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Controlled blood pressure, A1c modify diabetic retinopathy progression

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WAILEA, Hawaii – Retina specialists can help shape patient behavior that can modify the progression of diabetic retinopathy, a speaker said at Retina 2015.“As retina specialists, we have a responsibility to change behavior, not only because [diabetic retinopathy] is the number one cause of blindness in working age adults, but more importantly because diabetic patients fear blindness,” Allen S. Ho, MD, said.Consequently, retina specialists have more opportunity to influence their patients’ behavior because they see diabetic patients more often than they see their primary care doctor.

Allen S. Ho

Controlling hemoglobin A1c levels and reducing blood pressure have a significant impact on modifying diabetic retinopathy progression, he said.

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%, he said.

“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%,” Ho said.

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, he said.

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, he said.

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

Disclosure: Ho reports receiving grant funding from, consulting for and serving on scientific advisory boards for Allergan, Genentech and Regeneron.