Previous dramatic reduction of HbA1c and retinopathy in Type 2 Diabetes

Aims: Does Diabetic Retinopathy (DR) relate to a previous dramatic reduction of HbA1c in Type 2 Diabetes (12D)? Methods: In patients hospitalized for T2D, we collected HbA1c values from previous years, and we defined "Rapid declinors" by a more than -3% reduction between two consecutive HbA1c, and "sustained moderate declinors" by HbA1c declining less than -3%. We analyzed the relation between DR and previous HbA1c courses, adjusted for other risk factors. Results: Our 680 patients had a mean HbA1c at 8.7 +/- 1.7% at admission and 8.7 +/- 1.8 to 9.0 +/- 2.2% during previous years (1500 HbA1C values collected), and 24% had a DR. A previous rapid decline of HbA1c occurred in 13.5% of subjects and related to DR (OR =1.86, 95%CI:1.02-3.40), especially proliferative (OR = 2.64, 95% CI:1.02-6.80), after adjustment for age, gender, body mass index, arterial hypertension and diabetic kidney disease, blood lipids and statin treatment, duration of diabetes and mean previous HbA1c. A previous moderate reduction of HbA1c as occurred in 28.3% other subjects was not related to DR. Conclusions: In subjects hospitalized for T2D, a previous rapid decline of HbA1c was related to proliferative DR. whereas a sustained moderate decline appeared to be safe. (C) 2020 Elsevier Inc. All rights reserved.