends towards a benefit were observed, with significant reductions in some lesions observed.121 (Evidence Grade: A) A follow-up study of individuals with type 2 diabetes in the United Kingdom Prospective Diabetes Study (UKPDS) who received intensive glucose therapy had a lower risk of microvascular complications than did those receiving conventional dietary therapy.11 (Evidence Grade: B) Intensive glycemic control (Persons with diabetes should be educated about the ocular signs and symptoms of diabetic retinopathy and other nonretinal ocular complications of diabetes, and encouraged to comply with recommendations for followup eye examinations and care. (Consensus Statement) Patients with diabetes should be encouraged to participate in lifestyle education and diabetes self-management programs.353,376-381 (Evidence Grade: B, Recommendation) Individuals should be advised by their health care providers of the risks of smoking and encouraged to quit smoking and/or seek smoking cessation assistance.389-392 (Evidence Grade: A, Strong Recommendation) Persons who experience vision loss from diabetes should be counseled on the availability and scope of vision rehabilitation care and provided, or referred for, a comprehensive examination of their visual impairment by a practitioner trained or experienced in vision rehabilitation. (Consensus Statement) Referral for counseling is indicated for any individual experiencing difficulty dealing with vision and/or health issues associated with diabetes or diabetic retinopathy.
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