www.diabeticretinopathy.org.uk

General

HbA1C and Retinopathy

David Kinshuck

 

patient and doctor

teamwork helps to
improve diabetic control

Controlling your diabetes can slow down diabetic complications and retinopathy. In practice this means that conditions such as retinopathy may stopped in most people, and good sight maintained. In a few people the retinopathy may still progress, but at a much slower rate. See DCCT and UKPDS.

 

Relationship between HbA1c and retinopathy

The progression rate of retinopathy is 37% less for each 10mmol/l (1%) reduction in the HbA1C or 1mmol/l of blood sugar. Teamwork is crucial to good diabetic control: the patient is the focus, but assistance from many health professionals is usually needed to assist good control.

 

Ideal Targets for HbA1c

 

At the onset of type 2 diabetes 48mmol/mol  (6.5%) is the target
if well, and diet or tablet controlled HbA1c less than 48mmol/mol (6.5%)
if very ill higher levels may be accepted
if using insulin and keen to control diabetes and able to test glucose 4-6 times day (basal bolus insulin/pump) HbA1c
48-58 mmol/mol (6.5-7.5%)
(without many hypos)
if using insulin and keen to control diabetes and able to test glucose <4 times day (basal bolus insulin/pump)..the average patient HbA1c ~ 58 mmol/mol (7.5%)
(or as low as possible without many hypos)

 

What does this mean in practice?

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testing your glucose level is essential for most people with diabetes, especially insulin users

 

 

retinopathy progression ...74% over 2 years higher for each 1% rise in HbA1c

Enlarge If your HbA1C is 53mmol/mol (7%) retinopathy may develop, but it is much slower to develop than if it is 75mmol/l (9%) . If your HbA1C is 53mmol/mol (7%) , you will have about 74% less progression after 2 years than if it is 75mmol/l (9%). Blue...no retinopathy;        red... retinopathy  

 

A graph

a graph rerling higher HbA1c to much more retinopathy

 

What is your HbA1c? Is it below 75mmol/l (9%) ? If not, can you get it lower? Ask your nurse for help.

 

enlarge The relationship between your sugar level and retinopathy and kidney disease is illustrated here.

Sudden improvement in your control

If you suddenly improve control and your HbA1C drops the retinopathy may need laser treatment. The benefits of an HbA1C drop, say from 75 (9%)  to 53mmol/l ( 7%), are long term. The retinopathy may actually deteriorate in the short term, and so require laser. If this is difficult to understand, ask your ophthalmologist to explain.
After two-three years however, assuming you have any laser that may be necessary, you will be better off and the retinopathy will be less active than it would otherwise have been. Retinopathy progression detail.