Glycemic Control in Patients After Initiation of Treatment for Vision-Threatening Diabetic Retinopathy

Abstract

Purpose: To understand changes in glycemic control in patients being managed with vision-threatening diabetic retinopathy (DR). Methods: A retrospective cohort study was performed of patients with type 2 diabetes mellitus who were at least 18 years old. Patients who started treatment for vision-threatening DR were matched with controls based on age, sex, race/ethnicity, duration of diabetes, history of diabetes, and history of hypertension. The primary outcome was the difference in hemoglobin A_1c (HbA_1c) change after 12 months between cases and controls. Results: Four hundred fifty patients were included (225 cases paired with 225 controls); 58.7% of patients were men, and 33.8% were Hispanic. The mean (±SD) baseline HbA_1c was 8.12% ± 1.57%. Patients receiving retinal interventions did not experience a significant change in HbA_1c compared with controls 12 months after starting treatment (0.11% ± 1.51% vs -0.02% ± 1.52%; P = .31). In addition, there was not a significant difference in HbA_1c change between cases and controls when considering the number of interventions: 2 or fewer interventions (+0.08% ± 1.30% vs -0.07% ± 1.15%; P = .46), 3 to 6 interventions (+0.41% ± 1.71% vs +0.01% ± 2.0%; P = .08), and 7 or more interventions (-0.17% ± 1.49% vs 0.0% ± 1.31%; P = .50). Conclusions: Patients who received treatment for vision-threatening DR did not experience a change in HbA_1c. Increasing number of retinal interventions also did not appear to impact glycemic control. There appears to be a missed opportunity for improving diabetes management in patients with vision-threatening DR.

Keywords: diabetes mellitus; diabetic macular edema; hemoglobin A1c; intravitreal injection; laser; proliferative diabetic retinopathy; vision-threatening diabetic retinopathy.