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Diabetic Retinopathy

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12 Î It is important to educate patients with diabetes, in conjunction with their primary care physician, on the importance of optimizing control of blood glucose to as near normal as is safely possible. (III, G, S) Î It is recommended that an HbA 1c of 7.0% or lower is the target for glycemic control in most patients, while in selected patients there may be some benefit to setting a target of 6.5%. (I++, G, S) Î Aspirin appears to be neither helpful nor harmful in the management of diabetic retinopathy. (I++, G, D) Î Aspirin may be used by diabetic patients for other medical indications without concern that the aspirin therapy will worsen diabetic retinopathy. (III, M, D) Î Ophthalmic examinations are recommended beginning 5 years after the diagnosis of Type I diabetes and annually thereafter. (II++, G, S) Diabetes and Pregnancy Î Patients with diabetes who plan to become pregnant should have an ophthalmologic examination prior to pregnancy and should be counseled about the risk of development and/or progression of diabetic retinopathy. (III, G, S) Î The obstetrician or primary care physician should carefully guide the management of the pregnant diabetic's blood glucose as well as other issues related to pregnancy. (III, G, S) Î During the first trimester, an eye examination should be performed with repeat and follow-up visits scheduled depending on the severity of retinopathy. (III, G, S) Î Women who develop gestational diabetes do not require an eye examination during pregnancy and do not appear to be at increased risk for diabetic retinopathy during pregnancy. (II+, G, S) Î After the first-trimester eye examination, the ophthalmologist should discuss the results and their implications with the patient. (III, G, S) Management

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