HbA1c, systolic blood pressure variability and diabetic retinopathy in Asian type 2 diabetics: 亚洲2型糖尿病患者的HbA1c以及收缩压的变异性与糖尿病视网膜病变之间的关系. (22nd June 2016) - Foo, Valencia
Abstract: Background: The aim of the present study was to examine the association between variability in HbA1c or systolic blood pressure (SBP) and diabetes‐specific moderate retinopathy in Asians with type 2 diabetes (T2D). Methods: A retrospective study was conducted of 172 cases of moderate diabetic retinopathy (DR) cases and 226 controls without DR, matched for age, sex, and ethnicity. Serial HbA1c and SBP (range 3–6 readings) over the 2 years prior to photographic screening of DR were collected. Intrapersonal mean and SD values for HbA1c (iM‐HbA1c and iSD‐HbA1c) and SBP (iM‐SBP and iSD‐SBP) were derived. Moderate DR was assessed from digital retinal photographs and defined as levels >43 using the Early Treatment Diabetic Retinopathy Study scale. Results: Cases of moderate DR had higher iM‐HbA1c (8.2 % vs 7.3 %; P = 0.001), iSD‐HbA1c (1.22 vs 0.64; P = 0.001), iM‐SBP (136.8 vs 129.6 mmHg; P = 0.001) and iSD‐SBP (13.3 vs 11.1; P = 0.002) than controls. In the multivariate regression model adjusted for age, gender, ethnicity, duration of diabetes, SBP, and HbA1c, iM‐HbA1c and iM‐SBP were significantly associated with moderate DR (odds ratio [OR] 1.80, 95 % confidence interval [CI] 1.37–2.36; and OR 1.03, 95 % CI 1.01–1.05, respectively). Neither iSD‐HbA1c nor iSD‐SBP were associated with moderate DR. When stratified by HbA1c <7 %, only iSD‐SBP remained significantly associated with moderate DR (OR 1.11, 95 % CI 1.01–1.21). Conclusion: In a cohort of Asian patients with T2D, both higher mean HbA1c levels and SBP, but not their variability, were associated with moderate DR. Among those with good glycemic control, wider variability of SBP is associated with moderate DR. Highlights: In a retrospective cohort of Asian patients with type 2 diabetes, mean HbA1c and systolic BP were significantly associated with moderate DR HbA1c and systolic BP variability were not significantly associated with moderate DR Among those with good glycemic control, wider variability of systolic BP was associated with moderate DR. Future prospective studies with a large sample size and sequential HbA1c and systolic BP values collected at uniform intervals are warranted to confirm or refute our study findings Association of HbA1c and systolic blood pressure variables with moderate diabetic retinopathy