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Research provides new insights into diabetic retinopathy risk

DCUK NewsBot

DCUK NewsBot

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People with diabetes could reduce their risk of diabetic retinopathy for every hour they achieve target blood glucose levels, research suggests. Chinese researchers reported the association following a study of 3,262 people with type 2 diabetes. A total of 780 people in the study had diabetic retinopathy before it began. On average, the participants were aged 60 years and had elevated average HbA1c readings of 74 mmol/mol (8.9%). They wore continuous glucose monitors for a three-day period and had their time measured in real time for how often their blood glucose was within a target range of 3.9-10 mmol/l. Those whose typical 24-hour readings were in range the least amount of time were more likely to have retinopathy. The less time spent being in range was also associated with increased eye damage among those with retinopathy. Significantly, the association between time in range and retinopathy was separate from HbA1c, indicating that people who had good control over a three-month period could still do damage with fluctuations. "To minimise the risk of retinopathy, a patient needs to control his/her blood glucose as soon as possible, and maintain the glucose levels in the target range as long as possible," said study author Dr Weiping Jia, who works at the Shanghai Jiao Tong University Affiliated Sixth People's Hospital. While only an association was observed, and the study was not designed to show whether time spent in blood glucose target range could impact retinopathy risk, the results add further credence to the importance of managing blood glucose levels to reduce complications risk. Commenting on the research, Dr. Roy Beck, executive director of the Jaeb Center for Health Research in Tampa, Florida, who wasn't involved in the study, said: "The closer to the normal range a person with diabetes can achieve, the lower will be the risk of retinopathy. If near normal glucose levels can be achieved, the risk is very low." The research was published in the journal Diabetes Care.

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kitedoc said:
So ......why do some doctors say for those with T2D not to do blood testing of their BSLs???
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My GP has never told me not to test, it seems to me that it is only the tight rsed NHS GP's do this to save a dollar or two.
 
Dark Horse said:
Probably because of this? https://www.phc.ox.ac.uk/about/impact/blood-glucose-self-monitoring-type-2-diabetes
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Than you @Dark Horse, I guess the question is unless you do something with the BSL result the monitoring of BSL in any form of diabetes is pretty useless. So this study could easily assume there would be no benefit unless (a) patient's had some improvement in their quality of life vs the obsessing over tests and sore fingers, or (b) their GPs actually helped them to improve their diabetes through dietary advice, medication changes etc or (c) through their own initiative and help of others, including this forum, patient's took matters into their own hands and tried various diets etc to help improve their BSLs.
The study and its influence on NHS policy has a heavy paternal (and maternal) flavour to it in my albeit biased mind!!!
 
bulkbiker said:
I wonder how many amputations have happened since that advice was promoted.. Prof Farmer has a fair bit of responsibility for that...
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To be fair to the researchers, they appear to have taken the view that, although three existing systematic reviews found no evidence that self-monitoring was beneficial for people with type 2, the trials which the reviews were based on had some problems with methodology so it was worth further research to establish whether self-monitoring could be useful. A quick appraisal suggests that this later research appears to have been very thorough.

The researchers include this statement in their recommendations:-

The qualitative element of the trial identifies a group of patients who consider that use of SMBG provides them with motivation to adopt and maintain behaviours that lead to better diabetes control. Further work is required to characterise those who gain most benefit in terms of glycaemic control and whether this is related to use of the procedure.
https://www.journalslibrary.nihr.ac.uk/hta/hta13150/#/full-report
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Notice that the paper was published in 2009.
 
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