Do patients receiving laser treatment for sight threatening diabetic retinopathy and those under the care of a consultant led multidisciplinary diabetes specialist team have better HbA1c value than those that are not under a diabetes specialist?

Abstract

AbstractPurposeTo evaluate if patients with sight threatening diabetic retinopathy who undergo laser photocoagulation treatment and are under the care of a consultant‐led specialist diabetes team have a better HbA1c value than those that are not under a specialist diabetes team.MethodsRetrospective review of all patients who underwent pan laser photocoagulation (PRP) treatment or macular laser therapy between 1st January 2018 and 31st December 2018 were included in the study.ResultsWe identified 64 patients who underwent laser treatment for diabetic retinopathy in the 12‐month period, 21 female and 43 male. Of these, 36 patients (56%) had type‐2 diabetes, 12 patients (18%) had type‐1 diabetes and in 16 patients (25%), this was undocumented. In terms of type of laser therapy, 50 (78%) underwent PRP and 14 (22%) underwent macular laser. 33 patients (51%) who underwent laser treatment were under the care of a specialist diabetes team within 1 year of receiving treatment. The average HbA1c value of patients who were under a diabetes specialist was 80.9 mmol/mol (9.6%), versus those who were not under a diabetes specialist was 72.7 mmol/mol (8.8%).ConclusionOur study showed that amongst patients who underwent laser treatment for sight threatening diabetic retinopathy, majority underwent pan retinal photocoagulation for proliferative disease rather than macular laser for maculopathy. This observation is expected, as macular laser is less commonly practiced since the advent of anti‐VEGF therapy for diabetic maculopathy. Surprisingly, the HbA1c values on average were better in those who were not under a specialist diabetes team compared to those who were under the care of a specialist. Although this is unexpected, it may be explained by the fact that those under a diabetes team have poorer control of their blood sugars, and/or more advanced diabetes to begin with.