Primary prevention
Effective primary prevention of diabetic retinopathy depends on provisions made at national, community, and individual levels.
National level provision
Multidisciplinary primary care services: to coordinate appropriate measures to improve patient health. Many newly affluent countries vulnerable to diabetes do not have an established primary care infrastructure.
A retinopathy screening programme: to reach the majority of patients with diabetes and ensure that the appropriate action is taken on the basis of the information acquired. Few countries have established national screening programmes.[3]
Media and educational campaigns: to raise awareness of the complications of diabetes, to launch wellness initiatives, to legislate healthy food labelling, to tax unhealthy food, and to provide environments conducive to a healthy lifestyle.[66]
Community level provision
Encouragement of the person with diabetes by the healthcare team to adopt a healthier lifestyle, incorporating an appropriate diet, exercise, and the use of glucose and blood pressure monitoring equipment; encouraging them to participate actively in their own care.[67]
Good communication between different members of the primary care team, the retinopathy screening team, optometrists, and ophthalmologists. A consistent care pathway must be formulated, disseminated, and adhered to.[3]
Education of patients and carers towards an understanding of diabetic retinopathy sufficient to direct them to appropriate action.[3]
Formulation of care packages by primary care physicians tailored to the individual.[68]
Individual level provision
Optimum control of blood pressure and glucose delays the onset and slows the progression of diabetic retinopathy. The effect has been shown to be proportional to the reduction in blood glucose in patients with type 1 and 2 diabetes, and proportional to the reduction in blood pressure in patients with type 2 diabetes.[48][50][53] The beneficial effects of optimum glycaemic and hypertensive control appear synergistic in patients with type 2 diabetes.[53] Treatment with candesartan may protect against development of retinopathy in type 1 diabetes.[69]
Secondary prevention
Progression of retinopathy can be slowed by effective blood pressure, serum lipid level, and glycaemic control.[61][83] It is therefore essential that good communication exists between those undertaking retinopathy surveillance and the physician managing the patient's diabetes.
Women with pre-existing type 1 or type 2 diabetes who are planning pregnancy or who are pregnant should:[61]
be counselled about the risk for development and/or progression of diabetic retinopathy
have an eye examination before pregnancy and in the first trimester, with monitoring every trimester and for 1 year postnatal, as indicated by the degree of retinopathy.
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