Is it of Importance to Estimate Hba1c Excursion among Type 2 Diabetis Mellitus Patints with Diabetic Retinopathy

Abstract

Diabetic Retinopathy (DR) continued to be the leading cause of sight threatening in the middle – age population with diabetes mellitus that affect job performance and quality of life for millions of people word wide. Glycated hemoglobin (HbA1c) identified as modifiable risk factors for DR, in addition to its importance in the diagnosis and as an index of glycemic control, so that the absolute HbA1c value and/or variability were included in many studies and researches for their implication to both microvascular and macrovascular complications of diabetes. The study aims to see the pattern and risk factor(s) of DR, and whether the estimation of HbA1c excursion is of importance as associated risk or index in among type 2 diabetic patients. This is an observational descriptive cross sectional study involved 404 type 2 diabetic patients attending Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC) and the outpatient clinic in Faiha Teaching Hospital, in Basra, Southern Iraq between May2017–August2018. All of them were registered in the center, with their demographic, clinical, and biochemical parameters and at least 3 HbA1c readings in the last year that were taken for estimation of HbA1c mean and excursion, and they were send for full comprehensive ophthalmological assessment. The total number of the patients were 404, 157 (38.9%) male, 247 (61.1%) female. Mean age was 56.12 ± 9.58, range 31-88 years. The mean HbA1c was 9.86 ± 2, the mean HbA1c excursion evaluated in 266 patients was 2.49±1.73, the positive excursion was 2.26 ± 1.63 and the negative excursion was – 2.7 ±1.78. Diabetic retinopathy was found in 168(41.6%), background diabetic retinopathy 50 (12.4%) preproliferative diabetic retinopathy 10(2.5%), proliferative diabetic retinopathy 47(11.6%). Maculopathy found in 71 (17.6%), with exudative type 62 (15.3 %) and ischemic type in 9 (2.2 %). Conclusions: Age ≥85, duration of diabetes ≥8years, the mean maximum HbA1c ≥12.8 are independent risk for the development of DR, Age ≥45, duration of diabetes ≥4 years, BMI ≤37.5 the mean HbA1c ≥10 were independent risk for the development of diabetic maculopathy. Mean HbA1c excursion has no relation with development of DR or maculopathy, but only with subtypes of DR (background diabetic retinopathy, proliferative diabetic retinopathy).