Current pattern of ophthalmologists' awareness and importance of HbA1c in managing diabetic retinopathy patients.

Dear Editor:

HbA1c levels correlate well with diabetic control, the progress and the outcome of diabetic retinopathy (DR).[12] Till date and to the best of our knowledge, there is no study that evaluates the knowledge of ophthalmologists regarding the monitoring patterns of HbA1c in their diabetic patients. We have conducted a study that surveys the prevailing clinical practices of ophthalmologists about HbA1c estimation, awareness and relevance of HbA1c in managing DR patients.

A prevalidated printed questionnaire comprising of questions regarding the normal and abnormal levels of HbA1c, clinical significance, association of HbA1c with DR and other co-morbid conditions was circulated among ophthalmologists attending an annual conference.

In total, 900 questionnaires were distributed of which 738 were returned. Total of 690 ophthalmologists completed our questionnaire fully (76.67% response rate), which formed the sample size of our study [Supplementary Fig. 1].

The normal range of HbA1c was correctly answered as 4–5.6% by just 41.07% (283) of ophthalmologists.[3] These values for the awareness of ophthalmologists of the normal range of HbA1c were statistically significant by Chi-square (X2) testing; p = 0.01 (99%). Only 60.75% (420) of ophthalmologists correctly recommended HbA1c for all diabetic patients, while 80% (552) correctly said that HbA1c provided an average of plasma glucose control for the last 8–12 weeks.[3] In total, 97.37% (672) of ophthalmologists overwhelmingly agreed that the higher the HbA1c, the higher the risk of developing diabetic complications,[4] while only 2.63% (18) disagreed. A total of 41.59% (287) correctly opted for HbA1c target <7%,[1] while 59.82% (413) thought it should be done every 3 months [Fig. 1].

Figure 1

Results of the HbA1c questionnaire used- pictorial representation

Our study provides a cross-sectional assessment of the awareness and perception of ideal glycemic targets among ophthalmologists. Patient awareness of HbA1c is important,[5] of course, but so also is the awareness and knowledge of ophthalmologists. To our knowledge and belief, this has not been considered prior to the present study.

Results from the Diabetes Control and Complications Trial[2] showed a strong exponential relationship between the risk of DR and the mean HbA1c level. The lack of appropriate glycemic control is a significant risk factor for the onset and progression of DR.[2] Therefore, the importance of HbA1c estimation cannot be emphasized enough.

We found out here that though ophthalmologists were reasonably aware of the importance of HbA1c in glycemic control, there was variability in the practice pattern of frequency of testing as well as its interpretation. Updating knowledge by webinars and workshops with credit point incentives will definitely help to fill these lacunae.

This is the first study that explores the knowledge and awareness of ophthalmologists regarding HbA1c as a potential index of glycemic control. This, we feel, is the singular strength of this study. The main limitation is that the sample size should have been larger. Also, demography of the responding ophthalmologists regarding their area of practice, subspeciality status, or training has not been explored.

To conclude, ophthalmologists in India need to be more aware of HbA1c and its immense importance in managing diabetic patients who are at risk of losing their sight permanently.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

HbA1c questionnaire used in this study