RT Journal Article
SR Electronic
T1 HbA1c reduction following flash monitoring commencement is not independently associated with adverse diabetic eye disease outcomes in type 1 diabetes
JF BMJ Open Diabetes Research & Care
JO BMJ Open Diab Res Care
FD American Diabetes Association
SP e001668
DO 10.1136/bmjdrc-2020-001668
VO 8
IS 2
A1 Al-Dalla Ali, Muhammad
A1 Stimson, Roland H
A1 Dover, Anna R
A1 Forbes, Shareen
A1 Annoh, Roxanne
A1 Madill, Karen
A1 Gibb, Fraser W
YR 2020
UL http://drc.bmj.com/content/8/2/e001668.abstract
AB Introduction Intensification of therapy has been associated with early worsening of retinopathy prior to subsequent risk reduction. We sought to assess whether glycated hemoglobin (HbA1c) reduction, following flash monitoring, was associated with early worsening.Research design and methods An observational study in 541 individuals with type 1 diabetes and paired HbA1c and eye assessment prior to and following flash monitoring commencement.Results Change in HbA1c was −4 mmol/mol (IQR −9–1) (−0.4% (−0.8–0.1)) and 25% achieved a fall in HbA1c of ≥10 mmol/mol. The occurrence of the composite end point (panretinal photocoagulation, macular laser or anti-VEGF therapy) was associated with baseline HbA1c >75 mmol/mol (9.0%) (HR 4.0 (95% CI 2.0 to 7.9), p<0.001) but not with fall in HbA1c of ≥10 mmol/mol (0.9%) (HR 1.6 (95% CI 0.8 to 3.2), p=0.203) over a follow-up period of 615 days (527–863). In multivariate analysis, diabetes duration (p=0.035) and prior retinopathy (p<0.001) were most predictive of the composite end point. Baseline HbA1c was the strongest predictor of worsening retinopathy (p=0.002) or new retinopathy (p=0.002) in multivariate analysis whereas change in HbA1c was not independently associated with either (p=0.930 and p=0.830, respectively).Conclusions Progression of eye disease is associated with baseline HbA1c, diabetes duration and previous retinopathy and such individuals should be monitored during intensification of glycemic therapy. Reassuringly, the extent of glucose lowering does not appear to be an independent risk factor for early worsening of eye disease in this context.