title: HbA1c, systolic blood pressure variability and diabetic retinopathy in Asian type 2 diabetics.
abstract: BACKGROUND
  The aim of the present study was to examine the association between variability in HbA1c or systolic blood pressure (SBP) and diabetes-specific moderate retinopathy in Asians with type 2 diabetes (T2D).
  
  
  METHODS
  A retrospective study was conducted of 172 cases of moderate diabetic retinopathy (DR) cases and 226 controls without DR, matched for age, sex, and ethnicity. Serial HbA1c and SBP (range 3-6 readings) over the 2 years prior to photographic screening of DR were collected. Intrapersonal mean and SD values for HbA1c (iM-HbA1c and iSD-HbA1c) and SBP (iM-SBP and iSD-SBP) were derived. Moderate DR was assessed from digital retinal photographs and defined as levels >43 using the Early Treatment Diabetic Retinopathy Study scale.
  
  
  RESULTS
  Cases of moderate DR had higher iM-HbA1c (8.2 % vs 7.3 %; P = 0.001), iSD-HbA1c (1.22 vs 0.64; P = 0.001), iM-SBP (136.8 vs 129.6 mmHg; P = 0.001) and iSD-SBP (13.3 vs 11.1; P = 0.002) than controls. In the multivariate regression model adjusted for age, gender, ethnicity, duration of diabetes, SBP, and HbA1c, iM-HbA1c and iM-SBP were significantly associated with moderate DR (odds ratio [OR] 1.80, 95 % confidence interval [CI] 1.37-2.36; and OR 1.03, 95 % CI 1.01-1.05, respectively). Neither iSD-HbA1c nor iSD-SBP were associated with moderate DR. When stratified by HbA1c <7 %, only iSD-SBP remained significantly associated with moderate DR (OR 1.11, 95 % CI 1.01-1.21).
  
  
  CONCLUSIONS
  In a cohort of Asian patients with T2D, both higher mean HbA1c levels and SBP, but not their variability, were associated with moderate DR. Among those with good glycemic control, wider variability of SBP is associated with moderate DR.
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Valencia
authors.initials: V
authors.lastname: Foo
authors.affiliation: SingHealth Polyclinics, Singapore.
authors.forename: Joanne
authors.initials: J
authors.lastname: Quah
authors.affiliation: Singapore Eye Research Institute, Singapore.|Singapore National Eye Centre, Singapore.
authors.forename: Gemmy
authors.initials: G
authors.lastname: Cheung
authors.affiliation: SingHealth Polyclinics, Singapore.
authors.forename: Ngiap Chun
authors.initials: NC
authors.lastname: Tan
authors.affiliation: SingHealth Polyclinics, Singapore.
authors.forename: Kyi Lin
authors.initials: KL
authors.lastname: Ma Zar
authors.affiliation: SingHealth Polyclinics, Singapore.
authors.forename: Choi Mun
authors.initials: CM
authors.lastname: Chan
authors.affiliation: Singapore Eye Research Institute, Singapore.|Singapore National Eye Centre, Singapore.|Office of Clinical Sciences, Duke-NUS Medical School, Singapore.|Department of Ophthalmology, National University of Singapore, Singapore.
authors.forename: Ecosse
authors.initials: E
authors.lastname: Lamoureux
authors.affiliation: Singapore Eye Research Institute, Singapore.|Singapore National Eye Centre, Singapore.|Office of Clinical Sciences, Duke-NUS Medical School, Singapore.|Department of Ophthalmology, National University of Singapore, Singapore.
authors.forename: Wong
authors.initials: W
authors.lastname: Tien Yin
authors.affiliation: Singapore Eye Research Institute, Singapore.|Singapore National Eye Centre, Singapore.|Office of Clinical Sciences, Duke-NUS Medical School, Singapore.
authors.forename: Gavin
authors.initials: G
authors.lastname: Tan
authors.affiliation: Singapore Eye Research Institute, Singapore.|Department of Ophthalmology, National University of Singapore, Singapore.|Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore.
authors.forename: Charumathi
authors.initials: C
authors.lastname: Sabanayagam
mesh_terms: D000368:Aged; D044466:Asian People; D001794:Blood Pressure; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000208:ethnology; D003930:Diabetic Retinopathy / Q000097:blood / Q000208:ethnology / Q000209:etiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012846:Singapore
chemical_list: D006442:Glycated Hemoglobin
keywords: HbA1c; blood pressure; diabetes mellitus; diabetic retinopathy