Glycated Hemoglobin Improvement After Medical and Surgical Eye Care in American Veterans Involves Multidisciplinary Care

Christopher M Santilli,1 Shaun Johnson,2 Coltt R Thunstrom,3 Karen R Armbrust1,4 1Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA; 2School of Medicine, Case Western Reserve University, Cleveland, OH, USA; 3Department of Statistics, University of Minnesota, Minneapolis, MN, USA; 4Department of Ophthalmology, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USACorrespondence: Karen R Armbrust, Minneapolis VA Health Care System, Mail Code 112N, One Veterans Drive, Minneapolis, MN, 55417, USA, Tel +1 612-467-3857, Fax +1 612-727-5972, Email karen.armbrust@va.govPurpose: The effects of diabetes mellitus (DM) on visual function have been extensively studied. Fewer studies evaluate the effect of visual function on DM, and previous small studies have shown mixed results concerning the relationship between glycated hemoglobin (HbA1c) and cataract surgery. We performed a retrospective, observational, single-site study at a Veterans hospital to evaluate this relationship and the relationship between HbA1c and non-surgical eye care.Patients and Methods: We compared pre- and post-operative/examination HbA1c in 431 surgical and 431 matched, non-surgical subjects who underwent eye examination at the same institution. Subgroup analysis was performed by age, elevated (≥ 8) pre-operative/examination HbA1c, and change in diabetic management. We also assessed for a relationship between changes in best-corrected visual acuity (BCVA) and HbA1c. The Minneapolis Veterans Affairs Health Care System Research Administration determined this study to be Institutional Review Board exempt from the requirements of 38 CFR 16 under Category 4 (iii).Results: Pairwise comparison of pre- versus post-operative HbA1c trended towards reduction at 3– 6 months in all surgical subjects, with a statistically significant reduction in older subjects, and those with higher pre-operative HbA1c. Eye examination subjects experienced a significant HbA1c reduction 3– 6 months after eye examination. Reduction in post-operative/examination HbA1c was associated with concurrent change in diabetic management.Conclusion: We found an overall reduction in HbA1c in diabetic Veterans who interacted with an ophthalmologist, whether for cataract surgery or eye examination. HbA1c reduction was greatest when ophthalmic care was delivered as part of a multidisciplinary care team. Our findings add new evidence to further support the importance of ophthalmic care in patients with DM and suggest improved visual function may facilitate improved glycemic control.Keywords: cataract, cataract surgery, diabetes mellitus, glycated hemoglobin