Previous dramatic reduction of HbA1c and retinopathy in Type 2 Diabetes

Abstract

Aims: Does Diabetic Retinopathy (DR) relate to a previous dramatic reduction of HbA1c in Type 2 Diabetes (T2D)? Methods: In patients hospitalized for T2D, we collected HbA1c values from previous years, and we defined "Rapid declinors" by a more than −3% reduction between two consecutive HbA1c, and "sustained moderate declinors" by HbA1c declining less than −3%. We analyzed the relation between DR and previous HbA1c courses, adjusted for other risk factors. Results: Our 680 patients had a mean HbA1c at 8.7 ± 1.7% at admission and 8.7 ± 1.8 to 9.0 ± 2.2% during previous years (1500 HbA1C values collected), and 24% had a DR. A previous rapid decline of HbA1c occurred in 13.5% of subjects and related to DR (OR = 1.86, 95%CI:1.02-3.40), especially proliferative (OR = 2.64, 95% CI:1.02-6.80), after adjustment for age, gender, body mass index, arterial hypertension and diabetic kidney disease, blood lipids and statin treatment, duration of diabetes and mean previous HbA1c. A previous moderate reduction of HbA1c as occurred in 28.3% other subjects was not related to DR. Conclusions: In subjects hospitalized for T2D, a previous rapid decline of HbA1c was related to proliferative DR, whereas a sustained moderate decline appeared to be safe.

Epigenetic Mechanisms in Type 2 Diabetes Retinopathy: A Systematic Review

“…DR is a highly specific microvascular complication of diabetes and its main risk factors are long diabetes duration and poor glucose, lipid, and blood pressure control [ 59 , 60 , 61 ]. In addition, unhealthy lifestyles—low physical activity level, unbalanced diet and tobacco consumption—could directly contribute to the development of DR and other diabetes-related vascular complications [ 7 , 62 , 63 ].…”

Effect of Statin Therapy on Diabetes Retinopathy in People With Type 2 Diabetes Mellitus: A Meta-Analysis

“…The exposure to oxidative stress in diabetic patients may promote lipid peroxidation, leading to the determinism of microvascular dysfunction in DM. 46 Rapid decline of HbA1c 37 and changed fibrin-clot properties 38 were associated with DR. Advanced glycosylation end products (AGEs), protein kinase C (PKC) pathways and renin–angiotensin system (RAS) activation might have important roles in the development of DR. 44 Besides the consistent risk factors for DR (hyperglycaemia, hypertension, diabetes duration), 47 dyslipidaemia might be a risk factor. Furthermore, the AGE and protein kinase C (PKC) pathways mentioned above are involved in the lipid levels.…”

“…The exposure to oxidative stress in diabetic patients may promote lipid peroxidation, leading to the determinism of microvascular dysfunction in DM. 46 Rapid decline of HbA1c 37 and changed fibrin-clot properties 38 were associated with DR.…”

My tryst with academia – Reflections from an era gone by

“…Additionally, the legacy of abrupt glucose control in type-2 DM increases the risk of proliferative diabetic retinopathy in later years. [ 3 ] Unless backed by prompt bench research that explores the biology of what you observe in your patients, clinical research is, at best, a story that you start telling but stop halfway through. Dr Badrinath paid me a rich compliment for publishing in one of the most prestigious international journals!…”