Diabetes is a devastating disease that affects nearly 10% of the overall population. Of that group, nearly 30% are undiagnosed, meaning they are living with the destructive condition and do not know the damage it is causing. The number of diagnosed cases of diabetes has steadily risen over the last decade, and the number of both type 1 and type 2 found in young people has increased significantly between 2002 and 2012 according to a recent study. With diabetic retinopathy being the leading cause of new blindness, it is necessary for eye care professionals to initiate the diabetes conversation with their patients.
Another study looked at the frequency of eye exams after diagnosis of diabetes. The research shows that 65% with type 1 diabetes have had an eye exam within the first 6 years after diagnosis, while only 42% with type 2 diabetes have. A third study found that among young people diagnosed during childhood and adolescence, disease-related complications were more common in those with type 2, but frequent in both groups. Researchers concluded, “These findings support early monitoring of these patients for development of complications,” especially considering 95% of diabetic vision loss can be prevented with regular eye exams.
This is where the opportunity lies for eye care professionals. According to a recent article on the American Optometric Association (AOA) website, Drs. David Masihdas and Tina MacDonald believe that ODs can use this information as an opportunity for conversations with patients about diabetes. Though 35% of type 1 patients and 58% of type 2 patients do not keep regular eye exams, it is important to educate all patients about the troubles and complications of diabetes. The current route for treatment of this disease is effective, but expensive and invasive to the patient. The steps are as follows:
- Keep blood glucose, blood pressure and blood lipids as close to normal as possible.
- Get annual dilated retinal examinations
- Get treatment if/when sight-threatening retinopathy (STR) develops
A Proactive Approach
The key is a proactive approach and starting the conversation with them. Unlike type 1, type 2 patients rarely show symptoms at diagnosis. Paul Chous, MA, OD, FAAO, estimates that by the time it is caught, patients have had the disease for 6 years, leaving over half of the beta cells in the pancreas impaired. Feeling it was not enough for ECPs to wait for diabetes to visibly affect the eyes, Dr. Chous started looking for a way to proactively support diabetic eye health from the inside out. The AREDS and AREDS 2 studies proved that both visual function and progression of age-related macular degeneration (AMD) can benefit from a multi-component nutritional supplement, and he wanted to see if diabetic patients can react in a similar way.
Diabetes and Visual Function Supplementation Study
Building off AREDS 2, Chous and his colleagues, Drs. Stuart Richer, Jeffry Gerson and Renu Kowluru, designed a six-month, randomized, placebo-controlled clinical research study called Diabetes and Visual Function Supplementation Study (DiVFuSS). The study included 67 subjects that have had type 1 or type 2 diabetes for at least 5 years, both with and without retinopathy. Chous explains, “Targeting the pathways that cause [diabetic retinopathy] with a science-based supplement makes biologic sense.” When building the supplement, the researchers included ingredients that have been shown to:
- Reduce free radicals and inflammatory proteins
- Reduce VEGF
- Seal leaky retinal capillaries
- Improve mitochondrial health
- Neuroprotection of RGCs
- Block toxic glucose metabolites
During the study, the researchers tested several different areas to measure the changes in eye health. One of the measurements taken was macular pigment optical density (MPOD). Chous argues that having low macular pigment is an indicator of heightened risk of several serious eye health concerns, including diabetic retinopathy and AMD. When supplementing with the DiVFuSS formula, subjects had statistically significant improvements with nearly every category. Results include:
- Significantly increased contrast sensitivity by 19%.
- Color vision improvement of 21%.
- Macular pigment optical density (MPOD) increase of 31%.
- 31% reduction in diabetic neuropathy symptoms.
One of the most important takeaways from this clinical research is that the supplement achieved these results WITHOUT significantly affecting blood sugar control (A1c).
Utilizing this information can help boost your practice as well as your patient care. Besides improving the way you and your patients see diabetes, it can help your patients see your practice in a new light. The differentiation helps encourage referrals from your patients and other providers focused on being proactive. With the increased foot traffic, there can be a subsequent increase in income for your practice, and if you begin prescribing a DiVFuSS-based supplement, that number can only go up.
Using the DiVFuSS Knowledge in Your Practice
Dr. Chous has a few suggestions on how to put this information into action in your practice. First, begin measuring MPOD in your patients. It is important to remember that diabetes is affecting the eyes, even when you don’t see it and when glucose control is good, so monitoring early and often is key to detecting subtle changes in eye health. This can be an excellent gateway into the diabetes conversation with the patients at risk with low MPOD. Though there is an emphasis on pre-diabetic and diabetic patients, Drs. Chous and Richer stress that MPOD measurement can be used to accurately gauge macular and overall eye health in all patient types.
Next, recommend a DiVFuSS-formulated eye health nutraceutical to your patients. Nutrition is an important variable in the disease, and it is no different for diabetic eye health. Finally, re-measure MPOD every 6 months to ensure patient compliance and track progress. Diabetes may be a growing problem in current society, but you can help change the outcome for your patients by having the diabetes conversation early and having a proactive plan.