In the JournalsPerspective

HbA1c a major risk factor in retinopathy progression

The strongest risk factor in the progression of retinopathy was mean HbA1c, according to findings presented in Diabetes Care.

The researchers also stated that elevated albumin excretion rate and diastolic blood pressure were modifiable risk factors associated with retinopathy progression.

Dean P. Hainsworth, MD, and colleagues sought to identify retinopathy risk factor outcomes in the context of a multicenter study with a well-characterized cohort of participants with type 1 diabetes after 30 years of follow-up.

The researchers examined the risks for proliferative diabetic retinopathy (PDR), clinically significant macular edema (CSME) and ocular surgery.

Hainsworth and colleagues found the rate of ocular events per 1,000 person years was 12 for participants with PDR, 14.5 for CSME and 7.6 in ocular surgery. Sixty-five percent of the participants remained free of PDR, 70% were free of CSME, and 75% remained free of ocular surgery.

The researchers wrote that the greatest risk factors for PDR, in descending order, were higher mean HbA1c, longer duration of type 1 diabetes, elevated excretion rate and higher mean diastolic blood pressure (BP). Risk factors for CSME were higher mean HbA1c, longer duration of type 1 diabetes and greater age and diastolic BP.

In ocular surgeries, risk factors included higher mean HbA1c, older ag, and longer duration of type 1 diabetes, Hainsworth and colleagues wrote.

“The general principles derived from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study most likely apply to current patients with [type 1 diabetes], but the higher rate of overweight and obesity in current patients may lead to additional risk factors,” Hainsworth and colleagues wrote. – by Earl Holland Jr.


Disclosures: The authors report no relevant financial disclosures.

The strongest risk factor in the progression of retinopathy was mean HbA1c, according to findings presented in Diabetes Care.

The researchers also stated that elevated albumin excretion rate and diastolic blood pressure were modifiable risk factors associated with retinopathy progression.

Dean P. Hainsworth, MD, and colleagues sought to identify retinopathy risk factor outcomes in the context of a multicenter study with a well-characterized cohort of participants with type 1 diabetes after 30 years of follow-up.

The researchers examined the risks for proliferative diabetic retinopathy (PDR), clinically significant macular edema (CSME) and ocular surgery.

Hainsworth and colleagues found the rate of ocular events per 1,000 person years was 12 for participants with PDR, 14.5 for CSME and 7.6 in ocular surgery. Sixty-five percent of the participants remained free of PDR, 70% were free of CSME, and 75% remained free of ocular surgery.

The researchers wrote that the greatest risk factors for PDR, in descending order, were higher mean HbA1c, longer duration of type 1 diabetes, elevated excretion rate and higher mean diastolic blood pressure (BP). Risk factors for CSME were higher mean HbA1c, longer duration of type 1 diabetes and greater age and diastolic BP.

In ocular surgeries, risk factors included higher mean HbA1c, older ag, and longer duration of type 1 diabetes, Hainsworth and colleagues wrote.

“The general principles derived from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study most likely apply to current patients with [type 1 diabetes], but the higher rate of overweight and obesity in current patients may lead to additional risk factors,” Hainsworth and colleagues wrote. – by Earl Holland Jr.


Disclosures: The authors report no relevant financial disclosures.

    Perspective
    Kyle Sandberg

    Kyle Sandberg

    It is no surprise that this 30+ year analysis of type 1 diabetics found a strong correlation between the development of diabetic retinopathy and increased HbA1c. It also identified nonmodifiable risk factors such as disease duration and age. These factors are well known to the average clinician, and this study does little to impact our traditional patient counseling on these points. However, it highlights other important factors that should influence the clinical evaluation of our type 1 diabetics, including blood pressure, albumin excretion rates and cholesterol levels. Simply put, the earlier these factors are managed, the more likely our patients will avoid PDR, CSME or surgical intervention.

    While the ability to directly manage these nonglycemic factors is often limited by state laws, there are no restrictions limiting the ability to measure blood pressure in office or discuss the importance of routine lab work. The data specifically suggests that diastolic blood pressure control is among the top modifiable risk factors for development of PDR and CSME.

    A simple in-office blood pressure measurement should be routine on all diabetics. Diastolic readings above 80 mm Hg warrant referral for intervention. Furthermore, analysis of lab work to ensure that cholesterol and albumin excretion rates are within normal ranges completes the clinical picture for determining risk of retinopathy progression. This study once again highlights the important role that optometrists play in the management and education of their diabetic patients to prevent vision loss.

    • Kyle Sandberg, OD, FAAO
    • Assistant professor
      Chief, Refractive Surgery and Laser Services
      Chief, Outpatient Surgery Service
      Rosenberg School of Optometry

    Disclosures: Sandberg reports he is a consultant for Shire Pharmaceuticals.