Response to Comment on Ipp and Kumar. A Clinical Conundrum: Intensifying Glucose Control in the Presence of Advanced Diabetic Retinopathy. Diabetes Care 2021;44:2192 –2193

Rigalleau et al. (1) provide interesting findings from their observational follow-up study of long-term sequelae of type 2 diabetes that suggest rapid reduction in A1C (>1.5% in less than 4 months) is associated with significant worsening in diabetic retinopathy (DR), cardiovascular events, and foot ulcers, with notably high hazard ratios (38.74, 3.34, and 7.03, respectively). After this early and considerable decrease of A1C (mean 3.1%), these events presumably occurred over the ensuing mean 54 months of follow-up of their study. The comparator group had a stable A1C (although “stable” was not defined) and was not associated with increased DR worsening or cardiovascular events. Foot ulcers did nevertheless occur with a lower hazard ratio (3.08). They emphasize that in addition to the deterioration that may be seen in DR with rapid reduction in A1C discussed in our com mentary (2), deleterious outcomes may occur in macrovascular disease and perhaps foot ulcers as well (1).
Source: Diabetes Care - Category: Endocrinology Source Type: research