Relevant factors of diabetic retinopathy and intervention: The incidence is 48.4% (44/91). There are significant differences in the duration of disease between the DR group and the NDR group (P < 0.01). Most scholars believe that high blood sugar is the root cause of diabetic microangiopathy, and poor glycemic control affects the severity of DR. Electron microscopy shows that the three parts constituting the retinal capillary—endothelial cells, pericytes, and basement membrane—are increased due to the hyperglycemic state of diabetic patients, which increases HbA1c levels, oxygen affinity of red blood cells, and an incomplete compensatory mechanism of 2,3-diphosphoglycerate. This results in reduced oxygen release from red blood cells, relative hypoxia in tissues, and the generation of harmful products, thereby affecting the structure and function of microvessels, leading to basement membrane thickening, pericyte loss, and damage, causing DR. Glycemic control directly impacts the development of DR.
The traditional determination of fasting blood sugar (FBS) and postprandial blood sugar (PPBS) is influenced by many factors and only represents instant sugar metabolism, while HbA1c is a product of non-enzymatic protein glycosylation of hemoglobin and glucose. Glycemic status can be reflected in the determination over 8 to 12 weeks. Elevated HbA1c is a risk factor for the development of DR, as confirmed by the Fosin Diabetes Center study, which showed that the long-term risk of DR in diabetic patients is related to HbA1c levels.
3.2 Intervention:
3.2.1 Enhancing health education and effective blood glucose control: For patients with impaired glucose tolerance or already diagnosed with diabetes, we should first strengthen the publicity and education of diabetes knowledge. Introduce the importance and necessity of treatment and complications so that patients can consciously accept and cooperate with treatment, acquiring relevant knowledge. Our department has consistently provided monthly health education since January 2001, including expert explanations, educational specialist Q&A sessions, and received good results. Additionally, patients receive drug and dietary therapy, planned according to their individual conditions. Guidance helps patients gain a sense of control, adjust negative emotions, effectively control blood sugar, and prevent and mitigate diabetic retinopathy.
3.2.2 Aggressive treatment of complications: Diabetic retinopathy and elevated blood pressure are closely related to increased blood viscosity. Due to increased blood viscosity, blood flow is slow, making lumen blockage prone to cause micro-thrombus formation. Besides requiring diabetic patients to have a reasonable diet and increase physical activity to achieve hypoglycemic and lipid-lowering purposes, guidance should also be given for active treatment of complications such as hypertension, high cholesterol, and coronary heart disease to delay or reduce diabetic retinopathy.
3.2.3 Trace element and vitamin supplementation: Some scholars believe that the lack of trace elements may be the cause of retinopathy. Studies have confirmed that serum zinc concentrations gradually decrease with the progression of diabetic retinopathy. Zinc deficiency not only impacts insulin synthesis and secretion, red blood cell metabolism, and deformability but also inadequately promotes the further development of diabetes and retinopathy. Additionally, Mavair reported in 1978 that hypomagnesemia is a risk factor for diabetic retinopathy, and lower serum magnesium concentrations correlate with more severe lesions. Therefore, diabetic patients should supplement magnesium and zinc under a doctor's guidance, such as taking multivitamin formulas or receiving intravenous supplementation.
3.2.4 Retinopathy care: For patients who have developed retinopathy, treatment should be carried out under the guidance of specialists for eye care, avoiding eye fatigue and maintaining emotional stability. Patients should wear soft-soled, non-slip shoes as much as possible. Severe lesions should avoid going out alone and prevent various activities that might cause trauma to the body.