Metabolic Control in Diabetic Retinopathy - Take Charge of Your Own Health

Vision problems are a common side effect of growing old, but, if you are a person living with diabetes, it can signal other problems. One of the lesser known complications of Diabetes is Diabetic Retinopathy (DR) - a catch-all term for all disorders of the retina caused by diabetes. Left unchecked, DR can lead to permanent loss of vision¹.Diabetic Retinopathy can be hard to diagnose, as a lot of the symptoms just feel like standard issue age related degeneration, however, there are particular signs people with diabetes and their caregivers must watch for. Should you, or your loved ones experience these, it's time to see a doctor¹.Once you have a DR diagnosis however, there is plenty you can do to keep the disease from progressing. Looking at the body as a whole, there are various systems that interact with one another. What happens in your kidneys is significant to what happens with your retina even if you don't see the relation. Over the years, the research around DR has shown several connections between the progression of the disease and hypertension, high cholesterol, diabetic kidney disease, high blood sugar, vitamin and mineral deficiencies, even exercise².Controlling Sugar FluctuationsControlling sugar fluctuations is something that you do anyway, as someone with diabetes. The good news is, this helps both lower the risk of developing DR, and also its progression. Even a 1% decrease in HbA1c is related to a 35% reduction in the risk of DR development, 15–25% in the disease’s progression, 25% in visual acuity loss and 15% in the development of blindness³.The NHS UK recommends checking sugar levels several times a day, as levels can vary. If you check your blood sugar level at home, it should be 4 to 7mmol/l. As someone with diabetes, your average blood sugar level, or HbA1c, should be around 48mmol/mol or 6.5%⁴.Controlling blood pressure If you have diabetes, the NHS recommends that you aim for blood pressure readings of no more than 140/80mmHg, or less than 130/80mmHg if you have diabetes complications, such as eye damage⁴. A comparison of patients with BP 180/100 mmHg and those with BP 150/85 mmHg, showed a 33% decrease in DR progression and a 50% reduction in loss of vision in the second group³.Controlling lipids in the bloodstream When we say 'lipids', we typically include cholesterol levels, lipoproteins, chylomicrons, VLDL, LDL, apolipoproteins and HDL³. The NHS recommends a healthy total cholesterol level of below 4mmol/l⁴.Elevated serum lipid levels are linked with a specific risk of a DR complication known as 'hard exudates'. Lowering high serum lipid levels has been shown to decrease the risk of hard exudates in people living with diabetic retinopathy⁵. So even if your serum lipids are high right now, you can make a difference to your vision by taking corrective action today.Obesity, physical activity, and DR It is common knowledge that obesity and diabetes can go hand in hand. Now, science backs this up. In people with Type 2 Diabetes, a meta analysis shows that obesity increases the incidence of DR³.The good news is that increasing physical activity reduces the risk of developing DR! Not only are higher levels of physical activity independently associated with a lower incidence of DR in people with type 2 diabetes, the risk of DR progression could be reduced by 40% when the physical activity is for no less than 30 min for five days per week³.Proven diets and foods that help DR For those who want to battle DR with improvements in their diet, the options are many. While we all try to get a good mix of fruits, vegetables, dairy, cereal and other food groups, there are particular diets as well as certain foods that have been shown to be more effective in battling DR and other chronic conditions.

1. A  study found that Mediterranean diet enhanced with extra virgin olive oil or nuts with a low-fat diet was associated with an over 40% reduced risk of retinopathy!³
2. The intake of oily fish at least twice a week was associated with a nearly 60% reduction in the risk of retinopathy³.
3. Many vegetables, fruits and seeds contain minerals, polyphenols and other phytochemicals which bring down oxidative stress, inflammation and insulin resistance. In fact, high consumption of fruit and vegetables rich in flavonoids is linked to a lower risk of diabetic retinopathy³.

Vitamin and mineral deficiencies We all try to eat well. Between the daily stresses of cooking and ordering in, the quality of the produce available in our cities, and our likes and dislikes of certain foods, small deficiencies can creep in. Regular blood tests and doctors visits can help you navigate these deficiencies, and safeguard not just your vision, but several other organ systems in the body.Vitamin B1 (thiamine):Thiamine supplementation in high doses (50–100 mg/day) is safe and useful for neuroprotection, treatment and prevention of end-organ injuries, including DR and diabetic nephropathy³.Vitamin D: Maintaining an optimum level of vitamin D plays an essential role in reducing the risk and severity of DR. Not only that, it helps in the proper functioning of the pancreas, and helps with atherosclerosis, Cardiovascular Disease, Type 2 diabetes and hypertension³.Vitamin E: In a 10 year study of people living with Type 1 diabetes, vitamin E supplementation by a dose of 1800 IU daily improved blood flow in the retina. It also reduced oxidative stress, which is elevated in DR³.Zinc: Zinc deficiency is linked with the progression of chronic conditions like metabolic syndrome, diabetes, diabetic microvascular complications and DR³.The most potent defence against vision loss: regular testing The journey to good health, particularly when it comes to diabetes and DR, begins with the correct diagnosis. Often, diabetes causes complications that seem to have nothing to do with insulin or high blood sugar levels. This is because diabetes affects the functioning of several organ systems in the body; so understanding what is wrong is the first step to taking corrective action.As DR symptoms become noticeable only once the disease has advanced, it is important to do pre-emptive and regular screening for DR. Based on an analysis of 35 studies carried out between 1980 and 2008 worldwide, the overall prevalence of DR in people with diabetes using retinal images was estimated to be 35%, with vision-threatening DR present in 12%⁶. In India, the number of people with diabetes is expected to rise to 134 million by 2045⁷, making DR a significant public health challenge.However, once DR is detected, you and your doctor can chart a clear path for you, to manage your health, and to prevent further damage to your vision. All it takes is awareness that DR exists, and that one must test for it regularly¹.This is the motivation behind why Network18 launched the 'Netra Suraksha' - India Against Diabetes initiative, in association with Novartis, in 2021. In the first season, the initiative brought together the best minds in medicine, policy making and think tanks to raise awareness about DR. This year, the initiative is taking an enormous step forward by foraying into in-person health camps across the nation.You can find knowledge articles, explainer videos and panel discussions from season 1 on the Netra Suraksha website, along with the latest information on when and where health camps are being held. Partner with us in getting the word out there to other people living with diabetes, and to arm yourself with knowledge.Remember, vision loss from DR can be stopped in its tracks. As with anything to do with your health, make all changes to your diet, exercise regime and lifestyle in consultation with your doctor. Slow and steady wins the race! References: 

• Diabetic Retinopathy. Available [online] at URL: https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/diabetic-retinopathy. Accessed on August 3rd 2022.
• Saini DC, Kochar A, Poonia R. Clinical correlation of diabetic retinopathy with nephropathy and neuropathy. Indian J Ophthalmol 2021;69:3364-8.
• Bryl A, Mrugacz M, Falkowski M, Zorena K. The Effect of Diet and Lifestyle on the Course of Diabetic Retinopathy-A Review of the Literature. Nutrients. 2022 Mar 16;14(6):1252.
• Diabetic Retinopathy Prevention. Available [online] at URL: https://www.nhs.uk/conditions/diabetic-retinopathy/prevention/. Accessed on August 3rd 2022.
• Chew EY, Klein ML, Ferris FL, et al. Association of Elevated Serum Lipid Levels With Retinal Hard Exudate in Diabetic Retinopathy: Early Treatment Diabetic Retinopathy Study (ETDRS) Report 22. Arch Ophthalmol.1996;114(9):1079–1084.
• Yau JW, et al. Meta-Analysis for Eye Disease (META-EYE) Study Group. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012 Mar;35(3):556-64.
• Nanditha A, et al. Secular TRends in DiabEtes in India (STRiDE–I): Change in Prevalence in 10 Years Among Urban and Rural Populations in Tamil Nadu.Diabetes Care 2019;42:476–485

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