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The Berlin Retinopathy Study follows children from the onset of diabetes with serial retinal examinations by fluorescein angiography. It confirmed that long-term poor glycemic control, both before and after puberty, is the major risk factor for the development of retinal changes. The relationship between long-term HbA1c and background retinopathy follows an exponential, non-linear function. Apart from glycemia, several other factors (age at onset, puberty, lipids, blood pressure, genetic factors, smoking) may be of varying relevance in the individual patient. Nevertheless, best glycemic control from the onset of diabetes appears to be of outstanding importance as the HbA1c levels already during the first year of diabetes are related to the later development of background retinopathy. [ABSTRACT FROM AUTHOR]