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Category: Volume 10 Issue 01 January 2022
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Title: Correlation between Glycosylated Haemoglobin in Type 2 Diabetes Mellitus and Diabetic Retinopathy

Authors: Dr Vinayak Ganesh Bhat MD, Dr Rajkumar Patra MS

 DOI: https://dx.doi.org/10.18535/jmscr/v10i1.03

Abstract

Introduction: Diabetic Retinopathy is one of the major causes of visual impairment and blindness in Indians suffering from Diabetes mellitus. Early detection and treatment are the key to stop its progression. Onset and progression of Diabetic Retinopathy can be assessed by regular HbA1c tests in every three months, Duration of diabetes, Hypertension, Hypercholesterolemia. This study assess association between HbA1c levels and severity of Retinopathy.

Materials and Methods: this was a progressive study conducted in Maharajah’s Institute of Medical Sciences, Vizianagaram, Andhra Pradesh over a period of 1 year. Total 100 patients suffering from Type 2 diabetes mellitus and visiting institution were included in this study. HbA1c, Fasting and post prandial blood glucose, lipid profile were tested in all the subjects. Ophthalmological fundus examination was done using slit lamp biomicroscopy and indirect ophthalmoscopy in all patients. Patients were followed up for 1 year for progression of disease.

Results: there was a strong association between high and uncontrolled levels of HbA1c and severity of Diabetic retinopathy. A statistically significant association was found (p < 0.01). however, retinopathy was not related to HbA1c alone. There were other risk factors like duration of diabetes, Hypercholesterolemia which also contributed to the progression.

Conclusion: HbA1c levels > 7.0% was significantly associated with Diabetic Retinopathy. The severity of retinopathy was dependent on Blood glucose levels and duration of diabetes.  Strict control of HbA1c levels is crucial to prevent diabetic retinopathy and its vision impairing complications.

References

  1. Babran M, Laher I. Type II Diabetes mellitus in Arabic-speaking countries. International journal of endocrinology 2012;2012.
  2. Kannan, Ramya. India is home to 77 million diabetics, second highest in the world. The Hindu. ISSN 0971-751X. 2020-04-29.
  3. Krishnamurti U, Steffes MW. Glycohemoglobin: a primary predictor of the development or reversal of complications of diabetes mellitus. Clin Chem. 2001;47 (7):1157-65.
  4. Davis MD, Fisher MR, Gangnon RE, Barton F,Aiello LM, Chew EY, Ferris FL 3rd, Knatterud GL. Risk factors for high-risk proliferative diabetic retinopathy and severe visual loss: Early Treatment Diabetic Retinopathy Study Report #18. Invest Ophthalmol Vis Sci. 1998 Feb; 39(2):233-52.
  5. Ciulla TA, Amador AG, Zinman B. Diabetic retinopathy and diabetic macular edema: pathophysiology, screening, and novel therapies. Diabetes Care. 2003 Sep;26(9):2653-64.
  6. Klein R, Klein BE, Magli YL, Brothers RJ, MeuerSM, Moss SE, Davis MD. An alternative method ofgrading diabetic retinopathy. Ophthalmology 1986 Sep; 93(9):1183–7.
  7. Agarwal S, Raman R, Paul PG, Rani PK, Uthra S, Gayathree R, McCarty C, Kumaramanickavel G,Sharma T. Sankara Nethralaya-Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN-DREAMS1): study design and  research methodology. Ophthalmic Epidemiol. 2005 Apr;12(2):143-53.
  8. Tapp RJ, Tikellis G, Wong TY, Harper CA, Zimmet PZ, Shaw JE; Australian Diabetes Obesity and Lifestyle Study Group. Longitudinal association of glucose metabolism with retinopathy: results from the Australian Diabetes Obesity and Lifestyle (Aus Diab) study. Diabetes Care. 2008 Jul; 31(7):1349-54.  doi:10.2337/dc07-1707. Epub 2008 Apr 14.
  9. Brown JB, Pedula KL, Summers KH. Diabetic retinopathy: contemporary prevalence in a well controlled population. Diabetes Care. 2003 Sep; 26(9):2637-42.
  10. Anitha B, Sampathkumar R, Balasubramanyam M,Rema M. Advanced glycation index and its association with severity of diabetic retinopathy in type 2 diabetic subjects. J Diabetes Complications. 2008 Jul-Aug;22(4):261-6.  doi:10.1016/j.jdiacomp.2007.05.005.Epub2008 Apr 16.
  11. Priyadharshini N, Annamalai R, Muthayya M.K. The relationship between blood sugar levels (glycosylated haemoglobin) and the risk of development of diabetic retinopathy. Int JMed Res Rev 2017;5(01):61-67.doi:10.17511/ijmrr. 2017.i01.09.
  12. Liew G, Wong VW, Ho IV. Mini–Review: Changesin the Incidence of and Progression to Proliferative and Sight-Threatening Diabetic Retinopathy Over the Last30 Years. Ophthalmic Epidemiol. 2017 Jan 19: 1-8. doi:10.1080/09286586.2016.1259638.
  13. Akil H, Buluş AD, Andiran N, Alp MN. Ocular manifestations of Type 1 diabetes mellitus in pediatric population. Indian J Ophthalmol. 2016 Sep;64(9):654- 658. doi:10.4103/0301-4738.194336.
  14. Roy S, Kern TS, Song B, Stuebe C. Mechanistic Insights into Pathological Changes in the Diabetic Retina: Implications for Targetng Diabetic Retinopathy. Am J Pathol. 2017 Jan; 187(1): 9-19. doi: 10.1016/jajpath.2016.08.022.
  15. Umayahara Y, Fujita Y, Watanabe H, Kasai N,Fujiki N, Hatazaki M, Koga M. Association of glycatedalbumin to HbA1c ratio with diabetic retinopathy butnot  diabetic nephropathy in patients with type 2diabetes. Clin Biochem. 2016; Dec 5. pii: S0009-9120 (16)30390-3. doi: 10.1016/j.clinbiochem. 2016.11.032.
  16. Amin ZA, Islam QU, Mehboob MA. Comparison of serum lipid profile in Type-2 Diabetics with and without retinopathy in Pakistani population. Pak J Med Sci. 2016 Nov-Dec;32(6):1349-1353. doi: 10.12669 /pjms. 326.11056.

Corresponding Author

Dr Rajkumar Patra MS

Assistant Professor, Department of Ophthalmology, Maharajah’s Institute of Medical Sciences, Nellimarla, Vizianagaram, Andhra Pradesh, India