Management of Diabetic Retinopathy: An Integrated Approach Through Systemic Diabetes Treatment

Diabetic retinopathy (DR) is one of the most common and vision-threatening complications of diabetes, affecting approximately one-third of patients. Systemic management of diabetes plays a crucial role in delaying the onset and progression of DR. Intensive glycemic control, as demonstrated in the DCCT (Diabetes Control and Complications Trial) and the UKPDS (United Kingdom Prospective Diabetes Study), significantly reduces long-term risk of retinopathy. However, rapid glucose lowering, particularly in patients with preexisting DR, may lead to an early worsening phenomenon. This transient deterioration is thought to be related to hypoglycemia, hemodynamic changes, and synergistic effects of insulin and vascular endothelial growth factor. In addition to glucose control, strict management of blood pressure and lipid profiles, including use of fenofibrate, further reduces the risk of progression. The role of glucagonlike peptide-1 receptor agonists in DR remains controversial, with early signals of worsening observed in SUSTAIN-6 but not consistently demonstrated in meta-analyses. Current evidence emphasizes the long-term benefits of early intensive systemic management, despite short-term risks. A patient-specific multifactorial management approach effectively reduces the risk of onset and progression of DR.