Role of Lifestyle Modification in Preventing Diabetic Retinopathy – A Systematic Review DR and lifestyle

Abstract

The vision-threatening stages of diabetic retinopathy (DR), which is still one of the main causes of vision loss, are mostly determined by progression rather than onset.  The need for scalable adjuncts like lifestyle modification is highlighted by the fact that, despite their effectiveness, pharmaceutical and procedural therapy are expensive, time-consuming, and not always available. In order to discuss the implications for clinical pharmacy practice, it is necessary to systematically synthesize the evidence regarding the potential effects of lifestyle modification programs, dietary patterns, physical activity and sedentary time, alcohol and tobacco use, sleep/mental health, and multi-component programs on the progression of diabetes mellitus in adults with diabetes and pre-existing DR. In accordance with PRISMA 2020, we used MeSH and free-text phrases covering population, intervention, and progressive outcomes to search seven databases (Google Scholar, PubMed/MEDLINE, Web of Science, Scopus, ScienceDirect, ProQuest, and Cochrane Library).  We searched in duplicate for eligible trials (adults with diabetes; retinal endpoints like development to proliferative DR/diabetic macular edema or therapy commencement; peer-reviewed designs). The MMAT 2018 was utilized to evaluate the methodological quality.  The protocol (CRD420251058239) was registered on PROSPERO. While culturally specific interventions improved glycemia and screening, increased physical activity and less sitting were associated with slower DR progression and fewer treatments across a variety of research designs.  Omega-3-rich Mediterranean/low-GI meals were linked to a decreased incidence of DR that could cause blindness, but refined high-GI staples had the opposite effect.  Depression and lack of sleep increased risk; modest alcohol consumption did not clearly improve development; and smoking results were mixed.  Benefits most likely manifest as improved lipids, blood pressure, and HbA1c. A Mediterranean/low-GI diet, frequent exercise that breaks up sitting, and sleep/mental health assistance are all examples of lifestyle changes that regularly enhance conventional DR care and are achievable for pharmacist-led implementation, especially in areas with limited resources.  To enhance causal inference, more studies using objective behavior measures and standardized retinal endpoints are necessary, given the reliance on observational designs and potential exposure misclassification.