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Vergleich der Risikoparameter der diabetischen Retinopathie und der leitliniengerechten Prävention für Patienten einer diabetischen Schwerpunktambulanz und eines Lasertherapiezentrums

Comparison of risk factors and guideline oriented prevention and therapy of diabetic retinopathy between type 2 diabetes patients undergoing laser therapy and Type 2 diabetes outpatients

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Zusammenfassung

Ziel:

Ziel der Arbeit war der Vergleich von Risikofaktoren der diabetischen Retinopathie bei Diabetes mellitus Typ 2 für Patienten einer diabetischen Schwerpunktambulanz und eines Lasertherapiezentrums. Zudem wurde die Umsetzung der leitliniengerechten Prävention der diabetischen Retinopathie im klinischen Alltag untersucht.

Patienten und Methodik:

In einer prospektiven Studie wurden Patienten mit Diabetes mellitus Typ 2, welche zur ambulanten Lasertherapie der diabetischen Retinopathie in der Universitätsaugenklinik Leipzig vorgestellt wurden, befragt und untersucht. Die Patienten der Vergleichsgruppe ohne diabetische Retinopathie wurden in der Diabetesambulanz der Medizinischen Klinik III der Universität Leipzig rekrutiert.

Ergebnisse:

Im Zeitraum von August 2004 bis Mai 2008 wurden insgesamt 180 Patienten befragt und untersucht, 107 waren von einer diabetischen Retinopathie betroffen (48 mit nicht-proliferativer Retinopathie/ 59 mit proliferativer Retinopathie). 73 Patienten ohne Nachweis einer Retinopathie gehörten der Vergleichsgruppe an. Die Patienten der Retinopathie-Gruppen wiesen mit 112 bzw. 110 mmHg deutlich höhere mittlere arterielle Blutdruckwerte auf als die Ohne-Retinopathie-Patienten (96 mmHg). ACE/ AT1-Blocker wurden von den Patienten mit manifester Retinopathie signifikant seltener eingenommen als in der Vergleichsgruppe. Insgesamt wurden nur 37% der Hochrisikopatienten mit diabetischer Retinopathie der empfohlenen medikamentösen Therapie zur Vermeidung einer Progression der Retinopathie zugeführt.

Schlussfolgerung:

In der Umsetzung der leitliniengerechten Prävention der diabetischen Retinopathie bestehen im klinischen Alltag erhebliche Defizite. Die möglichen Ursachen hierfür liegen in der häufig schlechten Therapietreue vieler Hochrisikopatienten, die sich oftmals erst aufgrund eines bereits manifesten Visusverlustes in ärztliche Behandlung begeben, sowie in der zu optimierenden diabetologischen Therapie und der zum Teil ungenügenden Zusammenarbeit der augenärztlichen und diabetologischen Fachrichtungen.

Abstract

Purpose:

The purpose of this study was the comparison of risk factors for development or progression of diabetic retinopathy in patients with type 2 diabetes between patients of a laser therapy center and a diabetes outpatient clinic. Furthermore, the implementation of the guidelines of the German Diabetic Association for the prevention and therapy of diabetic retinopathy was analysed.

Patients and Methods:

In a prospective study, patients with type 2 diabetes and diabetic retinopathy of the laser therapy center at the ophthalmology department, Leipzig University, were interviewed and examined. Patients of the reference group without diabetic retinopathy were recruited from the diabetes outpatient clinic Leipzig University.

Results:

Between August 2004 and May 2008, a total of 180 patients with type 2 diabetes were included (48 patients with non-proliferative diabetic retinopathy (NPDR), 59 patients with proliferative diabetic retinopathy (PDR) and 73 patients belonging to the reference group). Patients with diabetic retinopathy had significantly higher mean blood pressures of 112 and 110 mmHg as compared to patients without diabetic retinopathy (96 mmHg). ACE/ AT1-inhibitors were used significantly less by patients with as compared to patients without diabetic retinopathy. Only 37% of patients with diabetic retinopathy were treated according to DDG and ADA guidelines.

Conclusion:

There are striking deficits for the implementation of guideline oriented prevention and therapy of diabetic retinopathy in daily practice. The possible reasons are insufficient compliance of patients who consulted medical advice only when complications of diabetes occurred, the necessary improvement of the medical therapy and the suboptimal cooperation between ophthalmology and diabetes specialists.

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Authors and Affiliations

  1. Medizinische Klinik und Poliklinik III in Klinik für Endokrinologie und Nephrologie, Universität Leipzig, Leipzig, Germany

    Ralf Paschke, Florian Gerhard Wuthe & Katja Kühn

  2. Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Leipzig, Leipzig, Germany

    Claudia Jochmann & Peter Wiedemann

  3. Medizinische Klinik und Poliklinik III in Klinik für Endokrinologie und Nephrologie, Universität Leipzig, Liebigstraße 20, 04103, Leipzig, Germany

    Ralf Paschke

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  1. Ralf Paschke
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  2. Florian Gerhard Wuthe
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  4. Claudia Jochmann
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  5. Peter Wiedemann
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Correspondence to Ralf Paschke.

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Paschke, R., Wuthe, F.G., Kühn, K. et al. Vergleich der Risikoparameter der diabetischen Retinopathie und der leitliniengerechten Prävention für Patienten einer diabetischen Schwerpunktambulanz und eines Lasertherapiezentrums. Med Klin 105, 772–778 (2010). https://doi.org/10.1007/s00063-010-1131-6

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