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Small Change, Big Rewards in A1c and Blood Pressure Control for Diabetes Patients

Controlling hemoglobin A1c levels and reducing blood pressure have a significant impact on modifying diabetic retinopathy (DR) progression, stated Dr. Allen S. Ho, MD, at Retina 2015. Diabetic retinopathy is a leading cause of blindness among working adults worldwide, and diabetic macular edema (DME), is a complication of diabetic retinopathy.

The average A1c level among patients with diabetic retinopathy is 9, and each 1% increase in A1c level above 7 increases the chance of the incidence of progression to proliferative diabetic retinopathy by 50% and increases the chance of development of diabetic macular edema by 40%, stated Dr. Ho. “Conversely, if you reduce your A1c by 1% when it’s elevated, you reduce your chance of diabetic macular edema by 40% for each elevated increment of 1%.”

This relationship holds true whether the patient has type 1 or type 2 diabetes, whether macular edema is proliferative or non-proliferative, or whether disease is mild, moderate or severe.

Blood pressure control and lipid management, too, can impact diabetic retinopathy progression. The American Diabetes Association recommends a target blood pressure of 130/80 mm Hg or less, and each 10 mm Hg reduction in systolic pressure when blood pressure is elevated reduces microvascular complications of diabetic retinopathy by 10%, regardless of severity of hypertension.

“We can modify progression of diabetic retinopathy by getting back to basics with glycemic control, blood pressure control and lipid management,” commented Dr. Ho.

Source: Healio