596-P: Previous Dramatic Reduction of HbA1c and Retinopathy in Type 2 Diabetes

Abstract

In type 2 diabetes, Diabetic Retinopathy (DR) can worsen with rapid glucose control in specific circumstances. We sought whether DR can be systematically related to a previous dramatic reduction of HbA1c. In patients hospitalized for uncontrolled or complicated type 2 diabetes, we collected values of HbA1c from the previous years. "Rapid declinors" were defined by a reduction of more than -3% between two consecutive HbA1c values, and "sustained moderate declinors" if the HbA1c always declined without reaching -3%. We compared the prevalences of DR according to the previous HbA1c courses, and adjusted the analysis for risk factors for DR. Our 680 patients were mainly men (56.8%), 62±10 years old, with 14±10 year duration of diabetes. Their BMI was 32.1±6.1 kg/m2. Sixty-seven percent had arterial hypertension, 67.5% were treated by a statin and 44.5% had a Diabetic Kidney Disease. They were poorly controlled: mean HbA1c at 8.7±1.7% at admission. One thousand and five hundred previous HbA1c values were available: 9.0±1.9% during the previous year (n=641, time -4±4 months before), 8.7±1.8% during the year before (n=363, time -16±4 months), 8.7±1.8% during the second year before (n=253, time -30±4 months), and 9.0±2.2% for the most ancient (n=243, time -65±27 months).One hundred and sixty-three subjects (24%) had a DR, associated to a longer duration of diabetes, higher previous HbA1c, arterial hypertension, Diabetic kidney disease, and dyslipidemia. A previous rapid decline of HbA1c was related to DR (OR=1.869, 95% CI:1.028-3.401) after adjustment for age, gender, BMI, arterial hypertension and DKD, blood lipids and statin treatment, duration of diabetes and the mean of previous available HbA1c. The relation between DR and a previous sustained moderate reduction of HbA1c as occurred in 193 other subjects (28.3%) was NS (OR=0.798, 95% CI:0.485-1.313). In subjects with poorly controlled T2D, a history of rapid decline of HbA1c was found to predispose to DR in our population, whereas a sustained moderate decline was safe. Disclosure A. Larroumet: None. J. Korobelnik: Board Member; Self; Novo Nordisk Inc. Consultant; Self; Allergan, Bayer AG, Novartis France, Roche Pharma. N. Foussard: None. L. Blanco: None. K. Mohammedi: None. M. Monlun: None. V. Rigalleau: None.