Abstract
Purpose :
Rapid control of blood sugar has been documented to initially worsen diabetic retinopathy before achieving long-term stability. To identify why this happens, we performed a prospective, cohort pilot study designed to evaluate the development of diabetic retinopathy (DR) in patients undergoing intensive hyperglycemic correction over a 90-day period. We hypothesize that patients’ retinopathy will worsen and, that select microRNA biomarkers will be elevated in the pathogenesis of the retinopathy. This report summarizes the retinal findings after 3 months of intensive hyperglycemic therapy.
Methods :
21 diabetic patients were identified via a Temple Ophthalmology electronic medical record database search based on past HbA1c results. The mean age of study participants was 50 (std. dev = 13.3) years. Patients with pre-existing ocular (excluding DR) or autoimmune conditions were not included. Each subject received monetary compensation for their participation. Fundoscopic images and HbA1c levels were obtained at the initial visit prior to commencing their standard of care pharmacological treatment. Each subject returned for three subsequent visits during the 90-day study period to obtain further retinal imaging and HbA1c readings. Fundoscopic images were deidentified, randomized, and interpreted by a retinal ophthalmologist. The data, comprising of image interpretations and HbA1c levels, were summarized utilizing descriptive statistics.
Results :
Of the initial 21 participants, 10 patients either withdrew or did not complete the study and were therefore omitted from the analysis. Additionally, 2 subjects with greater than one uninterpretable fundoscopic image were likewise excluded. With 9 subjects remaining, the mean HbA1c at the initial visit was 9.6% (std. dev = 1.1, SEM = 0.38). Over three subsequent monthly visits, the mean HbA1c was 9.2% (std. dev = 1.5, SEM = 0.49); 8.8% (std. dev = 1.6, SEM = 0.52); and 8.7% (std. dev = 1.7, SEM = 0.58). At the initial, first, second, and third month visits, 11.1%, 33.3%, 22.2%, and 22.2% of patients, respectively, had fundoscopic images suggestive of DR.
Conclusions :
The percentage of subjects with DR increased, while average HbA1c levels decreased with intensive hyperglycemic therapy over a 90-day period.
This is a 2020 ARVO Annual Meeting abstract.