Katja Hatz1, Anna Elisabeth Minder2, Roger Lehmann3, Tilman Drescher4, Bianca Gerendas5, Ursula Schmidt-Erfurth5, Alexandra Kaider6, Christian Pruente7, Henryk Zulewski8. 1. Vista Klinik Binningen, Binningen, Switzerland; Department of Ophthalmology, University of Basel, Basel, Switzerland; Vienna Reading Center, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. 2. Division of Endocrinology & Diabetes, Stadtspital Triemli, Zürich, Switzerland. 3. Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Zürich, Switzerland. 4. Division of Endocrinology & Diabetes, Kantonsspital St. Gallen, St. Gallen, Switzerland. 5. Vienna Reading Center, Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. 6. Center for Medical Statistics, Informatics and Intelligent Systems, Section for Clinical Biometrics, Medical University of Vienna, Vienna, Austria. 7. Department of Ophthalmology, Kantonsspital Baselland, Liestal, Switzerland; Department of Ophthalmology, University of Basel, Basel, Switzerland. Electronic address: christian.pruente@unibas.ch. 8. Division of Endocrinology & Diabetes, Stadtspital Triemli, Zürich, Switzerland; Department Biosystems Science and Engineering (D-BSSE), ETH Zürich, Mattenstrasse 26, Basel, Switzerland; Faculty of Medicine, University of Basel, Switzerland. Electronic address: henryk.zulewski@unibas.ch.
Abstract
AIM: Prevalence of retinopathy (DR) in patients with type 1 diabetes treated with education-based intensified insulin therapy (EBIIT) and its association with parameters of glucose control. METHODS: 151 patients with mean diabetes duration of 14.3 years [SD ± 5.8]) were analyzed. Eyes were examined using standardized 7 field ETDRS (Early Treatment Diabetic Retinopathy Study) settings and images analyzed by a professional external reading center. The glucose exposure over time was defined as HbA1c years, i.e. the sum of the differences between annual mean HbA1c (in %) minus the ideal HbA1c of 6.0% (42 mmol/mol) for each diabetes year (e.g. HbA1c of 8% (64 mmol/mol) over 6 years gives an excess HbA1c of 2.0% (22 for mmol/mol) for 6 years, resulting in 12 HbA1c years (or 131 for mmol/mol)). RESULTS: The median (interquartile range) of individual mean HbA1c was 7.3% (6.8-7.8) [56 mmol/mol (51-62)]. and the median HbA1c years was 16.8 (9.1-29.1) [183 mmol/mol (99-319)]. No evidence for DR was found in 59 patients (39%), stage 1 DR in 43 (28.5%), stage 2 in 41 (27.2%), stage 3 in 7 (4.6%) and proliferative DR stage 4 in 1 patient. The best correlation between severity of DR and diabetes control measures was found for HbA1c years (Pearson r = 0.41, p < 0.001). CONCLUSIONS: In type 1 diabetes EBIIT is associated with good diabetes control and a low prevalence of DR. The cumulative glucose exposure over time given as HbA1c years is the best predictor for development of DR. ClinicalTrials.gov Identifier: NCT02307110.
AIM: Prevalence of retinopathy (DR) in patients with type 1 diabetes treated with education-based intensified insulin therapy (EBIIT) and its association with parameters of glucose control. METHODS: 151 patients with mean diabetes duration of 14.3 years [SD ± 5.8]) were analyzed. Eyes were examined using standardized 7 field ETDRS (Early Treatment Diabetic Retinopathy Study) settings and images analyzed by a professional external reading center. The glucose exposure over time was defined as HbA1c years, i.e. the sum of the differences between annual mean HbA1c (in %) minus the ideal HbA1c of 6.0% (42 mmol/mol) for each diabetes year (e.g. HbA1c of 8% (64 mmol/mol) over 6 years gives an excess HbA1c of 2.0% (22 for mmol/mol) for 6 years, resulting in 12 HbA1c years (or 131 for mmol/mol)). RESULTS: The median (interquartile range) of individual mean HbA1c was 7.3% (6.8-7.8) [56 mmol/mol (51-62)]. and the median HbA1c years was 16.8 (9.1-29.1) [183 mmol/mol (99-319)]. No evidence for DR was found in 59 patients (39%), stage 1 DR in 43 (28.5%), stage 2 in 41 (27.2%), stage 3 in 7 (4.6%) and proliferative DR stage 4 in 1 patient. The best correlation between severity of DR and diabetes control measures was found for HbA1c years (Pearson r = 0.41, p < 0.001). CONCLUSIONS: In type 1 diabetes EBIIT is associated with good diabetes control and a low prevalence of DR. The cumulative glucose exposure over time given as HbA1c years is the best predictor for development of DR. ClinicalTrials.gov Identifier: NCT02307110.
Authors: Janina de Sales Guilarducci; Breno Augusto Ribeiro Marcelino; Isaac Filipe Moreira Konig; Tamira Maria Orlando; Mary Suzan Varaschin; Luciano José Pereira Journal: Diabetol Metab Syndr Date: 2020-08-10 Impact factor: 3.320