Editor in Chief :

Mahmoud Ashraf Ibrahim ,MD

      Issues per Volume: Quarterly
Current Volume: 1
Current Issue : 1

Volume 1 number 1 Summer 2003
Special issue for the abstracts of the 7th Pan Arab Conference on Diabetes
PACD7 , 25 – 28 March 2003 Cairo


 Abstract Number : 6 
Glycemic Control and Glucose Fluctuations in Pregnancy and the Progression of
Retinopathy in Type 1 Diabetes Mellitus

Khalid S. Aljabri , MBChB, FRCPC, FRCPC(endo), ABIM, MACP , Saudi Arabia

  • Division of adult endocrinology and metabolism
  • Department of medicine, University of British Columbia, BC, Canada
  • Currently: Prince Mansour Military Hospital
  • Taif, Kingdom of Saudi Arabia
  • Iain S.Begg , MB , FRCS ( Edin. ) , FRCSC
  • Department of ophthalmology, University of British of Columbia
  • David M. Thompson , MD , FRCPC
  • Division of adult endocrinology and metabolism, Department of medicine, University of British
  • Columbia
Abstract:

Aims/hypothesis:

Pregnancy and poor glucose control at conception can cause progression of diabetic retinopathy. 
It is less clear if rapid lowering of glucose levels is independently associated with progression. We examined the relation between the initial HbA1c, the improvement in HbA1c, and capillary glucose levels on the progression of retinopathy during pregnancy.

Methods:

Retrospective analysis of the relation between glycemic parameters and the progression of retinopathy during pregnancy. Colour stereoscopic fundus photographs of 7 standard fields were assessed by an independent observer masked to the clinical status. Progression was defined as any of an increase of ¡Ý 1 steps on the ETDRS scale or the development of soft exudates or IRMA, between 2 trimesters. We examined 49 pairs of photographs in 38 women with type 1 diabetes and assessed various measures of glucose control on the risk of progression.

Results:

Retinopathy progressed in 21(42.9%) sets of two trimesters. Baseline HbA1c was significantly (P=0.02) higher in the progression group (7.0 +_ 0.2) than in the group who did not progress (6.2 +_ 0.2). There was a significant 3.6-fold (95%CI: 1.0,12.9) increase in the risk of progression if the magnitude decreased in the HbA1c concentration by >_ 0.7 (P=0.04, X2 test). A logistic regression model was used to determine the influence of several risk factors in describing the change in the severity of retinopathy. Baseline higher HbA1c (P=0.015) and hypertension (P=0.007) were the significant variables in describing progression. Baseline higher HbA1c was associated significantly with the development of soft exudates (P=0.02) and the development of soft exudate and/or IRMAs (P=0.02). No statistically significant difference was found between baseline means of blood glucose, standard deviation of the means of five measurements of blood glucose and the standard deviation of all blood glucose levels in the progression and non-progression groups, even when the individual lesions were analyzed separately.

Conclusion/interpretation:

An elevated initial HbA1c and hypertension increase the risk of progression of retinopathy. We found no evidence of a difference in daily capillary glucose levels during pregnancy between patients who did and did not progress.

 

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