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Q. Nguyen, D.V. Do; Correlation Between Hemoglobin A1C and Persistent Diabetic Clinically Significant Macular Edema . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3951.
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Purpose: The United Kingdom Prospective Diabetes Study demonstrated that intensive control of blood glucose [reducing hemoglobin A1C (HbA1C) from 7.9% to 7.0%] was associated with a decrease in microvascular complications, including the need for retinal photocoagulation, in patients with type 2 diabetes mellitus (DM). Our study was to determine the correlation between hyperglycemia, as measured by HbA1C, and persistent clinically significant macular edema (CSME) in patients with type 2 DM. Methods: The records of all type 2 diabetics who received eye care from a single retina specialist (QDN) for persistent CSME from August 2001 to August 2002 were reviewed. Subjects who had the following criteria were identified: (1) persistent CSME, as detected by contact lens biomicroscopy, despite at least 2 focal laser photocoagulation (FLP); (2) CSME, in one or both eyes, present at least 3 months from the last FLP; (3) HbA1C measured at the Johns Hopkins Medical Institutions within 3 months of the time at which persistent CSME was detected (patients who had their HbA1C values measured elsewhere were excluded to provide uniformity among the laboratory results). Medical records of these individuals were reviewed to correlate hyperglycemia, as measured by HbA1C, to persistent CSME. Results: Fifty patients were identified. Thirty-three patients were women. Age ranged from 43 to 82 years (mean 65 years). Nineteen patients (38%) had unilateral persistent CSME; 31 patients (62%) had bilateral CSME. The average number of FLP among all eyes was 3.5. HbA1C values ranged from 5.3% to 15.6% (mean 8.9%; median 8.7%). Forty-one patients (82%) had HbA1C greater than 7.0%, and 36 patients (72%) had HbA1C greater than 7.5%, within 3 months of the time of their persistent CSME. Among the 19 patients with unilateral CSME, mean HbA1C was 8.2%; median was 8.4%. Among the 31 patients with bilateral CSME, mean HbA1C was 9.2%; median was 9.0%. Conclusions: Patients with type 2 DM and persistent CSME had elevated HbA1C at time of their disease, indicating that persistent CSME may be associated with less tightly controlled DM. Patients with bilateral diseases may have diabetes that is less tightly controlled than those with unilateral disease. Management of persistent CSME may require tighter glucose control (in relative to the recommended HbA1C value of 7.0%) in addition to other forms of ophthalmic treatments. Awareness and understanding the HbA1C values of patients with persistent CSME may help ophthalmologists provide better management of CSME.
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