Axer-Siegel Ruth, Herscovici Zvi, Gabbay Meirav, Mimouni Karin, Weinberger Dov, Gabbay Uri
Department of Ophthalmology, Rabin Medical Center (Beilinson Campus), Petah Tiqva, Israel.
Isr Med Assoc J. 2006 Aug;8(8):523-6.
Hyperglycemia, high blood pressure and hypercholesterolemia are risk factors for diabetic retinopathy and vision loss in diabetic patients.
To evaluate risk factors in patients treated for diabetic retinopathy in our hospital clinic and assess patients' awareness of the impact of glycemic control; and to compare the findings with those in patients followed in a community clinic.
We performed a cross-sectional comparative study that included 178 consecutive patients with type 2 diabetes mellitus treated in the Retinal Vascular Service of Rabin Medical Center from 1 September to 31 December 2004, and 107 consecutive patients with type 2 diabetes mellitus examined in a community clinic during the same period. A questionnaire was completed; the main outcome measures were glycemic and risk factor control and their correlation with diabetic retinopathy and visual acuity.
Although only 43% of the patients had heard of HbA1c, 98% of them had undergone this analysis, with a mean level of 8.2% (SD 1.9) in the hospital patients and 7.7% (SD 1.6) in the community patients (P= 0.01, t-test). HbA1c was lower in hospital patients who were aware of the test. Correlations were found for visual acuity, diabetic retinopathy and laser treatment with HbA1c < or = 7%, cholesterol level < 200 mg/dl and blood pressure < 130/85 mmHg.
Since our study and previous reports have shown that HbA1c level < or = 7%, serum cholesterol level < 200 mg/dl and blood pressure < 130/85 mmHg are associated with better preservation of vision in patients with type 2 diabetes mellitus, we propose that the ophthalmologist has a role in educating patients about glucose, lipid and blood pressure control as part of the treatment of diabetic retinopathy.
高血糖、高血压和高胆固醇血症是糖尿病患者发生糖尿病视网膜病变和视力丧失的危险因素。
评估我院门诊接受糖尿病视网膜病变治疗患者的危险因素，并评估患者对血糖控制影响的知晓情况；并将研究结果与社区门诊随访患者的结果进行比较。
我们进行了一项横断面比较研究，纳入了2004年9月1日至12月31日在拉宾医疗中心视网膜血管科连续治疗的178例2型糖尿病患者，以及同期在社区门诊检查的107例连续2型糖尿病患者。完成了一份问卷；主要观察指标为血糖和危险因素控制及其与糖尿病视网膜病变和视力的相关性。
尽管只有43%的患者听说过糖化血红蛋白（HbA1c），但98%的患者进行了此项分析，住院患者的平均水平为8.2%（标准差1.9），社区患者为7.7%（标准差1.6）（P = 0.01，t检验）。知晓该项检查的住院患者HbA1c水平较低。发现视力、糖尿病视网膜病变和激光治疗与HbA1c≤7%、胆固醇水平<200mg/dl和血压<130/85mmHg之间存在相关性。
由于我们的研究和既往报告表明，HbA1c水平≤7%、血清胆固醇水平<200mg/dl和血压<130/85mmHg与2型糖尿病患者更好地保留视力相关，我们建议眼科医生在糖尿病视网膜病变治疗中发挥作用，对患者进行血糖、血脂和血压控制方面的教育。
