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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
