Wu Xinyan, Yan Yayi, Li Yuntong, Fan Yiran, Li Lingyi, Tsui Ching-Kit, Liu Kaiqun, Liang Xiaoling, Huang Wenyong, Hu Andina
State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Zhongshan Ophthalmic Center, Sun Yat-Sen University, 7 Jinsui Road, Guangzhou, 510060, China.
BMC Ophthalmol. 2025 May 26;25(1):313. doi: 10.1186/s12886-025-04139-z.
A large body of evidence supports the long-term benefits of intensive glycemic control for patients with type 2 diabetes mellitus (T2DM). However, the relationship between intensive glycemic control and diabetic retinopathy (DR) progression in T2DM patients in the short-term remains under debate. Therefore, we investigated the effect of intensive glycemic control on DR changes in the short-term.
A total of 254 patients with T2DM, all exhibition hemoglobin A (HbA) levels above 7% were included in the study. We collected HbA values at baseline and after 12-months. HbA control classified into two categories: intensive control, targeting an HbA of less than 7%, and less intensive control, targeting an HbA of 7% or higher at 12-month follow-up. The severity of DR were graded based on seven-field 45° conventional fundus photographs examinations according to the United Kingdom National Diabetic Eye Screening Program guidelines.
After a one-year follow-up, 129 participants achieved a target HbA of less than 7% and 125 achieved 7% or more. We found no significant difference in DR changes (incidence, progression, or regression) between two groups after adjustments for age and gender. Further adjustments for confounding factors such as body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), diabetes duration, insulin use and baseline HbA, revealed no association between intensive glycemic control and the DR changes.
This prospective cohort study demonstrates that intensive glycemic control did not associated with DR changes in T2DM patients in the short term. Further research is required to ascertain the long-term effects of intensive glycemic control on DR.
The trail has been registered at The UK's Clinical Study Registry ( https://www.isrctn.com ) on 2020/04/13 (ISRCTN15853192).
大量证据支持强化血糖控制对2型糖尿病（T2DM）患者的长期益处。然而，强化血糖控制与T2DM患者糖尿病视网膜病变（DR）短期进展之间的关系仍存在争议。因此，我们研究了强化血糖控制对DR短期变化的影响。
共有254例T2DM患者纳入研究，所有患者糖化血红蛋白A（HbA）水平均高于7%。我们收集了患者基线时和12个月后的HbA值。HbA控制分为两类：强化控制，目标是HbA低于7%；非强化控制，目标是12个月随访时HbA为7%或更高。根据英国国家糖尿病眼部筛查计划指南，通过七视野45°传统眼底照片检查对DR的严重程度进行分级。
经过一年的随访，129名参与者的目标HbA低于7%，125名参与者的目标HbA为7%或更高。在对年龄和性别进行调整后，我们发现两组之间的DR变化（发病率、进展或消退）没有显著差异。对体重指数（BMI）、收缩压（SBP）、舒张压（DBP）、糖尿病病程、胰岛素使用情况和基线HbA等混杂因素进行进一步调整后，发现强化血糖控制与DR变化之间没有关联。
这项前瞻性队列研究表明，强化血糖控制与T2DM患者DR的短期变化无关。需要进一步研究以确定强化血糖控制对DR的长期影响。
该试验于2020年4月13日在英国临床研究注册中心（https://www.isrctn.com）注册（ISRCTN15853192）。
