67 male with diabetes. last hba1c - 9. fundal image showb below



This is a case of uncontrolled T2DM with hard exudates, hemorrhagic spots in the fundi indicating NPDR, a microvascular complication,refer the case to a Retinal Specialist for further evaluation and laser therapy. But very strict control of DM is mandatory, even 1% reduction in HbA1c is associated with 37% less progression of Retinopathy, in other words if you maintain an HbA1c of less than 7%, one would never develop Retinopathy at all or other wise the development would be very slow, not only maintaining DM, one should also maintain hypertension, Dyslipidemia too.

Dr Alok Singh, that's why I asked this case to refer to a Retinal Specialist for laser therapy, go through my comment please, our duty ceases by sending the case to you, of course we need to meticulously control DM,HTN,Dyslipidemia.

The BMJ logo Toggle top menu ResearchEducationNews & ViewsCampaigns ArchiveFor authorsJobsHosted Research Article Rapid tightening of blood glucose control leads to transient deterioration of retinopathy in insulin dependent diabetes mellitus: the Oslo study. Br Med J (Clin Res Ed)1985;290doi: http://dx.doi.org/10.1136/bmj.290.6471.811(Published 16 March 1985)Cite this as:Br Med J (Clin Res Ed)1985;290:811 ArticleMetricsResponsesPeer review K Dahl-Jrgensen,O Brinchmann-Hansen,K F Hanssen,L Sandvik,O Aagenaes Abstract In a study of retinopathy during one year of tight blood glucose control 45 type I (insulin dependent) diabetics without proliferative retinopathy were randomised to receive either continuous subcutaneous insulin infusion, multiple insulin injections, or conventional insulin treatment (controls). Near normoglycaemia was achieved with continuous infusion and multiple injections but not with conventional treatment. Blind evaluation of fluorescein angiograms performed three monthly showed progression of retinopathy in the control group, transient deterioration in the continuous infusion group, and no change in the multiple injection group. Half the patients receiving continuous infusion and multiple injections developed retinal cotton wool spots after three to six months. These changes regressed in all but four patients after 12 months. Control patients did not develop cotton wool spots. Patients who developed cotton wool spots are characterised by a larger decrement in glycosylated haemoglobin and blood glucose values, more frequent episodes of hypoglycaemia, a longer duration of diabetes, and more severe retinopathy at onset. A large and rapid fall in blood glucose concentration may promote transient deterioration of diabetic retinopathy.

Pre proliferating diabetic retinopathy both eye ffa strict control of diabetes prp three sitting & macular grid strict follow up with nevanec e/d antioxidants with omega3fatt acid

other thing I want to add is to search for other microvascular complications. . diabetic nephropathy and neuropathy. ...

Early worsening of diabetic retinopathy in the Diabetes Control and Complications Trial. Arch Ophthalmol. 1998;116:874-886

Thanks Dr Parvez

But Dr Mohammed Parvez, my comment was on T2DM, your reference is for T1DM, you are the better judge.Thank you.

Good comment Rashid Vora, we should look for the other complications incuding macrovascular, not only microvascular,

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3713071/ Diabetic Retinopathy in T2 DM, worsen initially with strict glycemic control.

Very good share Dr Mohammad Parvez, Congratulations

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