Lakhani E, Wright T, Abdolell M, Westall CA.
Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Canada.
PURPOSE. To investigate the relationship between long-term glycemic control and localized neuro-retinal function in adolescents with Type 1 Diabetes (T1D) without diabetic retinopathy (DR). METHODS. Standard (103 hexagons) and slow-flash (61 hexagons) multifocal ERGs (standard mfERG and sf mfERG) were recorded from 48 patients and 45 controls. Hexagons with delayed responses were identified as abnormal. Negative binomial regression analysis was conducted with the number of abnormal hexagons as the outcome variable. Glycated haemoglobin (HbA1c) levels, time since diagnosis of T1D, age at diagnosis of T1D, age at testing and sex were considered as covariates. Another model replacing HbA1c closest to the date of testing with a one-year average was also generated. RESULTS. There were a greater number of abnormal hexagons for mfOPs in patients compared with controls (P = 0.005). There was no significant difference in the mean number of abnormal hexagons for standard mfERG responses between patients and controls (P = 0.11). Negative binomial regression analysis for the standard mfERG data demonstrated that a one unit increase in HbA1c was associated with an 80% increase in the number of abnormal hexagons (P = 0.002) when controlling for age at testing. Analysis using the one-year HbA1c averages did not result in significant findings. CONCLUSIONS. Poor long-term glycemic control is associated with an increase in areas of localized neuro-retinal dysfunction in adolescents with T1D and no clinically-visible DR. Stricter glucose control during the early stages of the disease may prevent neuro-retinal dysfunction in this cohort.
PMID: 20484588
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