Decreasing the Risk of Diabetic Retinopathy in a Study of Case Management The California Medi-Cal Type 2 Diabetes Study

OBJECTIVE — Diabetic retinopathy affects60 % of people with type 2 diabetes during the first 2 decades of the disease and is ameliorated by good glycemic control. This study tested whether intensive diabetes case management could prevent or delay diabetic retinopathy in patients with established type 2 diabetes. RESEARCH DESIGN AND METHODS — This study was part of a randomized, con-trolled clinical trial of diabetes case management in type 2 diabetes in southern California counties serving low income ethnic minority populations. Subjects were randomized to inter-vention (diabetes case management) or control (traditional treatment) groups. Subjects with at least two retinal photographs (n 149) were included in this analysis to assess the effect of intervention on development or progression of diabetic retinopathy. RESULTS — Progression of retinopathy in the intervention group was not significantly less than in the control group (P 0.226). However, those in the intervention group with no evidence of retinopathy at baseline were less likely to develop diabetic retinal changes (5/48) during a mean follow-up of 23.1 months than those in the control group (10/34, 2 4.805, P 0.028). This difference remained significant in a logistic regression model that controlled fo