RISK FACTORS AND PROGNOSTIC MODELS OF DIABETIC RETINOPATHY AND OPPORTUNITIES OF PRECISION MEDICINE (analytical review)

Abstract

Background. One of the priority directions of modern medicine development is prognostication, the purpose of which is to increase the accuracy and reliability of forecasts of outcomes related to diseases. In diabetes mellitus (DM), the task of precision medicine is to adapt diagnostic and treatment methods to subgroups of the population with similar characteristics in order to achieve maximum effectiveness. Currently, most forecasting methods are too narrowly focused on the blood glucose level, which makes the wide implementation of precision medicine approaches promising. Aim: to determine risk factors, existing prognostic models and possibilities of precision medicine to improve the effectiveness of diagnosis and treatment of diabetic retinopathy (DR). Materials and methods. The search for sources of Ukrainian and foreign literature for the analytical review was conducted keywords using the open medical scientific database PubMed (USA). At the first stage, 470 sources were selected, of which 46 were selected for this article. Results. It was established that the progression of DR in the initial stages is a consistent, significant and independent predictor of proliferative DR. The condition of the retina reflects the influence of the systemic environment and, in turn, has prognostic value for cardiovascular, renal and other complications. Most of the new biomarkers have yet to be tested in clinical practice, which requires additional studies to predict DR and clinical outcomes of its treatment. Most models include age, sex, ethnicity, and lifestyle variables as predictors: smoking, medical history, glycated hemoglobin, and DM duration. Increasing age of patients, DM duration and concomitant arterial hypertension are independent predictors of microvascular complications. We collected a database including 359 patients (359 eyes) with type 2 diabetes with DR of varying severity, the results of clinical, ophthalmological and laboratory examinations. Models for predicting progression and effectiveness of individualized treatment are being developed.