Reem Gebrekidan, Mercer University College of Pharmacy
According to the American Diabetes Association (ADA) guideline, retinopathy is a neurovascular complication which could lead to various eye disorders including blindness, glaucoma, cataracts, and others. It was recommended that an A1c level of less than 7% (53 mmol/mol) may be reasonable for nonpregnant adults without comorbidities. However, less stringent A1c levels between 7- 8% (64 mmol/mol) could be considered in patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, extensive comorbid conditions, or long-standing diabetes in which lower goals are more difficult to achieve. 
|Long term risk of severe retinopathy in childhood-onset type 1 diabetes: a data linkage study |
|Design||Retrospective, cohort, data linkage; N= 503|
|Objective||To examine the impact of childhood glycaemic control on the future risk of complications in people with type 1 diabetes|
|Study Groups||Stable (n= 143); low improving (n= 82); worsening (n= 96); stable high (n= 182)|
|Methods||Adults with type 1 diabetes with data transferred from the paediatric diabetes clinic, and at least one specialist adult diabetes clinic attendance were included. Patients who were lost to follow-up at the time of care transition from the paediatric clinic or who died were excluded. Glycemic control was defined as mean HbA1c 66 mmol/mol with the values calculated for paediatric (pre-transition), adult (post-transition, as an adult), and life course (level from diagnosis to end of study).
Trajectory groups used for analysis of mean HbA1c were: stable low (mean paediatric and adult HbA1c ≤ 66 mmol/mol); improving (mean paediatric HbA1c > 66 mmol/mol, mean adult HbA1c ≤ 66 mmol/mol); worsening (mean paediatric HbA1c ≤ 66 mmol/mol, mean adult HbA1c > 66 mmol/mol); or stable high (paediatric and adult mean HbA1c > 66 mmol/mol).
|Duration||Data from 1975- 2013|
|Primary Outcome Measure||Record of severe diabetic retinopathy|
|Record of other complications such as chronic kidney disease, ulceration/amputation, and death|
*Differences between groups: p< 0.001
**Difference between all four groups
|Adverse Events||Common Adverse Events: N/A|
|Serious Adverse Events: N/A|
|Percentage that Discontinued due to Adverse Events:N/A|
|Study Author Conclusions||Severe retinopathy was associated with uncontrolled pediatric glucose levels, independent of glycemic control during adulthood.|
These results challenge the belief that glycemic control in young adults with type 1 diabetes can wait until adolescence is surpassed and reinforce implementation of early glycemic control in pediatric diabetes care. Mediation interference may have been overlooked as comorbidities such as hypertension, hyperlipidemia, and obesity are associated with increased risk of retinopathy but were not recorded. Further, any history of pregnancy, which has been linked with a rapid progression of diabetic retinopathy, was not provided by women participants. With the A1c threshold for the groups being higher than what is recommended by ADA guidelines, the definition of controlled glucose level from this study was less valid.
 ADA, American Diabetes Association. Standards of medical care in diabetes—2017.
Diabetes Care. 2017;39(suppl 1):S1-S106.
 White M, Sabin MA, Magnussen CG, O’connell MA, Colman PG, Cameron F. Long term risk of severe retinopathy in childhood-onset type 1 diabetes: a data linkage study. Med J Aust. 2017;206(9):398-401.