Benefits of Renin-Angiotensin Blockade on Retinopathy in Type 1 Diabetes Vary With Glycemic Control
- Tasma Harindhanavudhi, MD1⇓,
- Michael Mauer, MD1,2,
- Ronald Klein, MD, MPH3,
- Bernard Zinman, MD4,
- Alan Sinaiko, MD2,
- M. Luiza Caramori, MD, PHD1,2 and
- for the Renin Angiotensin System Study (RASS) group
- 1Department of Medicine, University of Minnesota, Minneapolis, Minnesota
- 2Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
- 3Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin
- 4Department of Medicine, University of Toronto, Toronto, Canada
- Corresponding author: Tasma Harindhanavudhi, .
OBJECTIVE Optimal glycemic control slows diabetic retinopathy (DR) development and progression and is the standard of care for type 1 diabetes. However, these glycemic goals are difficult to achieve and sustain in clinical practice. The Renin Angiotensin System Study (RASS) showed that renin-angiotensin system (RAS) blockade can slow DR progression. In the current study, we evaluate whether glycemic control influenced the benefit of RAS blockade on DR progression in type 1 diabetic patients.
RESEARCH DESIGN AND METHODS We used RASS data to analyze the relationships between two-steps or more DR progression and baseline glycemic levels in 223 normotensive, normoalbuminuric type 1 diabetic patients randomized to receive 5 years of enalapril or losartan compared with placebo.
RESULTS Patients (147 of 223; 65.9%) had DR at baseline (47 of 74 patients [63.5%] in placebo and 100 of 149 patients [67.1%] in the combined treatment groups [P = 0.67]). Patients with two-steps or more DR progression had higher baseline A1C than those without progression (9.4 vs. 8.2%, P < 0.001). There was no beneficial effect of RAS blockade (P = 0.92) in patients with baseline A1C ≤7.5%. In contrast, 30 of 112 (27%) patients on the active treatment arms with A1C >7.5% had two-steps or more DR progression compared with 26 of 56 patients (46%) in the placebo group (P = 0.03).
CONCLUSIONS RAS blockade reduces DR progression in normotensive, normoalbuminuric type 1 diabetic patients with A1C >7.5%. Whether this therapy could benefit patients with A1C ≤7.5% will require long-term studies of much larger cohorts.
- Received March 9, 2011.
- Accepted April 25, 2011.
- © 2011 by the American Diabetes Association.
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