Lower HbA1c, no decline in quality of life for adults with diabetic retinopathy
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Adults with long-standing type 1 diabetes and proliferative diabetic retinopathy had worse functional vision than controls without diabetes, but no decline in quality of life was observed from 2007 to 2019, according to study findings.
In data from a follow-up of people with type 1 diabetes since childhood, researchers found that those with diabetes had worse central and peripheral visual field sensitivity compared with controls, but bilateral contrast sensitivity was similar in both groups and those with diabetes did not report a decline in vision-related quality of life from 2007 to 2019.
“Despite severe diabetic retinopathy and 35-year duration of type 1 diabetes in the current cohort, the proper visual function and good quality of life seemed to remain likely due to good glycemic balance and beneficial effect of novel glucose monitoring systems,” Nina Hautala, MD, PhD, professor of ophthalmology at the University of Oulu and chief physician in the department of ophthalmology at Oulu University Hospital, Finland, and colleagues wrote in a study published in Journal of Diabetes and Its Complications. “In addition, modern treatment of advanced retinopathy with intravitreal anti-VEGF agents preserves vision and helps to maintain vision-related quality of life in patients with diabetes.”
Researchers conducted a prospective study of people with type 1 diabetes who were enrolled in the Oulu Cohort Study of Diabetic Retinopathy in 1989 and participated in a 2007 follow-up. An ophthalmic reexamination was conducted in 29 adults diagnosed with peripheral diabetic retinopathy at the 2007 follow-up (mean age, 41 years; 62% men). At the 2019 reexamination, participants underwent a multifunctional vision test, had blood samples collected and completed the 15D questionnaire to assess quality of life. Results from the ophthalmology exam were compared with findings from 3,046 adults from Finland without diabetes.
Of the cohort, 17% had additional diabetic macular edema in 2019, and 57% had intravitreal hemorrhages. Anti-VEGF agents were used to successfully treat those with diabetic macular edema, and anti-VEGF injections were given to those with vitreous hemorrhages.
The percentage of participants using flash glucose monitoring increased from 0% in 2007 to 76% in 2019. Mean HbA1c decreased from 9.5% in 2007 to 8% in 2019 (P < .001). There were no changes in HDL cholesterol, LDL cholesterol and triglycerides.
“This improvement in daily monitoring of diabetes and relief in everyday life may explain the significant improvement of an average HbA1c from 9.5% in 2007 to 8% in 2019, despite the long duration of diabetes at the time of the reevaluation,” the researchers wrote. “In addition, lipid profile and blood pressure of the study patients had remained stable during the follow-up period. The stability and improvements in diabetes care might also explain good visual outcomes of the participants.”
Of the cohort, 7% had visual impairment in 2019. The type 1 diabetes group had lower central visual field sensitivity (23.2 dB vs. 26.9 dB; P < .001) and lower peripheral visual field sensitivity (14.9 dB vs. 21 dB; P < .001) than the control group. Bilateral contrast sensitivity was similar in both groups. Adults with diabetes had longer reaction time compared with the control group (490.5 ms vs. 462.8 ms; P = .004).
Researchers observed slight decreases in quality of life for sleep, usual activity, discomfort and symptoms, and sexual activity in 2019 compared with 2007. However, quality of life scores for mobility and distress improved from 2007 to 2019. No change was observed for vision-related quality of life. There was no difference in overall quality of life score after adjusting for age and gender between 2007 and 2019, the researchers reported.
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