J Korean Ophthalmol Soc.  2020 Aug;61(8):911-920. 10.3341/jkos.2020.61.8.911.

Long-term HbA1c Variability and Treatment Outcomes of Intravitreal Injection in Diabetic Macular Edema

  • 1Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea


To evaluate the association between long-term glycated hemoglobin A (HbA1c) variability and treatment outcomes ofanti-vascular endothelial growth factor (VEGF) injection in diabetic macular edema patients.
The medical records of 49 eyes (38 patients) that received anti-VEGF injection for diabetic macular edema were reviewedretrospectively. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) before injection and at onemonth and six months after injection were analyzed. HbA1c variability (HbA1c coefficient of variation [CV]) was calculated usingthe HbA1c results from the year prior to (before) and the year after injection and compared with clinical results.
In the group with a low mean HbA1c level before injection, the group with lower HbA1c CV showed greater reduction inmacular edema one month after injection (low HbA1c CV, 122.4 ± 123.2 μm versus high HbA1c CV, 5.2 ± 37.0 μm, p= 0.027).In the group with high mean HbA1c, there was no significant difference between HbA1c variability and clinical features. In a multivariateanalysis, the factor related to the reduction of macular edema was initial CMT (one month adjusted hazard ratio (aHR)0.5, p< 0.001; six months aHR 0.3, p= 0.023). The factor associated with visual gain was initial visual acuity (LogMAR) (onemonth aHR 0.4, p< 0.001; six months aHR 0.4, p< 0.001). The association between mean HbA1c or HbA1c variability and clinicaloutcome was not significant.
Unlike initial CMT or BCVA, mean HbA1c and HbA1c variability were not significantly associated with clinical outcomesof anti-VEGF injection in diabetic macular edema patients.


Diabetic retinopathy; Glycated hemoglobin A; Macular edema; Vascular endothelial growth factors
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