Association Between HbA1c Levels and the Severity of Diabetic Retinopathy

Diabetic retinopathy (DR) is a significant microvascular complication of diabetes mellitus (DM), contributing to visual impairment and blindness worldwide. Understanding the factors associated with the severity of DR is crucial for effective prevention and management. This study aimed to explore the association between hemoglobin A1c (HbA1c) level and other parameters with different stages of DR.

A retrospective cross-sectional study was conducted on patients diagnosed with DR between March and September 2024. Patients with type 2 diabetes who underwent fundus examinations and had HbA1c measurements were analyzed. Data on demographic and clinical parameters, including age, gender, duration of diabetes, glycemic control, anti-diabetic medications, body mass index (BMI), and diabetes-related complications, were collected. The severity of DR was classified into mild, moderate, and severe non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). Statistical analyses included chi-square tests, independent t-tests, and analysis of variance (ANOVA), with P-values < 0.05 considered significant.

A total of 106 participants were included, with a mean age of 57.3 years. PDR was present in 27 patients (25.5%), while 43 patients (40.6%) had mild NPDR. Very poor glycemic control (HbA1c > 9%) was noted in 36 patients (34%). Insulin use was significantly associated with higher DR severity (P = 0.039), while macular edema showed a strong association with advanced DR stages (P = 0.003). No significant associations were found between DR severity and neuropathy or nephropathy.

The study highlights that uncontrolled glycemic level, longer diabetes duration, and the presence of macular edema are key factors associated with the severity of DR. Insulin use may indicate a higher risk of severe DR, emphasizing the need for comprehensive diabetes management and regular ophthalmologic evaluations. These findings underscore the importance of targeted interventions to prevent vision-threatening complications in diabetic patients.