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Jared Nielsen, ; To assess the effect of a personalized diabetes complication risk assessment performed during a retinal ophthalmology exam on glycemic control. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1412.
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To assess the effect of a personalized diabetes complication risk assessment performed during a retinal ophthalmology exam on glycemic control
Glycemic control optimization is key to reducing diabetes related complications, however long-term optimization is challenging. The Diabetic Retinopathy Clinical Research Network (DRCR.net) conducted a randomized trial to assess a standardized diabetes education intervention on glycemic control. The intervention was performed at ophthalmologists’ offices and included point-of-care HbA1c and blood pressure measurement and retinopathy severity assessment. Based on these measurements, a personalized risk of retinopathy worsening was presented to the participants including a review of past HbA1c measurements. A structured education was performed. The intervention was performed at enrollment and routine follow-up visits at least 12 weeks apart. Investigators from 42 sites were randomly assigned to provide study additional diabetes assessment and education or usual care. Adults with type 1 or 2 diabetes were enrolled into two cohorts: “more frequent” than annual follow-up (502 control and 488 intervention participants) and “annual” follow-up (368 and 388 participants). The primary outcome was mean change in HbA1c from baseline to 1 year. Secondary outcomes included body mass index, blood pressure, and diabetes self-management practices and attitudes surveys
In the “more frequent” cohort, mean (SD) change in HbA1c at 1 year was -0.1% (1.5%) in the control group and -0.3% (1.4%) in the intervention group (adjusted mean difference +0.09%, 95% confidence interval -0.12% to +0.29%, P=0.35). In the “annual” cohort, mean (SD) change in HBA1c was 0.0% (1.1%) and -0.1% (1.6%), respectively (mean difference +0.05%, 95% confidence interval -0.18% to +0.27%, P=0.63). Results were similar for all secondary outcomes
Long-term optimization of glycemic control is not achieved by a majority of individuals with diabetes. Addition of personalized education and risk assessment during retinal ophthalmology visits, as provided in this study, did not result in HbA1c improvement compared with usual care over 1 year. These data suggest that optimizing glycemic control remains a substantive challenge requiring interventional paradigms other than those examined in this study
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