Can Ophthalmologists Achieve Better Blood Glucose Control in Their Diabetic Patients?

Ophthalmology is generally considered to be limited to disorders of the eye and its adnexa. Diabetes mellitus, however, is a systemic disease that we encounter frequently in our ophthalmic practices because of its ocular complications, especially diabetic retinopathy. When, after years of controversy, 2 seminal randomized clinical trials, the Diabetes Control and Complications Trial (DCCT)¹ and the UK Prospective Diabetes Study (UKPDS),² clearly found that near-normal blood glucose control significantly slows the development and progression of diabetic retinopathy in patients with type 1 and type 2 diabetes, with a marked effect on the protection of vision, ophthalmologists were offered an important opportunity to advise our diabetic patients on the management of their systemic disease. Consequently, the Diabetic Retinopathy Clinical Research Network (DRCR.net), a large group of collaborating centers funded by the National Eye Institute, conducted a randomized clinical trial to investigate whether measuring hemoglobin A_1c (HbA_1c) in the ophthalmology clinic, counseling patients on the relevance of good blood glucose control to prevent retinopathy, and providing personalized risk assessments to each patient could significantly improve glucose control in patients during a 1-year period. The negative results of this project are presented in this issue of JAMA Ophthalmology.³