In type 2 diabetes, Diabetic Retinopathy (DR) can worsen with rapid glucose control in specific circumstances. We sought whether DR can be systematically related to a previous dramatic reduction of HbA1c. In patients hospitalized for uncontrolled or complicated type 2 diabetes, we collected values of HbA1c from the previous years. "Rapid declinors" were defined by a reduction of more than -3% between two consecutive HbA1c values, and "sustained moderate declinors" if the HbA1c always declined without reaching -3%. We compared the prevalences of DR according to the previous HbA1c courses, and adjusted the analysis for risk factors for DR. Our 680 patients were mainly men (56.8%), 62±10 years old, with 14±10 year duration of diabetes. Their BMI was 32.1±6.1 kg/m2. Sixty-seven percent had arterial hypertension, 67.5% were treated by a statin and 44.5% had a Diabetic Kidney Disease. They were poorly controlled: mean HbA1c at 8.7±1.7% at admission. One thousand and five hundred previous HbA1c values were available: 9.0±1.9% during the previous year (n=641, time -4±4 months before), 8.7±1.8% during the year before (n=363, time -16±4 months), 8.7±1.8% during the second year before (n=253, time -30±4 months), and 9.0±2.2% for the most ancient (n=243, time -65±27 months).One hundred and sixty-three subjects (24%) had a DR, associated to a longer duration of diabetes, higher previous HbA1c, arterial hypertension, Diabetic kidney disease, and dyslipidemia. A previous rapid decline of HbA1c was related to DR (OR=1.869, 95% CI:1.028-3.401) after adjustment for age, gender, BMI, arterial hypertension and DKD, blood lipids and statin treatment, duration of diabetes and the mean of previous available HbA1c. The relation between DR and a previous sustained moderate reduction of HbA1c as occurred in 193 other subjects (28.3%) was NS (OR=0.798, 95% CI:0.485-1.313). In subjects with poorly controlled T2D, a history of rapid decline of HbA1c was found to predispose to DR in our population, whereas a sustained moderate decline was safe.


A. Larroumet: None. J. Korobelnik: Board Member; Self; Novo Nordisk Inc. Consultant; Self; Allergan, Bayer AG, Novartis France, Roche Pharma. N. Foussard: None. L. Blanco: None. K. Mohammedi: None. M. Monlun: None. V. Rigalleau: None.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at