title: Nonmydriatic retinal image review at time of endocrinology visit results in short-term HbA1c reduction in poorly controlled patients with diabetic retinopathy.
abstract: OBJECTIVE
  The objective of this study was to evaluate the effect of discussing retinal findings following nonmydriatic retinal imaging during an endocrinology visit on subsequent HbA1c in poorly controlled diabetic patients with diabetic retinopathy (DR).
  
  
  METHODS
  During a visit to an endocrinologist, patients with DR and documented HbA1c ≥ 8.0% within the preceding month were assigned to either addition of nonmydriatic imaging and discussion of retinal findings or standard endocrinology evaluation alone. Ophthalmology care was otherwise the same in both groups. Changes in HbA1c were evaluated 3 months later.
  
  
  RESULTS
  One hundred thirteen (94%) of the original 120 subjects completed the study. The mean HbA1c change in the retinal imaging group was a decline of 1.35%, whereas the control group had a 0.26% increase. Controlling for gender, age, duration of diabetes, presence of hypertension, and use of insulin, the difference between groups was significant (p<0.0003).
  
  
  CONCLUSIONS
  Nonmydriatic imaging and discussion of retinal findings during an endocrinologist visit may contribute, at least in the short term, to improved glycemic control in patients with DR and elevated HbA1c.
authors.affiliation: Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon. hs06@aub.edu.lb
authors.forename: Haytham
authors.initials: H
authors.lastname: Salti
authors.forename: Jerry D
authors.initials: JD
authors.lastname: Cavallerano
authors.forename: Nisreen
authors.initials: N
authors.lastname: Salti
authors.forename: Dalida Jaafar
authors.initials: DJ
authors.lastname: Jawhari
authors.forename: Sandra
authors.initials: S
authors.lastname: Haddad
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Sun
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Salti
authors.forename: Lloyd Paul
authors.initials: LP
authors.lastname: Aiello
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D004704:Endocrinology / Q000379:methods*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007861:Lebanon; D008297:Male; D008875:Middle Aged; D010781:Photography / Q000379:methods*; D012160:Retina / Q000473:pathology*
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human