Collaborative Efforts Toward a Common Goal
Panelists discuss the challenges of managing patients with diabetes.
David Boyer, MD: Our panel includes endocrinologists and retina specialists, who have come together to discuss best practices for collaborative management of patients who have diabetes and are at risk for diabetic retinopathy. Our hope is that by sharing insights from our unique perspectives, we can work together more effectively for the benefit of our patients.
Diabetes has reached an epidemic status worldwide. Some experts predict that between 2010 and 2030, there will be a 69% increase in the number of adults with diabetes in developing countries and a 20% increase in developed countries. In the United States alone, approximately 26.8 million people have diabetes,1 not only affecting each individual’s quality of life, but also creating a significant public health burden.
Steven Schwartz, MD: A high percentage of patients with diabetes develop diabetic retinopathy, whether it is diabetic macular edema or proliferative diabetic retinopathy. These conditions can be devastating to vision.
Yehuda Handelsman, MD: Our patients know that one of the dire complications of diabetes is retinopathy, which can lead to blindness. As endocrinologists and diabetologists, we do our best to prevent that from happening through early intervention and management.
Anne Peters, MD: I work closely with my patients to control their blood glucose levels to avoid diabetic retinopathy, but if a patient does develop diabetic retinopathy, I want to ensure that he has access to the latest treatments.
Dr. Handelsman: We know that until recently, laser photocoagulation was the mainstay therapy for retinopathy, but in the last year or two, we have become aware of some new therapeutic modalities.
Dr. Boyer: Yes, we’ve had some good news in ophthalmology in the last year. We now have treatments whose effects extend beyond merely stabilizing vision or achieving minimal improvements to attaining fairly significant visual gains.
One of the challenges we face is ensuring that we see patients early enough to realize significant benefits from treatment. That’s why it’s so important for us to have discussions among all of the stakeholders — to improve access and communication.
— Victor Gonzalez, MD
Victor Gonzalez, MD: The most important breakthrough to date is the development of agents that inhibit vascular endothelial growth factor (VEGF), one of which is approved to treat diabetic macular edema (DME). In addition, various combination therapies are currently under evaluation.
One of the challenges we face is ensuring that we see patients early enough to realize significant benefits from treatment. That’s why it’s so important for us to have discussions, such as the one we’re having today, among all of the stakeholders — the primary care doctors, the endocrinologists and the ophthalmologists — to improve access and communication.
Dr. Handelsman: Interactions between diabetologists and ophthalmologists are important so that we understand what’s available, how and when it can be used and when we should refer patients.
Dr. Schwartz: Perhaps equally as important as our interactions with our medical colleagues are our interactions with patients. By keeping communication flowing among all of us, we can triangulate the disease to improve glycemic control and decrease hypertension, anemia, renal failure, sleep apnea and other issues that exacerbate diabetic retinopathy.
1. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87:4-14.