Session Title: Free Paper Session 16: Vascular Diseases & Diabetic Retinopathy IV
Session Date/Time: Friday 08/09/2017 | 16:30-18:00
Paper Time: 17:18
Venue: Room 114
First Author: : E.Bessmertnaya RUSSIA
Co Author(s): : L. Bolotskaya
The aim of study: to estimate ΔHbA1c values within two cohorts of T1DM patients – with and without intercurrent autoimmune diseases (IAD) and to compare the frequency and severity of diabetic retinopathy (DR) within two groups.
Longitudinal Observation Study
The investigated group included 155 patients with T1DM onset occurred in 1994. All the patients received IAD diagnoses (rheumatoid arthritis, multiple sclerosis, vitiligo, chronic lymphocytic thyroiditis) based on conventional clinical criteria. HbA1c values in every patient were measured once in 3 months for 22 years (1994-2016). ΔHbA1c values were estimated using the relative frequency method with significance level α ≤0,05. The Centre ophthalmologist inspected all the patients twice a year. Examination of eye-ground was performed after mydriasis and all the eye-ground images were stored in the database.
25 patients received a diagnosis of IAD. 15 of them (60%) had nonproliferative DR, 8 (32%) had proliferative DR, and 2 patients (8%) had one-sided blindness. 130 patients without IAD 60 (46%) had nonproliferative DR and 70 had not any symptoms of DR. Average annual fluctuations of HbA1c value (ΔHbA1c, %) in patients with IAD were (data is presented as min-max scatter): 18,3-26,7 in patients with nonproliferative DR, 24,3-30,3 in patients with proliferative DR, 50,4-56,3 in patients with blindness. ΔHbA1c values, %, in patients without IAD had not significant differences and were 7,3-11,4 in patients with nonproliferative DR, 7,2-11,1 in patients without complications. The greater amplitude of HbA1c fluctuations in patients with IAD in comparison with patients without IAD was not associated with low quality of glucose control in patients with IAD. In patients whose fluctuations of HbA1c value are within the limit of 10% develop DR only in 5% of cases compared to patients whose fluctuations of HbA1c value go beyond the limit of 22% develop DR in 95% of cases. Mean ΔHbA1c value in patients with IAD (37,8%) demonstrated positive correlations with probability of development and progress of DR.
The presence of IAD in patients with T1DM leads to higher variability of HbA1c values and greater probability of DR development and progress. The stabilization ΔHbA1c values in patients with IAD may reduce the risk of DR development.