The New Science That Shows How Optimal Medical Therapy Prevents Blindness from Diabetes
Yesterday we discussed how we could reduce eye damage from diabetes at lower cost. The diagram above shows the core signaling involved. Most patients with type 2 diabetes have excessive abdominal fat which causes more angiotensin II production. Angiotensin II increases vascular endothelial growth factor (VEGF) levels in the eye. Losartan precisely blocks Angiotensin II effects and reduces VEGF levels in the eye for $9 per month.
Any growth factor can go in the purple box in the diagram that contains VEGF. For example, insulin is a growth factor also and it promotes the same signaling to the mechanistic target of rapamycin (mTOR) that stimulates growth in the tiny eye vessels that cause diabetic retinopathy. That is one reason treatments that reduce insulin requirements like carbohydrate restriction, metformin, and SGLT2 inhibitors are part of our recommended optimal medical therapy protocol.
This is another example of how the best care is the least expensive care. Vascular endothelial growth factor (VEGF) is one of the direct causes of diabetic eye damage. One treatment in more advanced disease is an antibody against VEGF. In usual care, the care that most people receive, patients receive these expensive antibodies against VEGF via an injection directly into the eyeball once a month. Optimal medical therapy (OMT) interferes with VEGF production and thus prevents diabetic eye disease by interfering directly with the molecular biology that causes it.
Losartan and lisinopril are medications that were developed to treat high blood pressure. They interfere precisely with angiotensin II. They are well known to have a beneficial impact beyond lowering the blood pressure on chronic kidney disease and heart failure progression. They also have that impact on diabetic eye disease because angiotensin II increases VEGF production. By blocking angiotensin II, you knock down VEGF production very precisely and you slow the progression of diabetic eye disease. Statins reduce VEGF levels in the eye. Metformin reduces VEGF signaling. Aldosterone aggravates retinopathy as well and that effect can be mitigated with spironolactone. Patients with diabetes on optimal medical therapy lose their vision one third as often as patients in usual care. New science helps us understand precisely why OMT is so effective. Medicine educators are not teaching OMT and medical institutions are not delivering it. We have a lot of work to do to bring this excellent treatment to all Americans who need it. Won’t you join us in working towards that goal. wbestermann@congruityhealth.com