CORRELATION OF HBA1C LEVEL WITH DIABETIC RETINOPATHY

Authors

DOI:

https://doi.org/10.55519/JAMC-01-13925

Keywords:

HbA1c, Diabetic Retinopathy, Proliferative Diabetic retinopathy, Non-Proliferative Diabetic Retinopathy, Vitreous Hemorrhage

Abstract

Background: Diabetes mellitus (DM) is considered to be a significant universal public health issue. According to the American Society of Retina Specialists, diabetic retinopathy (DR) is a complication of diabetes that damages retinal blood vessels. A Japanese study showed that HbA1C values can be considered as predictors for the development of DR. Thus, this study aimed to determine the correlation between HbA1c level and Diabetic Retinopathy. Methods: A descriptive cross-sectional study was conducted at the Department of Ophthalmology, Combined Military Hospital Kharian, from February 2024 to July 2024. Patients of either gender between 40 to 80 years of age with type 2 diabetes mellitus were included in this study. Complete ophthalmic examination was carried out of each patient. HbA1c was measured by standardized assay using high performance liquid chromatography. The data was analyzed using Statistical Package for Social Sciences (SPSS) version 26. Results: Out of 246 patients, 42.7% were male and 57.3% female, with a mean age of 49.26±11.47 years and a mean HbA1c of 9.11±2.54. The overall prevalence of diabetic retinopathy (DR) was 57.7%, with 52.8% having NPDR and 49% PDR. DR prevalence increased with diabetes duration and was significantly higher in those with HbA1c levels between 7–9.9%(p=0.000). The logistic regression identified age, duration of diabetes, and HbA1c levels as critical factors associated with the risk of DR. The odds ratio for HbA1c indicates higher levels are associated with increased DR risk (p<0.005). Conclusion: This study concluded that duration of diabetes and HbA1c level are important risk factors for onset or progression of Diabetic retinopathy in type 2 Diabetes and the patients with poor glycaemic control had severe diabetic retinopathy as compared to the patients with good diabetic control. There is a direct relation between HbA1c level and the severity of diabetic retinopathy.

References

1. Medscape. Diabetic Retinopathy Overview [Internet]. [cited 2025 Jan 21]. Available from: https://emedicine.medscape.com/article/117853-overview?form=fpf

2. Powers A, Niswender K, Molina C. Diabetes mellitus: diagnosis, classification, and pathophysiology. In: Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J, editors. Harrison’s principles of internal medicine. 20th ed. New York: McGraw-Hill Medical. 2020; p.2580–8.

3. Cho N, Shaw J, Karuranga S, Huang Y, da Rocha Fernandes J, Ohlrogge A, et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract 2018;138:271–81.

4. Fong DS, Aiello L, Gardner TW, King GL, Blankenship G, Cavallerano JD, et al. Retinopathy in diabetes. Diabetes Care 2004;27(Suppl 1):S84–7.

5. Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiologic study of diabetic retinopathy. II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol 1984;102(4):520–6.

6. Wang SY, Andrews CA, Herman WH, Gardner TW, Stein JD. Incidence and risk factors for developing diabetic retinopathy among youths with type 1 or type 2 diabetes throughout the United States. Ophthalmology 2017;124(4):424–30.

7. Nordwall M, Abrahamsson M, Dhir M, Fredrikson M. Impact of HbA1c, followed from onset of type 1 diabetes, on the development of severe retinopathy and nephropathy: the VISS Study (Vascular Diabetic Complications in Southeast Sweden). Diabetes Care 2015;38(2):308–15.

8. ValdezGuerrero AS, Quintana-Pérez JC, Arellano-Mendoza MG, Castañeda-Ibarra FJ, Tamay-Cach F, Alemán-González-Duhart D. Diabetic retinopathy: important biochemical alterations and the main treatment strategies. Can J Diabetes 2021;45(6):504–11.

9. Mohamed Q, Gillies MC, Wong TY. Management of diabetic retinopathy: a systematic review. JAMA 2007;298(8):902–16.

10. Rawat D. Retinopathy and its associated factors in type 2 diabetes mellitus in rural population of central India. J Med Sci Clin Res 2019;7(6):e69.

11. Kohner EM, Aldington SJ, Stratton IM, Manley SE, Holman RR, Turner RC. United Kingdom Prospective Diabetes Study, 30: diabetic retinopathy at diagnosis of non-insulin-dependent diabetes mellitus and associated risk factors. Arch Ophthalmol 1998;116:297–303.

12. Bate KL, Jerums G. Preventing complications of diabetes. Med J Aust 2003;179(9):498–503.

13. Kropp M, Golubnitschaja O, Mazurakova A, Koklesova L, Sargheini N, Vo T-TK S, et al. Diabetic retinopathy: molecular mechanisms, potential therapeutic targets, and experimental strategies. Front Mol Biosci 2023;10:1082061.

14. Khaw KT, Wareham N, Luben R, Bingham S, Oakes S, Welch A, et al. Glycated haemoglobin, diabetes, and mortality in men in the Norfolk cohort of the European Prospective Investigation of Cancer and Nutrition (EPIC-Norfolk). BMJ 2003;322(7277):15–8.

15. American Diabetes Association. 6. Glycemic targets: standards of medical care in diabetes-2018. Diabetes Care 2018;41(Suppl 1):S55–64.

16. National Institute for Health and Care Excellence. Type 1 diabetes in adults: diagnosis and management. NICE guideline; 26 August 2015. [Internet]. [cited 2019 Jul 9]. Available from: https://www.nice.org.uk/guidance/ng17

17. DiMeglio LA, Acerini CL, Codner E, Craig ME, Hofer SE, Pillay K, et al. ISPAD Clinical Practice Consensus Guidelines 2018: glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetes. Pediatr Diabetes 2018;19(Suppl 27):105–14.

18. Badawi AH, Al-barry M, Abusayf M, Rashwan M, Alghamdi A, Alsebaee A. Prevalence and risk factors of diabetic retinopathy: a clinical-based cross-sectional study in Madinah’s Tertiary Diabetic Center, Saudi Arabia. Int J Sci Res 2016;5:587–90.

19. DiMeglio LA, Acerini CL, Codner E, Craig ME, Hofer SE, Pillay K, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetes. Pediatr Diabetes 2018;19(Suppl 27):105–14.

20. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care 2004;27(Suppl 1):S15–35.

21. Fong DS, Aiello LP, Ferris FL, Klein R. Diabetic retinopathy. Diabetes Care 2004;27(10):2540–53.

22. International Diabetes Federation. IDF Diabetes Atlas. 10th ed. Brussels: International Diabetes Federation; 2021.

23. Yang QH, Zhang Y, Zhang XM, Li XR. Prevalence of diabetic retinopathy, proliferative diabetic retinopathy and non-proliferative diabetic retinopathy in Asian T2DM patients: a systematic review and Meta-analysis. Int J Ophthalmol 2019;12(2):302–11.

24. Vinker S, Shpiz M, Elhayany A, Nakar S. Improvement of early detection of diabetic retinopathy—a primary care intervention study. Harefuah 2003;142(12):826–8.

25. Valizadeh R, Moosazadeh M, Bahaadini K, Vali L, Lashkari T, Amiresmaili M. Determining the prevalence of retinopathy and its related factors among patients with type 2 diabetes in Kerman, Iran. Osong Public Health Res Perspect 2016;7(5):296–300.

26. Badawi AH, Al-barry M, Abusayf M, Rashwan M, Alghamdi A, Alsebaee A. Prevalence and risk factors of diabetic retinopathy: a clinical-based cross-sectional study in Madinah’s Tertiary Diabetic Center, Saudi Arabia. Int J Sci Res 2016;5(5):587–90.

Published

2025-03-15

How to Cite

Talat, K., Shahid Hamid Mahmud, Muhammad Fahad Ikram, Shehar Bano, Tariq Munawar, & Abdul Rafeh. (2025). CORRELATION OF HBA1C LEVEL WITH DIABETIC RETINOPATHY. Journal of Ayub Medical College Abbottabad, 37(1). https://doi.org/10.55519/JAMC-01-13925

Issue

Vol. 37 No. 1 (2025): JOURNAL OF AYUB MEDICAL COLLEGE ABBOTTABAD

Section

ORIGINAL ARTICLE

License

Copyright (c) 2025 Kainaat Talat, Tariq Munawar, Muhammad Fahad Ikram, Shehar Bano, Abdul Rafeh

Creative Commons License

This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License  CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.

USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.

AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.