Eye Outcomes in Veteran Affairs Diabetes Trial (VADT) After 17 Years
The objective of this study was to assess the long-term role of intensive glycemic control (INT) on accumulated eye procedures in patients with advanced diabetes compared with those receiving standard glycemic control (STD).
Research design and Methodology:
We compared the effect of treatment assignment on the accumulated number of eye procedures during the intervention period of Veteran Affairs Diabetes Trial (VADT) (2000-2008), median follow-up of 5.6 years), the interim VADT-Follow-up (2000-2013) and the full 17 years of VADT follow-up (2000-2017). We further analyzed data using various cardiovascular markers in 2 models; model I included total cholesterol, HDL-cholesterol (HDL-C), LDL -cholesterol (LDL-C), triglycerides, systolic and diastolic blood pressure, and BMI. Model II included the above covariates plus age and DR severity scores at baseline of the original trial.
The final analysis of the data (detailed in Results section) showed a mild but nonsignificant increase in number of procedures, retinal or retinal plus cataract surgery during the three periods of the study (Table 3,4).
We found no significant benefit of INT during the original trial period in eye related procedures such as various procedures for DR and cataract surgery during the 17 years follow up. Yet, after adjusting data for some known vascular markers, the increase in number of eye procedures in INT becomes more prevalent. This finding indicates that INT might not have a protective role on events that requires surgery in individual with advance DM.